St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OUTPATIENT EAPG 00878: GYNECOLOGIC PREVENTIVE MEDICINE

Facility

$329.85

Service Code	EAPG 00878
Hospital Charge Code	EAPG 00878
Min. Negotiated Rate	$146.60
Max. Negotiated Rate	$329.85
Rate for Payer: Affinity Essential Plan 1&2	$329.85
Rate for Payer: Affinity Essential Plan 3&4	$329.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$146.60
Rate for Payer: Amida Care Medicaid	$146.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$146.60
Rate for Payer: Fidelis Essential Plan Aliesa	$329.85
Rate for Payer: Fidelis Essential Plan QHP	$329.85
Rate for Payer: Fidelis Qualified Health Plan	$153.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$146.60
Rate for Payer: Healthfirst Commercial	$222.15
Rate for Payer: Healthfirst Essential Plan	$329.85
Rate for Payer: Healthfirst QHP	$146.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.60
Rate for Payer: SOMOS Essential	$329.85
Rate for Payer: United Healthcare Essential Plan 1&2	$329.85
Rate for Payer: United Healthcare Essential Plan 3&4	$161.26
Rate for Payer: United Healthcare Medicaid	$146.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$146.60

OUTPATIENT EAPG 00879: PREVENTIVE OR SCREENING ENCOUNTER

Facility

$329.85

Service Code	EAPG 00879
Hospital Charge Code	EAPG 00879
Min. Negotiated Rate	$146.60
Max. Negotiated Rate	$329.85
Rate for Payer: Affinity Essential Plan 1&2	$329.85
Rate for Payer: Affinity Essential Plan 3&4	$329.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$146.60
Rate for Payer: Amida Care Medicaid	$146.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$146.60
Rate for Payer: Fidelis Essential Plan Aliesa	$329.85
Rate for Payer: Fidelis Essential Plan QHP	$329.85
Rate for Payer: Fidelis Qualified Health Plan	$153.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$146.60
Rate for Payer: Healthfirst Commercial	$222.15
Rate for Payer: Healthfirst Essential Plan	$329.85
Rate for Payer: Healthfirst QHP	$146.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.60
Rate for Payer: SOMOS Essential	$329.85
Rate for Payer: United Healthcare Essential Plan 1&2	$329.85
Rate for Payer: United Healthcare Essential Plan 3&4	$161.26
Rate for Payer: United Healthcare Medicaid	$146.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$146.60

OUTPATIENT EAPG 00880: HIV INFECTION

Facility

$379.78

Service Code	EAPG 00880
Hospital Charge Code	EAPG 00880
Min. Negotiated Rate	$168.79
Max. Negotiated Rate	$379.78
Rate for Payer: Affinity Essential Plan 1&2	$379.78
Rate for Payer: Affinity Essential Plan 3&4	$379.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$168.79
Rate for Payer: Amida Care Medicaid	$168.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$168.79
Rate for Payer: Fidelis Essential Plan Aliesa	$379.78
Rate for Payer: Fidelis Essential Plan QHP	$379.78
Rate for Payer: Fidelis Qualified Health Plan	$177.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$168.79
Rate for Payer: Healthfirst Commercial	$255.78
Rate for Payer: Healthfirst Essential Plan	$379.78
Rate for Payer: Healthfirst QHP	$168.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$168.79
Rate for Payer: SOMOS Essential	$379.78
Rate for Payer: United Healthcare Essential Plan 1&2	$379.78
Rate for Payer: United Healthcare Essential Plan 3&4	$185.67
Rate for Payer: United Healthcare Medicaid	$168.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$168.79

OUTPATIENT EAPG 00881: AIDS

Facility

$432.63

Service Code	EAPG 00881
Hospital Charge Code	EAPG 00881
Min. Negotiated Rate	$192.28
Max. Negotiated Rate	$432.63
Rate for Payer: Affinity Essential Plan 1&2	$432.63
Rate for Payer: Affinity Essential Plan 3&4	$432.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$192.28
Rate for Payer: Amida Care Medicaid	$192.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$192.28
Rate for Payer: Fidelis Essential Plan Aliesa	$432.63
Rate for Payer: Fidelis Essential Plan QHP	$432.63
Rate for Payer: Fidelis Qualified Health Plan	$201.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$192.28
Rate for Payer: Healthfirst Commercial	$291.38
Rate for Payer: Healthfirst Essential Plan	$432.63
Rate for Payer: Healthfirst QHP	$192.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$192.28
Rate for Payer: SOMOS Essential	$432.63
Rate for Payer: United Healthcare Essential Plan 1&2	$432.63
Rate for Payer: United Healthcare Essential Plan 3&4	$211.51
Rate for Payer: United Healthcare Medicaid	$192.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$192.28

