St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RALTEGRAVIR POTASSIUM 600 MG PO TABS [139519]

Facility

$39.94

Service Code	NDC 00006308001
Hospital Charge Code	00006308001
Hospital Revenue Code	250
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$31.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.97
Rate for Payer: Aetna Government	$19.97
Rate for Payer: Brighton Health Commercial	$29.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.16
Rate for Payer: Group Health Inc Commercial	$19.97
Rate for Payer: Group Health Inc Medicare	$13.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.97
Rate for Payer: Hamaspik Choice Inc Medicare	$19.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.96

RAMICURUMAB 500MG/50ML VIAL-5MG

Facility

$80.00

Service Code	HCPCS J9308
Hospital Charge Code	41655761
Hospital Revenue Code	636
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$73.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.24
Rate for Payer: Aetna Government	$70.24
Rate for Payer: Affinity Essential Plan 1&2	$49.17
Rate for Payer: Affinity Essential Plan 3&4	$49.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$49.17
Rate for Payer: Brighton Health Commercial	$48.00
Rate for Payer: Cash Price	$70.24
Rate for Payer: Cash Price	$70.24
Rate for Payer: Cash Price	$70.24
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$70.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.00
Rate for Payer: Elderplan Medicare Advantage	$70.24
Rate for Payer: EmblemHealth Commercial	$70.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$70.24
Rate for Payer: Fidelis Essential Plan Aliesa	$70.24
Rate for Payer: Fidelis Essential Plan QHP	$73.76
Rate for Payer: Fidelis Medicare Advantage	$70.24
Rate for Payer: Fidelis Qualified Health Plan	$73.76
Rate for Payer: Group Health Inc Commercial	$70.24
Rate for Payer: Group Health Inc Medicare	$70.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00
Rate for Payer: Healthfirst Medicare Advantage	$59.71
Rate for Payer: Healthfirst QHP	$70.24
Rate for Payer: Humana Medicare	$71.65
Rate for Payer: Senior Whole Health Medicare Advantage	$70.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$73.83
Rate for Payer: SOMOS Essential	$73.83
Rate for Payer: United Healthcare Commercial	$66.86
Rate for Payer: United Healthcare Medicare Advantage	$70.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.20
Rate for Payer: Wellcare Medicare	$66.73

RAMICURUMAB 500MG/50ML VIAL-5MG

Facility

$80.00

Service Code	HCPCS J9308
Hospital Charge Code	41655761
Hospital Revenue Code	636
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$40.00
Rate for Payer: Cash Price	$70.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00

RAMUCIRUMAB 100 MG/10ML IV SOLN [125686]

Facility

$171.39

Service Code	HCPCS J9308
Hospital Charge Code	00002766901
Hospital Revenue Code	278
Min. Negotiated Rate	$85.69
Max. Negotiated Rate	$85.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.69
Rate for Payer: Hamaspik Choice Inc Medicare	$85.69

RAMUCIRUMAB 100 MG/10ML IV SOLN [125686]

Facility

$171.39

Service Code	HCPCS J9308
Hospital Charge Code	00002766901
Hospital Revenue Code	278
Min. Negotiated Rate	$56.20
Max. Negotiated Rate	$111.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.24
Rate for Payer: Aetna Government	$70.24
Rate for Payer: Brighton Health Commercial	$102.83
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$70.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.55
Rate for Payer: Elderplan Medicare Advantage	$70.24
Rate for Payer: EmblemHealth Commercial	$85.69
Rate for Payer: Fidelis Medicare Advantage	$70.24
Rate for Payer: Group Health Inc Commercial	$70.24
Rate for Payer: Group Health Inc Medicare	$70.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.69
Rate for Payer: Hamaspik Choice Inc Medicare	$85.69
Rate for Payer: Healthfirst Medicare Advantage	$59.71
Rate for Payer: Healthfirst QHP	$70.24
Rate for Payer: Humana Medicare	$71.65
Rate for Payer: Senior Whole Health Medicare Advantage	$70.24
Rate for Payer: United Healthcare Medicare Advantage	$70.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.20

