St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CYCLOPENTOLATE HCL 1 % OP SOLN

Facility

$14.56

Service Code	NDC 0065039605
Hospital Charge Code	0065039605
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$11.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.28
Rate for Payer: Aetna Government	$7.28
Rate for Payer: Brighton Health Commercial	$10.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.90
Rate for Payer: EmblemHealth Commercial	$7.28
Rate for Payer: Group Health Inc Commercial	$7.28
Rate for Payer: Group Health Inc Medicare	$5.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.28
Rate for Payer: Hamaspik Choice Inc Medicare	$7.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.46

CYCLOPENTOLATE HCL 1 % OP SOLN

Facility

$14.56

Service Code	NDC 0065039605
Hospital Charge Code	0065039605
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$7.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.28

CYCLOPENTOLATE HCL 1 % OP SOLN

Facility

$2.70

Service Code	NDC 6131439603
Hospital Charge Code	6131439603
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.35
Rate for Payer: Aetna Government	$1.35
Rate for Payer: Brighton Health Commercial	$2.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.84
Rate for Payer: EmblemHealth Commercial	$1.35
Rate for Payer: Group Health Inc Commercial	$1.35
Rate for Payer: Group Health Inc Medicare	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.35
Rate for Payer: Hamaspik Choice Inc Medicare	$1.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.75

CYCLOPENTOLATE HCL 1 % OP SOLN

Facility

$8.40

Service Code	NDC 6131439601
Hospital Charge Code	6131439601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$6.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.20
Rate for Payer: Aetna Government	$4.20
Rate for Payer: Brighton Health Commercial	$6.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.71
Rate for Payer: EmblemHealth Commercial	$4.20
Rate for Payer: Group Health Inc Commercial	$4.20
Rate for Payer: Group Health Inc Medicare	$2.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.20
Rate for Payer: Hamaspik Choice Inc Medicare	$4.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.46

CYCLOPENTOLATE HCL 1 % OP SOLN

Facility

$2.70

Service Code	NDC 6131439603
Hospital Charge Code	6131439603
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.35

CYCLOPENTOLATE HCL 1 % OP SOLN

Facility

$7.39

Service Code	NDC 1747810002
Hospital Charge Code	1747810002
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$5.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.69
Rate for Payer: Aetna Government	$3.69
Rate for Payer: Brighton Health Commercial	$5.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.02
Rate for Payer: EmblemHealth Commercial	$3.69
Rate for Payer: Group Health Inc Commercial	$3.69
Rate for Payer: Group Health Inc Medicare	$2.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.69
Rate for Payer: Hamaspik Choice Inc Medicare	$3.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.80

CYCLOPENTOLATE HCL 2 % OP SOLN

Facility

$26.50

Service Code	NDC 0065039702
Hospital Charge Code	0065039702
Hospital Revenue Code	250
Min. Negotiated Rate	$9.27
Max. Negotiated Rate	$21.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.25
Rate for Payer: Aetna Government	$13.25
Rate for Payer: Brighton Health Commercial	$19.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.02
Rate for Payer: EmblemHealth Commercial	$13.25
Rate for Payer: Group Health Inc Commercial	$13.25
Rate for Payer: Group Health Inc Medicare	$9.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.25
Rate for Payer: Hamaspik Choice Inc Medicare	$13.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.22

CYCLOPENTOLATE HCL 2 % OP SOLN

Facility

$14.76

Service Code	NDC 1747809702
Hospital Charge Code	1747809702
Hospital Revenue Code	250
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$11.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.38
Rate for Payer: Aetna Government	$7.38
Rate for Payer: Brighton Health Commercial	$11.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.03
Rate for Payer: EmblemHealth Commercial	$7.38
Rate for Payer: Group Health Inc Commercial	$7.38
Rate for Payer: Group Health Inc Medicare	$5.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.38
Rate for Payer: Hamaspik Choice Inc Medicare	$7.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.59

CYCLOPENTOLATE HCL 2 % OP SOLN

Facility

$26.50

Service Code	NDC 0065039702
Hospital Charge Code	0065039702
Hospital Revenue Code	250
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$13.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.25

CYCLOPENTOLATE HCL 2 % OP SOLN

Facility

$14.76

Service Code	NDC 1747809702
Hospital Charge Code	1747809702
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$7.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.38

CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OP SOLN

Facility

$21.16

Service Code	NDC 0065035902
Hospital Charge Code	0065035902
Hospital Revenue Code	250
Min. Negotiated Rate	$7.40
Max. Negotiated Rate	$16.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.58
Rate for Payer: Aetna Government	$10.58
Rate for Payer: Brighton Health Commercial	$15.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.39
Rate for Payer: EmblemHealth Commercial	$10.58
Rate for Payer: Group Health Inc Commercial	$10.58
Rate for Payer: Group Health Inc Medicare	$7.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.58
Rate for Payer: Hamaspik Choice Inc Medicare	$10.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.75

CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OP SOLN

Facility

$21.16

Service Code	NDC 0065035902
Hospital Charge Code	0065035902
Hospital Revenue Code	250
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$10.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.58

CYCLOPHOSPHAMIDE 1 G IJ SOLR

Facility

$879.00

Service Code	HCPCS J9075
Hospital Charge Code	1001995601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$703.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$483.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Affinity Essential Plan 1&2	$0.34
Rate for Payer: Affinity Essential Plan 3&4	$0.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.34
Rate for Payer: Brighton Health Commercial	$659.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$703.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$597.72
Rate for Payer: Elderplan Medicare Advantage	$0.48
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.43
Rate for Payer: Fidelis Essential Plan Aliesa	$0.41
Rate for Payer: Fidelis Essential Plan QHP	$0.43
Rate for Payer: Fidelis Medicare Advantage	$0.48
Rate for Payer: Fidelis Qualified Health Plan	$0.43
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.48
Rate for Payer: Healthfirst Medicare Advantage	$0.41
Rate for Payer: Healthfirst QHP	$0.48
Rate for Payer: Humana Medicare	$0.49
Rate for Payer: Senior Whole Health Medicare Advantage	$0.48
Rate for Payer: United Healthcare Medicare Advantage	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$571.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.46
Rate for Payer: Wellcare Medicare	$0.46

CYCLOPHOSPHAMIDE 1 G IJ SOLR

Facility

$824.06

Service Code	HCPCS J9075
Hospital Charge Code	0781324494
Hospital Revenue Code	250
Min. Negotiated Rate	$412.03
Max. Negotiated Rate	$412.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$412.03

CYCLOPHOSPHAMIDE 1 G IJ SOLR

Facility

$879.00

Service Code	HCPCS J9075
Hospital Charge Code	1001995601
Hospital Revenue Code	250
Min. Negotiated Rate	$439.50
Max. Negotiated Rate	$439.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$439.50

CYCLOPHOSPHAMIDE 1 G IJ SOLR

Facility

$824.06

Service Code	HCPCS J9075
Hospital Charge Code	0781324494
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$659.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$453.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Affinity Essential Plan 1&2	$0.34
Rate for Payer: Affinity Essential Plan 3&4	$0.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.34
Rate for Payer: Brighton Health Commercial	$618.04
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$659.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$560.36
Rate for Payer: Elderplan Medicare Advantage	$0.48
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.43
Rate for Payer: Fidelis Essential Plan Aliesa	$0.41
Rate for Payer: Fidelis Essential Plan QHP	$0.43
Rate for Payer: Fidelis Medicare Advantage	$0.48
Rate for Payer: Fidelis Qualified Health Plan	$0.43
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.48
Rate for Payer: Healthfirst Medicare Advantage	$0.41
Rate for Payer: Healthfirst QHP	$0.48
Rate for Payer: Humana Medicare	$0.49
Rate for Payer: Senior Whole Health Medicare Advantage	$0.48
Rate for Payer: United Healthcare Medicare Advantage	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$535.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.46
Rate for Payer: Wellcare Medicare	$0.46

CYCLOPHOSPHAMIDE 1 G IJ SOLR

Facility

$791.10

Service Code	HCPCS J9075
Hospital Charge Code	7012112391
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$632.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$435.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Affinity Essential Plan 1&2	$0.34
Rate for Payer: Affinity Essential Plan 3&4	$0.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.34
Rate for Payer: Brighton Health Commercial	$593.33
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$632.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$537.95
Rate for Payer: Elderplan Medicare Advantage	$0.48
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.43
Rate for Payer: Fidelis Essential Plan Aliesa	$0.41
Rate for Payer: Fidelis Essential Plan QHP	$0.43
Rate for Payer: Fidelis Medicare Advantage	$0.48
Rate for Payer: Fidelis Qualified Health Plan	$0.43
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.48
Rate for Payer: Healthfirst Medicare Advantage	$0.41
Rate for Payer: Healthfirst QHP	$0.48
Rate for Payer: Humana Medicare	$0.49
Rate for Payer: Senior Whole Health Medicare Advantage	$0.48
Rate for Payer: United Healthcare Medicare Advantage	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$514.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.46
Rate for Payer: Wellcare Medicare	$0.46

