St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OXALIPLATIN 50 MG/10ML IV SOLN [99610]

Facility

$21.22

Service Code	HCPCS J9263
Hospital Charge Code	50742040510
Hospital Revenue Code	278
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$22.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$12.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.20
Rate for Payer: EmblemHealth Commercial	$10.61
Rate for Payer: Fidelis Medicare Advantage	$22.28
Rate for Payer: Group Health Inc Commercial	$10.61
Rate for Payer: Group Health Inc Medicare	$7.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.61
Rate for Payer: Hamaspik Choice Inc Medicare	$10.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.79

OXALIPLATIN 50 MG/10ML IV SOLN [99610]

Facility

$3.00

Service Code	HCPCS J9263
Hospital Charge Code	25021023310
Hospital Revenue Code	278
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$3.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
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: EmblemHealth Commercial	$1.50
Rate for Payer: Fidelis Medicare Advantage	$3.15
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

OXANDROLONE 2.5 MG PO TABS [10803]

Facility

$6.69

Service Code	NDC 00245027111
Hospital Charge Code	00245027111
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$5.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.35
Rate for Payer: Aetna Government	$3.35
Rate for Payer: Brighton Health Commercial	$5.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.55
Rate for Payer: Group Health Inc Commercial	$3.35
Rate for Payer: Group Health Inc Medicare	$2.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.35
Rate for Payer: Hamaspik Choice Inc Medicare	$3.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.35

OXANDROLONE 2.5 MG TAB

Facility

$4.94

Hospital Charge Code	41641670
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$3.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.47
Rate for Payer: Aetna Government	$2.47
Rate for Payer: Brighton Health Commercial	$3.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.36
Rate for Payer: Group Health Inc Commercial	$2.47
Rate for Payer: Group Health Inc Medicare	$1.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.47
Rate for Payer: Hamaspik Choice Inc Medicare	$2.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.21

OXANDROLONE 2.5 MG TAB

Facility

$4.94

Hospital Charge Code	41651670
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$3.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.47
Rate for Payer: Aetna Government	$2.47
Rate for Payer: Brighton Health Commercial	$3.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.36
Rate for Payer: Group Health Inc Commercial	$2.47
Rate for Payer: Group Health Inc Medicare	$1.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.47
Rate for Payer: Hamaspik Choice Inc Medicare	$2.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.21

OXCARBAZEPINE 150 MG PO TABS [27049]

Facility

$1.51

Service Code	NDC 68084084501
Hospital Charge Code	68084084501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$1.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.03
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.98

OXCARBAZEPINE 150 MG PO TABS [27049]

Facility

$1.45

Service Code	NDC 62756018388
Hospital Charge Code	62756018388
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$1.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.98
Rate for Payer: Group Health Inc Commercial	$0.72
Rate for Payer: Group Health Inc Medicare	$0.51
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	$0.94

OXCARBAZEPINE 150 MG PO TABS [27049]

Facility

$1.44

Service Code	NDC 51991029201
Hospital Charge Code	51991029201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.15
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	$1.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.98
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

OXCARBAZEPINE 150 MG PO TABS [27049]

Facility

$1.43

Service Code	NDC 68462013701
Hospital Charge Code	68462013701
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	$0.71
Rate for Payer: Aetna Government	$0.71
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	$0.71
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71
Rate for Payer: Hamaspik Choice Inc Medicare	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.93

OXCARBAZEPINE 150 MG PO TABS [27049]

Facility

$1.51

Service Code	NDC 68084084511
Hospital Charge Code	68084084511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$1.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.03
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.98

OXCARBAZEPINE 150 MG PO TABS [27049]

Facility

$1.44

Service Code	NDC 51991029205
Hospital Charge Code	51991029205
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.15
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	$1.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.98
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

OXCARBAZEPINE 150 MG TAB

Facility

$0.42

Hospital Charge Code	41652558
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

OXCARBAZEPINE 150 MG TAB

Facility

$0.42

Hospital Charge Code	41642558
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

