St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ONABOTULINUMTOXINA 200 UNITS IJ SOLR [100509]

Facility

$1,521.60

Service Code	HCPCS J0585
Hospital Charge Code	00023392102
Hospital Revenue Code	250
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$1,217.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$836.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.33
Rate for Payer: Aetna Government	$6.33
Rate for Payer: Affinity Essential Plan 1&2	$4.43
Rate for Payer: Affinity Essential Plan 3&4	$4.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.43
Rate for Payer: Brighton Health Commercial	$1,141.20
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,217.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,034.69
Rate for Payer: Elderplan Medicare Advantage	$6.33
Rate for Payer: EmblemHealth Commercial	$6.33
Rate for Payer: Fidelis Essential Plan Aliesa	$5.38
Rate for Payer: Fidelis Essential Plan QHP	$5.63
Rate for Payer: Fidelis Medicare Advantage	$6.33
Rate for Payer: Fidelis Qualified Health Plan	$5.63
Rate for Payer: Group Health Inc Commercial	$6.33
Rate for Payer: Group Health Inc Medicare	$6.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$760.80
Rate for Payer: Hamaspik Choice Inc Medicare	$6.33
Rate for Payer: Healthfirst Medicare Advantage	$5.38
Rate for Payer: Healthfirst QHP	$6.33
Rate for Payer: Humana Medicare	$6.45
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.32
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$6.70
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$6.70
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$6.70
Rate for Payer: Senior Whole Health Medicare Advantage	$6.33
Rate for Payer: United Healthcare Medicare Advantage	$6.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$989.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.06
Rate for Payer: Wellcare Medicare	$6.01

ONABOTULINUMTOXINA 200U-PER 1 U

Facility

$10.39

Service Code	HCPCS J0585
Hospital Charge Code	41657907
Hospital Revenue Code	636
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$5.20
Rate for Payer: Cash Price	$6.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.20
Rate for Payer: Hamaspik Choice Inc Medicare	$5.20

ONABOTULINUMTOXINA 200U-PER 1 U

Facility

$10.39

Service Code	HCPCS J0585
Hospital Charge Code	41657907
Hospital Revenue Code	636
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$6.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.33
Rate for Payer: Aetna Government	$6.33
Rate for Payer: Affinity Essential Plan 1&2	$4.43
Rate for Payer: Affinity Essential Plan 3&4	$4.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.43
Rate for Payer: Brighton Health Commercial	$6.23
Rate for Payer: Cash Price	$6.33
Rate for Payer: Cash Price	$6.33
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.97
Rate for Payer: Elderplan Medicare Advantage	$6.33
Rate for Payer: EmblemHealth Commercial	$6.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.33
Rate for Payer: Fidelis Essential Plan Aliesa	$6.33
Rate for Payer: Fidelis Essential Plan QHP	$6.64
Rate for Payer: Fidelis Medicare Advantage	$6.33
Rate for Payer: Fidelis Qualified Health Plan	$6.64
Rate for Payer: Group Health Inc Commercial	$6.33
Rate for Payer: Group Health Inc Medicare	$6.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.20
Rate for Payer: Hamaspik Choice Inc Medicare	$5.20
Rate for Payer: Healthfirst Medicare Advantage	$5.38
Rate for Payer: Healthfirst QHP	$6.33
Rate for Payer: Humana Medicare	$6.45
Rate for Payer: Senior Whole Health Medicare Advantage	$6.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6.70
Rate for Payer: SOMOS Essential	$6.70
Rate for Payer: United Healthcare Commercial	$6.32
Rate for Payer: United Healthcare Medicare Advantage	$6.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.06
Rate for Payer: Wellcare Medicare	$6.01

ONDANESTRON 4MG/5ML ORAL PED

Facility

$2.00

Service Code	HCPCS Q0162
Hospital Charge Code	41647088
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

ONDANESTRON 4MG/5ML ORAL PED

Facility

$2.00

Service Code	HCPCS Q0162
Hospital Charge Code	41657088
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

ONDANESTRON 4MG/5ML ORAL PED

Facility

$2.00

Service Code	HCPCS Q0162
Hospital Charge Code	41647088
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
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	$0.02
Rate for Payer: SOMOS Essential	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

ONDANESTRON 4MG/5ML ORAL PED

Facility

$2.00

Service Code	HCPCS Q0162
Hospital Charge Code	41657088
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
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	$0.02
Rate for Payer: SOMOS Essential	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