OUTPATIENT EAPG 00882: GENETIC COUNSELING

Facility

$329.85

Service Code	EAPG 00882
Hospital Charge Code	EAPG 00882
Min. Negotiated Rate	$146.60
Max. Negotiated Rate	$329.85
Rate for Payer: Affinity Essential Plan 1&2	$329.85
Rate for Payer: Affinity Essential Plan 3&4	$329.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$146.60
Rate for Payer: Amida Care Medicaid	$146.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$146.60
Rate for Payer: Fidelis Essential Plan Aliesa	$329.85
Rate for Payer: Fidelis Essential Plan QHP	$329.85
Rate for Payer: Fidelis Qualified Health Plan	$153.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$146.60
Rate for Payer: Healthfirst Commercial	$222.15
Rate for Payer: Healthfirst Essential Plan	$329.85
Rate for Payer: Healthfirst QHP	$146.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.60
Rate for Payer: SOMOS Essential	$329.85
Rate for Payer: United Healthcare Essential Plan 1&2	$329.85
Rate for Payer: United Healthcare Essential Plan 3&4	$161.26
Rate for Payer: United Healthcare Medicaid	$146.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$146.60

OUTPT ED OBS W INPT ADMIT

Facility

$0.01

Service Code	HCPCS G2176
Hospital Charge Code	30300304
Hospital Revenue Code	929
Max. Negotiated Rate	$94.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$94.00

OUTREACH AND ENGAGEMENT

Facility

$250.63

Service Code	HCPCS H0023
Hospital Charge Code	30303190
Hospital Revenue Code	911
Min. Negotiated Rate	$87.72
Max. Negotiated Rate	$243.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$243.95
Rate for Payer: Aetna Government	$243.95
Rate for Payer: Brighton Health Commercial	$187.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.43
Rate for Payer: Group Health Inc Commercial	$125.32
Rate for Payer: Group Health Inc Medicare	$87.72
Rate for Payer: Hamaspik Choice Inc Medicare	$125.32

OVA PARASITES

Facility

$22.25

Service Code	HCPCS 87177
Hospital Charge Code	40614035
Hospital Revenue Code	306
Rate for Payer: Cash Price	$8.90

OVA PARASITES

Facility

$22.25

Service Code	HCPCS 87177
Hospital Charge Code	40614035
Hospital Revenue Code	306
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$16.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.90
Rate for Payer: Aetna Government	$8.90
Rate for Payer: Affinity Essential Plan 1&2	$6.23
Rate for Payer: Affinity Essential Plan 3&4	$6.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$6.23
Rate for Payer: Brighton Health Commercial	$16.69
Rate for Payer: Cash Price	$8.90
Rate for Payer: Cash Price	$8.90
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.97
Rate for Payer: Elderplan Medicare Advantage	$8.90
Rate for Payer: EmblemHealth Commercial	$8.90
Rate for Payer: Fidelis Essential Plan Aliesa	$7.56
Rate for Payer: Fidelis Essential Plan QHP	$7.92
Rate for Payer: Fidelis Medicare Advantage	$8.90
Rate for Payer: Fidelis Qualified Health Plan	$7.92
Rate for Payer: Group Health Inc Commercial	$8.90
Rate for Payer: Group Health Inc Medicare	$8.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.12
Rate for Payer: Hamaspik Choice Inc Medicare	$8.90
Rate for Payer: Healthfirst Medicare Advantage	$8.90
Rate for Payer: Healthfirst QHP	$8.90
Rate for Payer: Humana Medicare	$9.08
Rate for Payer: Senior Whole Health Medicare Advantage	$8.90
Rate for Payer: United Healthcare Commercial	$11.27
Rate for Payer: United Healthcare Medicare Advantage	$8.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7.12
Rate for Payer: Wellcare Medicare	$8.01

OVARIAN CYSTECTOMY

Facility

$12,937.43

Service Code	HCPCS 58925
Hospital Charge Code	40052245
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$9,703.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,751.94
Rate for Payer: Aetna Government	$5,751.94
Rate for Payer: Affinity Essential Plan 1&2	$4,026.36
Rate for Payer: Affinity Essential Plan 3&4	$4,026.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,026.36
Rate for Payer: Brighton Health Commercial	$9,703.07
Rate for Payer: Cash Price	$5,751.94
Rate for Payer: Cash Price	$5,751.94
Rate for Payer: Cash Price	$5,751.94
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5,751.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$5,751.94
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$4,889.15
Rate for Payer: Fidelis Essential Plan QHP	$5,119.23
Rate for Payer: Fidelis Medicare Advantage	$5,751.94
Rate for Payer: Fidelis Qualified Health Plan	$5,119.23
Rate for Payer: Group Health Inc Commercial	$5,751.94
Rate for Payer: Group Health Inc Medicare	$5,751.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,468.72
Rate for Payer: Hamaspik Choice Inc Medicare	$5,751.94
Rate for Payer: Healthfirst Medicare Advantage	$4,889.15
Rate for Payer: Healthfirst QHP	$5,751.94
Rate for Payer: Humana Medicare	$5,866.98
Rate for Payer: Senior Whole Health Medicare Advantage	$5,751.94
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$5,751.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,751.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4,601.55
Rate for Payer: Wellcare Medicare	$5,464.34

OVARIAN CYSTECTOMY

Facility

$12,937.43

Service Code	HCPCS 58925
Hospital Charge Code	40052245
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,751.94

