St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PYRIDOSTIGMINE 60 MG TAB

Facility

$1.00

Hospital Charge Code	41640274
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

PYRIDOSTIGMINE 60 MG TAB

Facility

$1.00

Hospital Charge Code	41650274
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

PYRIDOSTIGMINE BROMIDE 10 MG/2ML IV SOLN [127668]

Facility

$19.20

Service Code	NDC 00781304095
Hospital Charge Code	00781304095
Hospital Revenue Code	278
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.60
Rate for Payer: Hamaspik Choice Inc Medicare	$9.60

PYRIDOSTIGMINE BROMIDE 10 MG/2ML IV SOLN [127668]

Facility

$19.20

Service Code	NDC 00781304095
Hospital Charge Code	00781304095
Hospital Revenue Code	278
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$20.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.60
Rate for Payer: Aetna Government	$9.60
Rate for Payer: Brighton Health Commercial	$11.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.04
Rate for Payer: EmblemHealth Commercial	$9.60
Rate for Payer: Fidelis Medicare Advantage	$20.16
Rate for Payer: Group Health Inc Commercial	$9.60
Rate for Payer: Group Health Inc Medicare	$6.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.60
Rate for Payer: Hamaspik Choice Inc Medicare	$9.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.48

PYRIDOSTIGMINE BROMIDE 60 MG PO TABS [11239]

Facility

$1.28

Service Code	NDC 68382065906
Hospital Charge Code	68382065906
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.64
Rate for Payer: Aetna Government	$0.64
Rate for Payer: Brighton Health Commercial	$0.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.87
Rate for Payer: Group Health Inc Commercial	$0.64
Rate for Payer: Group Health Inc Medicare	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.64
Rate for Payer: Hamaspik Choice Inc Medicare	$0.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.83

PYRIDOSTIGMINE BROMIDE 60 MG PO TABS [11239]

Facility

$1.61

Service Code	NDC 00904662261
Hospital Charge Code	00904662261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$1.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.10
Rate for Payer: Group Health Inc Commercial	$0.81
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.81
Rate for Payer: Hamaspik Choice Inc Medicare	$0.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.05

PYRIDOXINE 100 MG/ML INJ

Facility

$17.33

Service Code	HCPCS J3415
Hospital Charge Code	41643429
Hospital Revenue Code	636
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$8.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.66
Rate for Payer: Hamaspik Choice Inc Medicare	$8.66

PYRIDOXINE 100 MG/ML INJ

Facility

$17.33

Service Code	HCPCS J3415
Hospital Charge Code	41643429
Hospital Revenue Code	636
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$15.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.23
Rate for Payer: Aetna Government	$11.23
Rate for Payer: Brighton Health Commercial	$10.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.96
Rate for Payer: Group Health Inc Commercial	$8.66
Rate for Payer: Group Health Inc Medicare	$6.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.66
Rate for Payer: Hamaspik Choice Inc Medicare	$8.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15.90
Rate for Payer: SOMOS Essential	$15.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.26

PYRIDOXINE 100 MG/ML INJ

Facility

$17.33

Service Code	HCPCS J3415
Hospital Charge Code	41653429
Hospital Revenue Code	636
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$15.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.23
Rate for Payer: Aetna Government	$11.23
Rate for Payer: Brighton Health Commercial	$10.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.96
Rate for Payer: Group Health Inc Commercial	$8.66
Rate for Payer: Group Health Inc Medicare	$6.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.66
Rate for Payer: Hamaspik Choice Inc Medicare	$8.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15.90
Rate for Payer: SOMOS Essential	$15.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.26

PYRIDOXINE 100 MG/ML INJ

Facility

$17.33

Service Code	HCPCS J3415
Hospital Charge Code	41653429
Hospital Revenue Code	636
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$8.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.66
Rate for Payer: Hamaspik Choice Inc Medicare	$8.66

PYRIDOXINE 50 MG TAB

Facility

$0.02

Hospital Charge Code	41643784
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
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	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
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	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

PYRIDOXINE 50 MG TAB

Facility

$0.02

Hospital Charge Code	41653784
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
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	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
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	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

PYRIDOXINE HCL 100 MG/ML IJ SOLN [6744]

Facility

$22.87

Service Code	HCPCS J3415
Hospital Charge Code	63323018001
Hospital Revenue Code	250
Min. Negotiated Rate	$8.01
Max. Negotiated Rate	$18.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.23
Rate for Payer: Aetna Government	$11.23
Rate for Payer: Brighton Health Commercial	$17.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.55
Rate for Payer: Group Health Inc Commercial	$11.44
Rate for Payer: Group Health Inc Medicare	$8.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.44
Rate for Payer: Hamaspik Choice Inc Medicare	$11.44
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$15.00
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$15.90
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$15.90
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$15.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.87

PYRIDOXINE HCL 100 MG/ML IJ SOLN [6744]

Facility

$22.87

Service Code	HCPCS J3415
Hospital Charge Code	63323018000
Hospital Revenue Code	250
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$18.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.23
Rate for Payer: Aetna Government	$11.23
Rate for Payer: Brighton Health Commercial	$17.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.55
Rate for Payer: Group Health Inc Commercial	$11.44
Rate for Payer: Group Health Inc Medicare	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.44
Rate for Payer: Hamaspik Choice Inc Medicare	$11.44
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$15.00
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$15.90
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$15.90
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$15.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.87