ONDANSETRON 2 MG/ML INJ

Facility

$0.59

Service Code	HCPCS J2405
Hospital Charge Code	41654711
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
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: 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: SOMOS CHP/HARP/Medicaid	$0.10
Rate for Payer: SOMOS Essential	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.38

ONDANSETRON 2 MG/ML INJ

Facility

$0.59

Service Code	HCPCS J2405
Hospital Charge Code	41644711
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
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: 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: SOMOS CHP/HARP/Medicaid	$0.10
Rate for Payer: SOMOS Essential	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.38

ONDANSETRON 2 MG/ML INJ

Facility

$0.59

Service Code	HCPCS J2405
Hospital Charge Code	41654711
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30

ONDANSETRON 2 MG/ML INJ

Facility

$0.59

Service Code	HCPCS J2405
Hospital Charge Code	41644711
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30

ONDANSETRON 2MG/ML INJ PEDS - 1MG

Facility

$17.00

Service Code	HCPCS J2405
Hospital Charge Code	41657144
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$11.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.10
Rate for Payer: SOMOS Essential	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

ONDANSETRON 2MG/ML INJ PEDS - 1MG

Facility

$17.00

Service Code	HCPCS J2405
Hospital Charge Code	41657144
Hospital Revenue Code	636
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

ONDANSETRON 2MG/ML INJ PEDS - 1MG

Facility

$17.00

Service Code	HCPCS J2405
Hospital Charge Code	41647144
Hospital Revenue Code	636
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

ONDANSETRON 2MG/ML INJ PEDS - 1MG

Facility

$17.00

Service Code	HCPCS J2405
Hospital Charge Code	41647144
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$11.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.10
Rate for Payer: SOMOS Essential	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

ONDANSETRON 2MG/ML ORAL PEDS SOL.

Facility

$1.00

Hospital Charge Code	41656043
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

ONDANSETRON 2MG/ML ORAL PEDS SOL.

Facility

$1.00

Hospital Charge Code	41646043
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

ONDANSETRON 32 MG/D5W 50 ML PREMIX

Facility

$3.00

Service Code	HCPCS J2405
Hospital Charge Code	41644712
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
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	$0.10
Rate for Payer: SOMOS Essential	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

ONDANSETRON 32 MG/D5W 50 ML PREMIX

Facility

$3.00

Service Code	HCPCS J2405
Hospital Charge Code	41654712
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
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	$0.10
Rate for Payer: SOMOS Essential	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

ONDANSETRON 32 MG/D5W 50 ML PREMIX

Facility

$3.00

Service Code	HCPCS J2405
Hospital Charge Code	41644712
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

ONDANSETRON 32 MG/D5W 50 ML PREMIX

Facility

$3.00

Service Code	HCPCS J2405
Hospital Charge Code	41654712
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

ONDANSETRON 4 MG PO TBDP [27697]

Facility

$23.11

Service Code	HCPCS Q0162
Hospital Charge Code	68462015713
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$18.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$17.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.72
Rate for Payer: Group Health Inc Commercial	$11.56
Rate for Payer: Group Health Inc Medicare	$8.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.56
Rate for Payer: Hamaspik Choice Inc Medicare	$11.56
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.02
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.02
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.02
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.02

ONDANSETRON 4 MG PO TBDP [27697]

Facility

$22.29

Service Code	HCPCS Q0162
Hospital Charge Code	65862039010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$17.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$16.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.16
Rate for Payer: Group Health Inc Commercial	$11.15
Rate for Payer: Group Health Inc Medicare	$7.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.15
Rate for Payer: Hamaspik Choice Inc Medicare	$11.15
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.02
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.02
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.02
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.49

ONDANSETRON 4 MG PO TBDP [27697]

Facility

$22.25

Service Code	HCPCS Q0162
Hospital Charge Code	62756024064
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$17.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$16.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.13
Rate for Payer: Group Health Inc Commercial	$11.12
Rate for Payer: Group Health Inc Medicare	$7.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.12
Rate for Payer: Hamaspik Choice Inc Medicare	$11.12
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.02
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.02
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.02
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.46

ONDANSETRON 4 MG PO TBDP [27697]

Facility

$22.28

Service Code	HCPCS Q0162
Hospital Charge Code	57237007710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$17.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$16.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.15
Rate for Payer: Group Health Inc Commercial	$11.14
Rate for Payer: Group Health Inc Medicare	$7.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.14
Rate for Payer: Hamaspik Choice Inc Medicare	$11.14
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.02
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.02
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.02
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.48

Know your out-of-pocket cost for care.

All Charges