RAMUCIRUMAB 100MG/10ML VIAL-5MG

Facility

$80.00

Service Code	HCPCS J9308
Hospital Charge Code	41655759
Hospital Revenue Code	636
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$40.00
Rate for Payer: Cash Price	$70.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00

RAMUCIRUMAB 100MG/10ML VIAL-5MG

Facility

$80.00

Service Code	HCPCS J9308
Hospital Charge Code	41655759
Hospital Revenue Code	636
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$73.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.24
Rate for Payer: Aetna Government	$70.24
Rate for Payer: Affinity Essential Plan 1&2	$49.17
Rate for Payer: Affinity Essential Plan 3&4	$49.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$49.17
Rate for Payer: Brighton Health Commercial	$48.00
Rate for Payer: Cash Price	$70.24
Rate for Payer: Cash Price	$70.24
Rate for Payer: Cash Price	$70.24
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$70.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.00
Rate for Payer: Elderplan Medicare Advantage	$70.24
Rate for Payer: EmblemHealth Commercial	$70.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$70.24
Rate for Payer: Fidelis Essential Plan Aliesa	$70.24
Rate for Payer: Fidelis Essential Plan QHP	$73.76
Rate for Payer: Fidelis Medicare Advantage	$70.24
Rate for Payer: Fidelis Qualified Health Plan	$73.76
Rate for Payer: Group Health Inc Commercial	$70.24
Rate for Payer: Group Health Inc Medicare	$70.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00
Rate for Payer: Healthfirst Medicare Advantage	$59.71
Rate for Payer: Healthfirst QHP	$70.24
Rate for Payer: Humana Medicare	$71.65
Rate for Payer: Senior Whole Health Medicare Advantage	$70.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$73.83
Rate for Payer: SOMOS Essential	$73.83
Rate for Payer: United Healthcare Commercial	$66.86
Rate for Payer: United Healthcare Medicare Advantage	$70.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.20
Rate for Payer: Wellcare Medicare	$66.73

RAMUCIRUMAB 500 MG/50ML IV SOLN [125687]

Facility

$171.39

Service Code	HCPCS J9308
Hospital Charge Code	00002767801
Hospital Revenue Code	278
Min. Negotiated Rate	$85.69
Max. Negotiated Rate	$85.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.69
Rate for Payer: Hamaspik Choice Inc Medicare	$85.69

RAMUCIRUMAB 500 MG/50ML IV SOLN [125687]

Facility

$171.39

Service Code	HCPCS J9308
Hospital Charge Code	00002767801
Hospital Revenue Code	278
Min. Negotiated Rate	$56.20
Max. Negotiated Rate	$111.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.24
Rate for Payer: Aetna Government	$70.24
Rate for Payer: Brighton Health Commercial	$102.83
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$70.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.55
Rate for Payer: Elderplan Medicare Advantage	$70.24
Rate for Payer: EmblemHealth Commercial	$85.69
Rate for Payer: Fidelis Medicare Advantage	$70.24
Rate for Payer: Group Health Inc Commercial	$70.24
Rate for Payer: Group Health Inc Medicare	$70.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.69
Rate for Payer: Hamaspik Choice Inc Medicare	$85.69
Rate for Payer: Healthfirst Medicare Advantage	$59.71
Rate for Payer: Healthfirst QHP	$70.24
Rate for Payer: Humana Medicare	$71.65
Rate for Payer: Senior Whole Health Medicare Advantage	$70.24
Rate for Payer: United Healthcare Medicare Advantage	$70.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.20

RANCHO 1 HOLE WITH POST

Facility

$521.68

Service Code	HCPCS C1713
Hospital Charge Code	64904106
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$547.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$286.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$313.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.97
Rate for Payer: EmblemHealth Commercial	$260.84
Rate for Payer: Fidelis Medicare Advantage	$547.76
Rate for Payer: Group Health Inc Commercial	$260.84
Rate for Payer: Group Health Inc Medicare	$182.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.84
Rate for Payer: Hamaspik Choice Inc Medicare	$260.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$339.09