PYRIMETHAMINE 25MG

Facility

$943.92

Hospital Charge Code	41640381
Hospital Revenue Code	250
Min. Negotiated Rate	$330.37
Max. Negotiated Rate	$755.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$519.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$471.96
Rate for Payer: Aetna Government	$471.96
Rate for Payer: Brighton Health Commercial	$707.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$755.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$641.87
Rate for Payer: Group Health Inc Commercial	$471.96
Rate for Payer: Group Health Inc Medicare	$330.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$471.96
Rate for Payer: Hamaspik Choice Inc Medicare	$471.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$613.55

PYRIMETHAMINE 25MG

Facility

$943.92

Hospital Charge Code	41650381
Hospital Revenue Code	250
Min. Negotiated Rate	$330.37
Max. Negotiated Rate	$755.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$519.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$471.96
Rate for Payer: Aetna Government	$471.96
Rate for Payer: Brighton Health Commercial	$707.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$755.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$641.87
Rate for Payer: Group Health Inc Commercial	$471.96
Rate for Payer: Group Health Inc Medicare	$330.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$471.96
Rate for Payer: Hamaspik Choice Inc Medicare	$471.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$613.55

PYRIMETHAMINE 25 MG PO TABS [11246]

Facility

$855.00

Service Code	NDC 00480372001
Hospital Charge Code	00480372001
Hospital Revenue Code	250
Min. Negotiated Rate	$299.25
Max. Negotiated Rate	$684.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$470.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$427.50
Rate for Payer: Aetna Government	$427.50
Rate for Payer: Brighton Health Commercial	$641.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$684.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$581.40
Rate for Payer: Group Health Inc Commercial	$427.50
Rate for Payer: Group Health Inc Medicare	$299.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$427.50
Rate for Payer: Hamaspik Choice Inc Medicare	$427.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$555.75

PYRIMETHAMINE 25 MG PO TABS [11246]

Facility

$900.00

Service Code	NDC 69413033030
Hospital Charge Code	69413033030
Hospital Revenue Code	250
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$450.00
Rate for Payer: Aetna Government	$450.00
Rate for Payer: Brighton Health Commercial	$675.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$585.00

PYRIMETHAMINE 25 MG PO TABS [11246]

Facility

$796.88

Service Code	NDC 47781092530
Hospital Charge Code	47781092530
Hospital Revenue Code	250
Min. Negotiated Rate	$278.91
Max. Negotiated Rate	$637.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$438.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.44
Rate for Payer: Aetna Government	$398.44
Rate for Payer: Brighton Health Commercial	$597.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$637.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$541.88
Rate for Payer: Group Health Inc Commercial	$398.44
Rate for Payer: Group Health Inc Medicare	$278.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$398.44
Rate for Payer: Hamaspik Choice Inc Medicare	$398.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$517.97

PYRIMETHAMINE 25 MG PO TABS [11246]

Facility

$796.88

Service Code	NDC 43598067230
Hospital Charge Code	43598067230
Hospital Revenue Code	250
Min. Negotiated Rate	$278.91
Max. Negotiated Rate	$637.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$438.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.44
Rate for Payer: Aetna Government	$398.44
Rate for Payer: Brighton Health Commercial	$597.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$637.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$541.88
Rate for Payer: Group Health Inc Commercial	$398.44
Rate for Payer: Group Health Inc Medicare	$278.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$398.44
Rate for Payer: Hamaspik Choice Inc Medicare	$398.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$517.97

PYRIMETHAMINE POWD [23288]

Facility

$17.43

Service Code	NDC 38779088403
Hospital Charge Code	38779088403
Hospital Revenue Code	250
Min. Negotiated Rate	$6.10
Max. Negotiated Rate	$13.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.72
Rate for Payer: Aetna Government	$8.72
Rate for Payer: Brighton Health Commercial	$13.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.86
Rate for Payer: Group Health Inc Commercial	$8.72
Rate for Payer: Group Health Inc Medicare	$6.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.72
Rate for Payer: Hamaspik Choice Inc Medicare	$8.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.33

PYRIMETHAMINE SUSP 2MG/ML

Facility

$1.25

Hospital Charge Code	41656567
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$1.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.85
Rate for Payer: Group Health Inc Commercial	$0.63
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.81

PYRIMETHAMINE SUSP 2MG/ML

Facility

$1.25

Hospital Charge Code	41646567
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$1.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.85
Rate for Payer: Group Health Inc Commercial	$0.63
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.81

PYROPHOSPHATE INJ

Facility

$72.37

Hospital Charge Code	41646572
Hospital Revenue Code	250
Min. Negotiated Rate	$25.33
Max. Negotiated Rate	$57.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.18
Rate for Payer: Aetna Government	$36.18
Rate for Payer: Brighton Health Commercial	$54.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.21
Rate for Payer: Group Health Inc Commercial	$36.18
Rate for Payer: Group Health Inc Medicare	$25.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.18
Rate for Payer: Hamaspik Choice Inc Medicare	$36.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.04

PYROPHOSPHATE INJ

Facility

$72.37

Hospital Charge Code	41656572
Hospital Revenue Code	250
Min. Negotiated Rate	$25.33
Max. Negotiated Rate	$57.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.18
Rate for Payer: Aetna Government	$36.18
Rate for Payer: Brighton Health Commercial	$54.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.21
Rate for Payer: Group Health Inc Commercial	$36.18
Rate for Payer: Group Health Inc Medicare	$25.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.18
Rate for Payer: Hamaspik Choice Inc Medicare	$36.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.04

Know your out-of-pocket cost for care.

All Charges