OXCARBAZEPINE 300 MG/5ML PO SUSP [30479]

Facility

$2.29

Service Code	NDC 00078035752
Hospital Charge Code	00078035752
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.15
Rate for Payer: Aetna Government	$1.15
Rate for Payer: Brighton Health Commercial	$1.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.56
Rate for Payer: Group Health Inc Commercial	$1.15
Rate for Payer: Group Health Inc Medicare	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.15
Rate for Payer: Hamaspik Choice Inc Medicare	$1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.49

OXCARBAZEPINE 300 MG/5ML PO SUSP [30479]

Facility

$1.09

Service Code	NDC 65162064978
Hospital Charge Code	65162064978
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

OXCARBAZEPINE 300 MG/5ML PO SUSP [30479]

Facility

$1.74

Service Code	NDC 50268064912
Hospital Charge Code	50268064912
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.87
Rate for Payer: Aetna Government	$0.87
Rate for Payer: Brighton Health Commercial	$1.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.19
Rate for Payer: Group Health Inc Commercial	$0.87
Rate for Payer: Group Health Inc Medicare	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87
Rate for Payer: Hamaspik Choice Inc Medicare	$0.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.13

OXCARBAZEPINE 300 MG PO TABS [21061]

Facility

$2.63

Service Code	NDC 51991029301
Hospital Charge Code	51991029301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$2.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.31
Rate for Payer: Aetna Government	$1.31
Rate for Payer: Brighton Health Commercial	$1.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.78
Rate for Payer: Group Health Inc Commercial	$1.31
Rate for Payer: Group Health Inc Medicare	$0.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.31
Rate for Payer: Hamaspik Choice Inc Medicare	$1.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.71

OXCARBAZEPINE 300 MG PO TABS [21061]

Facility

$2.64

Service Code	NDC 62756018488
Hospital Charge Code	62756018488
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$2.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.32
Rate for Payer: Aetna Government	$1.32
Rate for Payer: Brighton Health Commercial	$1.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.80
Rate for Payer: Group Health Inc Commercial	$1.32
Rate for Payer: Group Health Inc Medicare	$0.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.32
Rate for Payer: Hamaspik Choice Inc Medicare	$1.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.72

OXCARBAZEPINE 300 MG PO TABS [21061]

Facility

$2.76

Service Code	NDC 68084085301
Hospital Charge Code	68084085301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.38
Rate for Payer: Aetna Government	$1.38
Rate for Payer: Brighton Health Commercial	$2.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.87
Rate for Payer: Group Health Inc Commercial	$1.38
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.79

OXCARBAZEPINE 300 MG PO TABS [21061]

Facility

$1.01

Service Code	NDC 00904726361
Hospital Charge Code	00904726361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Brighton Health Commercial	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.69
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

OXCARBAZEPINE 300 MG TAB

Facility

$0.78

Hospital Charge Code	41642974
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.51

OXCARBAZEPINE 300 MG TAB

Facility

$0.78

Hospital Charge Code	41652974
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.51

OXCARBAZEPINE 60 MG/ML SUSP

Facility

$1.52

Hospital Charge Code	41653066
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Brighton Health Commercial	$1.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.03
Rate for Payer: Group Health Inc Commercial	$0.76
Rate for Payer: Group Health Inc Medicare	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.76
Rate for Payer: Hamaspik Choice Inc Medicare	$0.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.99

OXCARBAZEPINE 60 MG/ML SUSP

Facility

$1.52

Hospital Charge Code	41643066
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Brighton Health Commercial	$1.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.03
Rate for Payer: Group Health Inc Commercial	$0.76
Rate for Payer: Group Health Inc Medicare	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.76
Rate for Payer: Hamaspik Choice Inc Medicare	$0.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.99

OXCARBAZEPINE (TRILEPTAL),S

Facility

$33.13

Service Code	HCPCS 80183
Hospital Charge Code	40609813
Hospital Revenue Code	301
Rate for Payer: Cash Price	$13.25

Know your out-of-pocket cost for care.

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