St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OXYCODONE HCL ER 10 MG PO T12A [122363]

Facility

$3.02

Service Code	NDC 00093573101
Hospital Charge Code	00093573101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.51
Rate for Payer: Aetna Government	$1.51
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: Group Health Inc Commercial	$1.51
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51
Rate for Payer: Hamaspik Choice Inc Medicare	$1.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.96

OXYCODONE HCL ER 40 MG PO T12A [122368]

Facility

$20.95

Service Code	NDC 59011044020
Hospital Charge Code	59011044020
Hospital Revenue Code	250
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$16.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.48
Rate for Payer: Aetna Government	$10.48
Rate for Payer: Brighton Health Commercial	$15.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.25
Rate for Payer: Group Health Inc Commercial	$10.48
Rate for Payer: Group Health Inc Medicare	$7.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.48
Rate for Payer: Hamaspik Choice Inc Medicare	$10.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.62

OXYCODONE HCL ER 80 MG PO T12A [122370]

Facility

$36.58

Service Code	NDC 59011048020
Hospital Charge Code	59011048020
Hospital Revenue Code	250
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$29.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.29
Rate for Payer: Aetna Government	$18.29
Rate for Payer: Brighton Health Commercial	$27.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.87
Rate for Payer: Group Health Inc Commercial	$18.29
Rate for Payer: Group Health Inc Medicare	$12.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.29
Rate for Payer: Hamaspik Choice Inc Medicare	$18.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.78

OXYCODONE/OXYMORPHONE, URINE

Facility

$49.93

Service Code	HCPCS 80365
Hospital Charge Code	40609009
Hospital Revenue Code	300
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$39.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$37.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.95
Rate for Payer: Group Health Inc Commercial	$24.96
Rate for Payer: Group Health Inc Medicare	$17.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.96
Rate for Payer: Hamaspik Choice Inc Medicare	$24.96
Rate for Payer: United Healthcare Commercial	$23.93

OXYGEN FACE MASK

Facility

$35.44

Service Code	HCPCS A4620
Hospital Charge Code	40302100
Hospital Revenue Code	271
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$28.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$26.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.10
Rate for Payer: Group Health Inc Commercial	$17.72
Rate for Payer: Group Health Inc Medicare	$12.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.72
Rate for Payer: Hamaspik Choice Inc Medicare	$17.72

OXYGEN NON-BREATHING MASK

Facility

$35.44

Service Code	HCPCS A4620
Hospital Charge Code	40308030
Hospital Revenue Code	271
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$28.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$26.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.10
Rate for Payer: Group Health Inc Commercial	$17.72
Rate for Payer: Group Health Inc Medicare	$12.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.72
Rate for Payer: Hamaspik Choice Inc Medicare	$17.72

OXYGEN PARTIAL REBREATHING MASK

Facility

$35.44

Service Code	HCPCS A4620
Hospital Charge Code	40307402
Hospital Revenue Code	271
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$28.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$26.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.10
Rate for Payer: Group Health Inc Commercial	$17.72
Rate for Payer: Group Health Inc Medicare	$12.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.72
Rate for Payer: Hamaspik Choice Inc Medicare	$17.72

OXYGEN VENTIMASK

Facility

$35.44

Service Code	HCPCS A4620
Hospital Charge Code	40305300
Hospital Revenue Code	271
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$28.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$26.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.10
Rate for Payer: Group Health Inc Commercial	$17.72
Rate for Payer: Group Health Inc Medicare	$12.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.72
Rate for Payer: Hamaspik Choice Inc Medicare	$17.72

OXYMETAZOLINE 0.05% NASAL SPRAY

Facility

$2.00

Hospital Charge Code	41650640
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

OXYMETAZOLINE 0.05% NASAL SPRAY

Facility

$2.00

Hospital Charge Code	41640640
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

OXYMETAZOLINE HCL 0.05 % NA SOLN [5943]

Facility

$0.27

Service Code	NDC 70000000101
Hospital Charge Code	70000000101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

OXYMETAZOLINE HCL 0.05 % NA SOLN [5943]

Facility

$0.09

Service Code	NDC 00904676130
Hospital Charge Code	00904676130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