OVERDRILL AO, DIA 3.5MM X 122MM

Facility

$662.50

Service Code	HCPCS C1713
Hospital Charge Code	64904661
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$695.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$364.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$397.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$331.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$380.94
Rate for Payer: EmblemHealth Commercial	$331.25
Rate for Payer: Fidelis Medicare Advantage	$695.62
Rate for Payer: Group Health Inc Commercial	$331.25
Rate for Payer: Group Health Inc Medicare	$231.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$331.25
Rate for Payer: Hamaspik Choice Inc Medicare	$331.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$430.62

OVERDRILL AO, DIA 3.5MM X 122MM

Facility

$662.50

Service Code	HCPCS C1713
Hospital Charge Code	64904661
Hospital Revenue Code	278
Min. Negotiated Rate	$331.25
Max. Negotiated Rate	$331.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$331.25
Rate for Payer: Hamaspik Choice Inc Medicare	$331.25

OVERDRILL AO,DIA 3.5MMX122MM

Facility

$530.00

Hospital Charge Code	40005851
Hospital Revenue Code	272
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$424.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$291.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.00
Rate for Payer: Aetna Government	$265.00
Rate for Payer: Brighton Health Commercial	$397.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$424.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.40
Rate for Payer: Group Health Inc Commercial	$265.00
Rate for Payer: Group Health Inc Medicare	$185.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.00
Rate for Payer: Hamaspik Choice Inc Medicare	$265.00

OVERTUBE ESOPHAGEAL 8.6-10MM OD

Facility

$420.83

Hospital Charge Code	64903251
Hospital Revenue Code	270
Min. Negotiated Rate	$147.29
Max. Negotiated Rate	$336.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$210.42
Rate for Payer: Aetna Government	$210.42
Rate for Payer: Brighton Health Commercial	$315.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$336.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$286.16
Rate for Payer: Group Health Inc Commercial	$210.42
Rate for Payer: Group Health Inc Medicare	$147.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.42
Rate for Payer: Hamaspik Choice Inc Medicare	$210.42

OVERTUBE GASTRIC 10.0-11.7MM OD

Facility

$537.50

Hospital Charge Code	64903253
Hospital Revenue Code	270
Min. Negotiated Rate	$188.12
Max. Negotiated Rate	$430.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$295.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$268.75
Rate for Payer: Aetna Government	$268.75
Rate for Payer: Brighton Health Commercial	$403.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$365.50
Rate for Payer: Group Health Inc Commercial	$268.75
Rate for Payer: Group Health Inc Medicare	$188.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$268.75
Rate for Payer: Hamaspik Choice Inc Medicare	$268.75

OXACILLIN 1000 MG INJ

Facility

$5.16

Service Code	HCPCS J2700
Hospital Charge Code	41644274
Hospital Revenue Code	636
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

OXACILLIN 1000 MG INJ

Facility

$5.16

Service Code	HCPCS J2700
Hospital Charge Code	41654274
Hospital Revenue Code	636
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

OXACILLIN 1000 MG INJ

Facility

$5.16

Service Code	HCPCS J2700
Hospital Charge Code	41654274
Hospital Revenue Code	636
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$3.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.28
Rate for Payer: Aetna Government	$1.28
Rate for Payer: Brighton Health Commercial	$3.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.97
Rate for Payer: Group Health Inc Commercial	$2.58
Rate for Payer: Group Health Inc Medicare	$1.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.35

OXACILLIN 1000 MG INJ

Facility

$5.16

Service Code	HCPCS J2700
Hospital Charge Code	41644274
Hospital Revenue Code	636
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$3.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.28
Rate for Payer: Aetna Government	$1.28
Rate for Payer: Brighton Health Commercial	$3.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.97
Rate for Payer: Group Health Inc Commercial	$2.58
Rate for Payer: Group Health Inc Medicare	$1.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.35

OXACILLIN 100 MG/ML INJ PEDIATRIC

Facility

$1.00

Hospital Charge Code	41652938
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

OXACILLIN 100 MG/ML INJ PEDIATRIC

Facility

$1.00

Hospital Charge Code	41642938
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

OXACILLIN 2000 MG INJ

Facility

$5.02

Service Code	HCPCS J2700
Hospital Charge Code	41654273
Hospital Revenue Code	636
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51
Rate for Payer: Hamaspik Choice Inc Medicare	$2.51

OXACILLIN 2000 MG INJ

Facility

$5.02

Service Code	HCPCS J2700
Hospital Charge Code	41654273
Hospital Revenue Code	636
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$3.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.28
Rate for Payer: Aetna Government	$1.28
Rate for Payer: Brighton Health Commercial	$3.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.89
Rate for Payer: Group Health Inc Commercial	$2.51
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51
Rate for Payer: Hamaspik Choice Inc Medicare	$2.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.26

OXACILLIN 2000 MG INJ

Facility

$5.02

Hospital Charge Code	41644273
Hospital Revenue Code	636
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51
Rate for Payer: Hamaspik Choice Inc Medicare	$2.51

Know your out-of-pocket cost for care.

All Charges