CYCLOPHOSPHAMIDE 1 G IJ SOLR

Facility

$791.10

Service Code	HCPCS J9075
Hospital Charge Code	7012112391
Hospital Revenue Code	250
Min. Negotiated Rate	$395.55
Max. Negotiated Rate	$395.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$395.55

CYCLOPHOSPHAMIDE 1 GM/5ML IV SOLN

Facility

$175.80

Service Code	HCPCS J9075
Hospital Charge Code	5074252005
Hospital Revenue Code	258
Min. Negotiated Rate	$87.90
Max. Negotiated Rate	$87.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.90

CYCLOPHOSPHAMIDE 1 GM/5ML IV SOLN

Facility

$175.80

Service Code	HCPCS J9075
Hospital Charge Code	5074252005
Hospital Revenue Code	258
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$140.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Affinity Essential Plan 1&2	$0.34
Rate for Payer: Affinity Essential Plan 3&4	$0.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.34
Rate for Payer: Brighton Health Commercial	$131.85
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.54
Rate for Payer: Elderplan Medicare Advantage	$0.48
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.43
Rate for Payer: Fidelis Essential Plan Aliesa	$0.41
Rate for Payer: Fidelis Essential Plan QHP	$0.43
Rate for Payer: Fidelis Medicare Advantage	$0.48
Rate for Payer: Fidelis Qualified Health Plan	$0.43
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.48
Rate for Payer: Healthfirst Medicare Advantage	$0.41
Rate for Payer: Healthfirst QHP	$0.48
Rate for Payer: Humana Medicare	$0.49
Rate for Payer: Senior Whole Health Medicare Advantage	$0.48
Rate for Payer: United Healthcare Medicare Advantage	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$114.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.46
Rate for Payer: Wellcare Medicare	$0.46

CYCLOPHOSPHAMIDE 25 MG PO CAPS

Facility

$9.36

Service Code	HCPCS J8530
Hospital Charge Code	0054038225
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$7.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$7.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.37
Rate for Payer: EmblemHealth Commercial	$4.68
Rate for Payer: Group Health Inc Commercial	$4.68
Rate for Payer: Group Health Inc Medicare	$3.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.68
Rate for Payer: Hamaspik Choice Inc Medicare	$4.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.09

CYCLOPHOSPHAMIDE 25 MG PO CAPS

Facility

$9.36

Service Code	HCPCS J8530
Hospital Charge Code	0054038225
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$4.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.68

CYCLOPHOSPHAMIDE 2 G IJ SOLR

Facility

$1.00

Service Code	HCPCS J9075
Hospital Charge Code	1001995701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Affinity Essential Plan 1&2	$0.34
Rate for Payer: Affinity Essential Plan 3&4	$0.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.34
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$0.48
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.43
Rate for Payer: Fidelis Essential Plan Aliesa	$0.41
Rate for Payer: Fidelis Essential Plan QHP	$0.43
Rate for Payer: Fidelis Medicare Advantage	$0.48
Rate for Payer: Fidelis Qualified Health Plan	$0.43
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.48
Rate for Payer: Healthfirst Medicare Advantage	$0.41
Rate for Payer: Healthfirst QHP	$0.48
Rate for Payer: Humana Medicare	$0.49
Rate for Payer: Senior Whole Health Medicare Advantage	$0.48
Rate for Payer: United Healthcare Medicare Advantage	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.46
Rate for Payer: Wellcare Medicare	$0.46

CYCLOPHOSPHAMIDE 2 G IJ SOLR

Facility

$1.00

Service Code	HCPCS J9075
Hospital Charge Code	1001995701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

CYCLOPHOSPHAMIDE 2 GM/10ML IV SOLN

Facility

$175.80

Service Code	HCPCS J9070
Hospital Charge Code	5074252110
Hospital Revenue Code	258
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$140.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.15
Rate for Payer: Aetna Government	$29.15
Rate for Payer: Brighton Health Commercial	$131.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.54
Rate for Payer: EmblemHealth Commercial	$87.90
Rate for Payer: Group Health Inc Commercial	$87.90
Rate for Payer: Group Health Inc Medicare	$61.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.90
Rate for Payer: Hamaspik Choice Inc Medicare	$87.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$114.27

Know your out-of-pocket cost for care.

All Charges