St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MORPHINE SULFATE PCA 100 MG/100 ML NACL [40815005]

Facility

$0.18

Service Code	NDC 09999123436
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
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	$0.12

MORPHINE SULFATE PCA 100 MG/100 ML (PREMIX) [139024]

Facility

$0.18

Service Code	NDC 09999099999
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
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	$0.12

MORPHINE SULFATE PCA 1 MG/ML - COMPOUNDED [77005]

Facility

$4.72

Service Code	HCPCS J2270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$4.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.39
Rate for Payer: Aetna Government	$3.39
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$4.46
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$4.72
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4.72
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4.72

MORPHINE SULFATE PCA 1 MG/ML - COMPOUNDED [77005]

Facility

$4.45

Service Code	HCPCS J2270
Hospital Charge Code	70092113343
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$4.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.39
Rate for Payer: Aetna Government	$3.39
Rate for Payer: Aetna Government	$3.39
Rate for Payer: Brighton Health Commercial	$3.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.02
Rate for Payer: Group Health Inc Commercial	$2.22
Rate for Payer: Group Health Inc Medicare	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.22
Rate for Payer: Hamaspik Choice Inc Medicare	$2.22
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$4.46
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$4.46
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$4.72
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$4.72
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4.72
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4.72
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4.72
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.89

MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN [29464]

Facility

$0.99

Service Code	HCPCS J2274
Hospital Charge Code	00409381411
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$15.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.08
Rate for Payer: Aetna Government	$11.08
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.67
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$14.43
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$15.30
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$15.30
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$15.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.64

MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN [29464]

Facility

$0.99

Service Code	HCPCS J2274
Hospital Charge Code	00409381412
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$15.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.08
Rate for Payer: Aetna Government	$11.08
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.67
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$14.43
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$15.30
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$15.30
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$15.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.64

MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN [15852]

Facility

$3.48

Service Code	HCPCS J2274
Hospital Charge Code	00641601901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$15.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.08
Rate for Payer: Aetna Government	$11.08
Rate for Payer: Brighton Health Commercial	$2.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.36
Rate for Payer: Group Health Inc Commercial	$1.74
Rate for Payer: Group Health Inc Medicare	$1.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.74
Rate for Payer: Hamaspik Choice Inc Medicare	$1.74
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$14.43
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$15.30
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$15.30
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$15.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.26

MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN [15852]

Facility

$1.09

Service Code	HCPCS J2274
Hospital Charge Code	00409381512
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$15.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.08
Rate for Payer: Aetna Government	$11.08
Rate for Payer: Brighton Health Commercial	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.74
Rate for Payer: Group Health Inc Commercial	$0.55
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55
Rate for Payer: Hamaspik Choice Inc Medicare	$0.55
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$14.43
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$15.30
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$15.30
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$15.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN [15852]

Facility

$1.09

Service Code	HCPCS J2274
Hospital Charge Code	00409381511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$15.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.08
Rate for Payer: Aetna Government	$11.08
Rate for Payer: Brighton Health Commercial	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.74
Rate for Payer: Group Health Inc Commercial	$0.55
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55
Rate for Payer: Hamaspik Choice Inc Medicare	$0.55
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$14.43
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$15.30
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$15.30
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$15.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

MORPHINE SULFATE (PF) 2 MG/ML IV SOLN [119146]

Facility

$2.56

Service Code	HCPCS J2270
Hospital Charge Code	00409189001
Hospital Revenue Code	278
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.28
Rate for Payer: Hamaspik Choice Inc Medicare	$1.28

MORPHINE SULFATE (PF) 2 MG/ML IV SOLN [119146]

Facility

$2.56

Service Code	HCPCS J2270
Hospital Charge Code	00409189001
Hospital Revenue Code	278
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$3.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.39
Rate for Payer: Aetna Government	$3.39
Rate for Payer: Brighton Health Commercial	$1.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.47
Rate for Payer: EmblemHealth Commercial	$1.28
Rate for Payer: Fidelis Medicare Advantage	$2.68
Rate for Payer: Group Health Inc Commercial	$1.28
Rate for Payer: Group Health Inc Medicare	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.28
Rate for Payer: Hamaspik Choice Inc Medicare	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.66

MORPHINE SULFATE (PF) 2 MG/ML IV SOLN [119146]

Facility

$5.15

Service Code	HCPCS J2270
Hospital Charge Code	00409189013
Hospital Revenue Code	278
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2.58

MORPHINE SULFATE (PF) 2 MG/ML IV SOLN [119146]

Facility

$5.15

Service Code	HCPCS J2270
Hospital Charge Code	00409189013
Hospital Revenue Code	278
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$5.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.39
Rate for Payer: Aetna Government	$3.39
Rate for Payer: Brighton Health Commercial	$3.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.96
Rate for Payer: EmblemHealth Commercial	$2.58
Rate for Payer: Fidelis Medicare Advantage	$5.41
Rate for Payer: Group Health Inc Commercial	$2.58
Rate for Payer: Group Health Inc Medicare	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.35

MORPHINE SULFATE (PF) 4 MG/ML IJ SOLN [160804]