OXYTOCIN 10 UNIT/ML IJ SOLN [5944]

Facility

$1.89

Service Code	NDC 63323001230
Hospital Charge Code	63323001230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$1.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.29
Rate for Payer: Group Health Inc Commercial	$0.95
Rate for Payer: Group Health Inc Medicare	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.95
Rate for Payer: Hamaspik Choice Inc Medicare	$0.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.23

OXYTOCIN 10 UNIT/ML IJ SOLN [5944]

Facility

$4.32

Service Code	NDC 42023011625
Hospital Charge Code	42023011625
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$3.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.16
Rate for Payer: Aetna Government	$2.16
Rate for Payer: Brighton Health Commercial	$3.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.94
Rate for Payer: Group Health Inc Commercial	$2.16
Rate for Payer: Group Health Inc Medicare	$1.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.16
Rate for Payer: Hamaspik Choice Inc Medicare	$2.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.81

OXYTOCIN 10 UNIT/ML IJ SOLN [5944]

Facility

$4.14

Service Code	NDC 63323001211
Hospital Charge Code	63323001211
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$3.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.07
Rate for Payer: Aetna Government	$2.07
Rate for Payer: Brighton Health Commercial	$3.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.82
Rate for Payer: Group Health Inc Commercial	$2.07
Rate for Payer: Group Health Inc Medicare	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.07
Rate for Payer: Hamaspik Choice Inc Medicare	$2.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.69

OXYTOCIN 10 UNIT/ML IJ SOLN [5944]

Facility

$1.89

Service Code	NDC 63323001202
Hospital Charge Code	63323001202
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$1.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.29
Rate for Payer: Group Health Inc Commercial	$0.95
Rate for Payer: Group Health Inc Medicare	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.95
Rate for Payer: Hamaspik Choice Inc Medicare	$0.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.23

OXYTOCIN 10 UNIT/ML IJ SOLN [5944]

Facility

$4.14

Service Code	NDC 63323001203
Hospital Charge Code	63323001203
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$3.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.07
Rate for Payer: Aetna Government	$2.07
Rate for Payer: Brighton Health Commercial	$3.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.82
Rate for Payer: Group Health Inc Commercial	$2.07
Rate for Payer: Group Health Inc Medicare	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.07
Rate for Payer: Hamaspik Choice Inc Medicare	$2.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.69

OXYTOCIN 10 UNIT/ML IJ SOLN [5944]

Facility

$1.23

Service Code	NDC 63323001206
Hospital Charge Code	63323001206
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.61
Rate for Payer: Aetna Government	$0.61
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.84
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.80

OXYTOCIN 10 UNIT/ML IJ SOLN [5944]

Facility

$1.23

Service Code	NDC 63323001210
Hospital Charge Code	63323001210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.61
Rate for Payer: Aetna Government	$0.61
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.84
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.80

OXYTOCIN 10 UNIT/ML IJ SOLN [5944]

Facility

$1.68

Service Code	NDC 42023011602
Hospital Charge Code	42023011602
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

OXYTOCIN 10 UNITS/ML INJ

Facility

$1.21

Service Code	HCPCS J2590
Hospital Charge Code	41653871
Hospital Revenue Code	636
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$0.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.70
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.79

OXYTOCIN 10 UNITS/ML INJ

Facility

$1.21

Service Code	HCPCS J2590
Hospital Charge Code	41653871
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61

OXYTOCIN 10 UNITS/ML INJ

Facility

$1.21

Service Code	HCPCS J2590
Hospital Charge Code	41643871
Hospital Revenue Code	636
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$0.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.70
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.79

OXYTOCIN 10 UNITS/ML INJ

Facility

$1.21

Service Code	HCPCS J2590
Hospital Charge Code	41643871
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61

OXYTOCIN 30U 500ML -PER 10U D5RL

Facility

$4.23

Service Code	HCPCS J2590
Hospital Charge Code	41648037
Hospital Revenue Code	636
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$2.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$2.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.43
Rate for Payer: Group Health Inc Commercial	$2.12
Rate for Payer: Group Health Inc Medicare	$1.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.75

Know your out-of-pocket cost for care.

All Charges