RANCHO 1 HOLE WITH POST

Facility

$521.68

Service Code	HCPCS C1713
Hospital Charge Code	64904106
Hospital Revenue Code	278
Min. Negotiated Rate	$260.84
Max. Negotiated Rate	$260.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.84
Rate for Payer: Hamaspik Choice Inc Medicare	$260.84

RANITIDINE 15 MG/ML ELIXIR

Facility

$0.09

Hospital Charge Code	41641154
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

RANITIDINE 15 MG/ML ELIXIR

Facility

$0.09

Hospital Charge Code	41651154
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

RANITIDINE 1 MG/ML INJ PEDIATRIC

Facility

$1.00

Hospital Charge Code	41655578
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

RANITIDINE 1 MG/ML INJ PEDIATRIC

Facility

$1.00

Hospital Charge Code	41645578
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

RANITIDINE 1 MG/ML SOLN PEDIATRIC

Facility

$1.00

Hospital Charge Code	41652363
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

RANITIDINE 1 MG/ML SOLN PEDIATRIC

Facility

$1.00

Hospital Charge Code	41642363
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

RANITIDINE 25MG/ML 40ML BULK INJ

Facility

$2.74

Service Code	HCPCS J2780
Hospital Charge Code	41646999
Hospital Revenue Code	636
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$5.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.33
Rate for Payer: Aetna Government	$5.33
Rate for Payer: Brighton Health Commercial	$1.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.58
Rate for Payer: Group Health Inc Commercial	$1.37
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.78

RANITIDINE 25MG/ML 40ML BULK INJ

Facility

$2.74

Service Code	HCPCS J2780
Hospital Charge Code	41656999
Hospital Revenue Code	636
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$5.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.33
Rate for Payer: Aetna Government	$5.33
Rate for Payer: Brighton Health Commercial	$1.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.58
Rate for Payer: Group Health Inc Commercial	$1.37
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.78

RANITIDINE 25MG/ML 40ML BULK INJ

Facility

$2.74

Service Code	HCPCS J2780
Hospital Charge Code	41646999
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1.37

RANITIDINE 25MG/ML 40ML BULK INJ

Facility

$2.74

Service Code	HCPCS J2780
Hospital Charge Code	41656999
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1.37

RANITIDINE 50MG/ 2ML INJ

Facility

$0.80

Hospital Charge Code	41646044
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.40
Rate for Payer: Aetna Government	$0.40
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.54
Rate for Payer: Group Health Inc Commercial	$0.40
Rate for Payer: Group Health Inc Medicare	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.40
Rate for Payer: Hamaspik Choice Inc Medicare	$0.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.52

RANITIDINE 50MG/2ML INJ

Facility

$7.00

Hospital Charge Code	41646089
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

RANITIDINE 50MG/2ML INJ

Facility

$0.80

Hospital Charge Code	41656044
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.40
Rate for Payer: Aetna Government	$0.40
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.54
Rate for Payer: Group Health Inc Commercial	$0.40
Rate for Payer: Group Health Inc Medicare	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.40
Rate for Payer: Hamaspik Choice Inc Medicare	$0.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.52

RANITIDINE 50 MG IVPB PREMIX

Facility

$2.41

Service Code	HCPCS J2780
Hospital Charge Code	41650128
Hospital Revenue Code	636
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$5.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.33
Rate for Payer: Aetna Government	$5.33
Rate for Payer: Brighton Health Commercial	$1.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.39
Rate for Payer: Group Health Inc Commercial	$1.21
Rate for Payer: Group Health Inc Medicare	$0.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.21
Rate for Payer: Hamaspik Choice Inc Medicare	$1.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.57

Know your out-of-pocket cost for care.

All Charges