Facility

$3.44

Service Code	HCPCS J2270
Hospital Charge Code	63323045400
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$4.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.39
Rate for Payer: Aetna Government	$3.39
Rate for Payer: Brighton Health Commercial	$2.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.34
Rate for Payer: Group Health Inc Commercial	$1.72
Rate for Payer: Group Health Inc Medicare	$1.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.72
Rate for Payer: Hamaspik Choice Inc Medicare	$1.72
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$4.46
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$4.72
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4.72
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.24

MORPHINE SULFATE (PF) 4 MG/ML IJ SOLN [160804]

Facility

$3.44

Service Code	HCPCS J2270
Hospital Charge Code	63323045401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$4.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.39
Rate for Payer: Aetna Government	$3.39
Rate for Payer: Brighton Health Commercial	$2.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.34
Rate for Payer: Group Health Inc Commercial	$1.72
Rate for Payer: Group Health Inc Medicare	$1.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.72
Rate for Payer: Hamaspik Choice Inc Medicare	$1.72
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$4.46
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$4.72
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4.72
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.24

MORPHINE SULFATE (PF) 4 MG/ML IV SOLN [117338]

Facility

$2.34

Service Code	HCPCS J2270
Hospital Charge Code	00409189101
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$3.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.39
Rate for Payer: Aetna Government	$3.39
Rate for Payer: Brighton Health Commercial	$1.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.34
Rate for Payer: EmblemHealth Commercial	$1.17
Rate for Payer: Fidelis Medicare Advantage	$2.45
Rate for Payer: Group Health Inc Commercial	$1.17
Rate for Payer: Group Health Inc Medicare	$0.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.17
Rate for Payer: Hamaspik Choice Inc Medicare	$1.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.52

MORPHINE SULFATE (PF) 4 MG/ML IV SOLN [117338]

Facility

$2.34

Service Code	HCPCS J2270
Hospital Charge Code	00409189101
Hospital Revenue Code	278
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.17
Rate for Payer: Hamaspik Choice Inc Medicare	$1.17

MORPHINE SULF MICROINFUSION PF 200 MG/20ML (10 MG/ML) IJ SOLN [166793]

Facility

$12.49

Service Code	HCPCS J2274
Hospital Charge Code	66794016002
Hospital Revenue Code	250
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$15.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.08
Rate for Payer: Aetna Government	$11.08
Rate for Payer: Brighton Health Commercial	$9.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.49
Rate for Payer: Group Health Inc Commercial	$6.24
Rate for Payer: Group Health Inc Medicare	$4.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.24
Rate for Payer: Hamaspik Choice Inc Medicare	$6.24
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$14.43
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$15.30
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$15.30
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$15.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.12

MORPHINE SULF MICROINFUSION PF 500 MG/20ML (25 MG/ML) IJ SOLN [166792]

Facility

$21.24

Service Code	HCPCS J2274
Hospital Charge Code	66794016202
Hospital Revenue Code	250
Min. Negotiated Rate	$7.43
Max. Negotiated Rate	$16.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.08
Rate for Payer: Aetna Government	$11.08
Rate for Payer: Brighton Health Commercial	$15.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.44
Rate for Payer: Group Health Inc Commercial	$10.62
Rate for Payer: Group Health Inc Medicare	$7.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.62
Rate for Payer: Hamaspik Choice Inc Medicare	$10.62
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$14.43
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$15.30
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$15.30
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$15.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.80

MORRHUATE SODIUM 50 MG/ML INJ (ENDOSCOPY

Facility

$119.22

Hospital Charge Code	41643742
Hospital Revenue Code	250
Min. Negotiated Rate	$41.73
Max. Negotiated Rate	$95.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.61
Rate for Payer: Aetna Government	$59.61
Rate for Payer: Brighton Health Commercial	$89.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.07
Rate for Payer: Group Health Inc Commercial	$59.61
Rate for Payer: Group Health Inc Medicare	$41.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.61
Rate for Payer: Hamaspik Choice Inc Medicare	$59.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$77.49

MORRHUATE SODIUM 50 MG/ML INJ (ENDOSCOPY

Facility

$119.22

Hospital Charge Code	41653742
Hospital Revenue Code	250
Min. Negotiated Rate	$41.73
Max. Negotiated Rate	$95.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.61
Rate for Payer: Aetna Government	$59.61
Rate for Payer: Brighton Health Commercial	$89.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.07
Rate for Payer: Group Health Inc Commercial	$59.61
Rate for Payer: Group Health Inc Medicare	$41.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.61
Rate for Payer: Hamaspik Choice Inc Medicare	$59.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$77.49

MOTHPIECE E-Z GUARD PEDS

Facility

$0.35

Hospital Charge Code	40200497
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.18
Rate for Payer: Aetna Government	$0.18
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18

MOUTHPIECE BREATHALYZER

Facility

$0.60

Hospital Charge Code	64902851
Hospital Revenue Code	270
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Brighton Health Commercial	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
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

MOUTHPIECE ORIGINAL SM

Facility

$5.00

Hospital Charge Code	64905934
Hospital Revenue Code	270
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50

MOUTHPIECE ORIG MED

Facility

$5.00

Hospital Charge Code	64905932
Hospital Revenue Code	270
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50

Know your out-of-pocket cost for care.

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