St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Depression except major depressive disorder

Facility

$9,529.00

Service Code	APR-DRG 7542
Min. Negotiated Rate	$3,406.16
Max. Negotiated Rate	$9,529.00
Rate for Payer: Affinity Essential Plan 1&2	$3,406.16
Rate for Payer: Affinity Essential Plan 3&4	$3,406.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,406.16
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,406.16
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,663.86
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,406.16
Rate for Payer: Fidelis Qualified Health Plan	$4,087.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,406.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,406.16
Rate for Payer: Healthfirst Commercial	$9,529.00
Rate for Payer: Healthfirst Essential Plan	$7,663.86
Rate for Payer: Healthfirst QHP	$6,199.21
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,406.16
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,663.86
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,663.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,406.16
Rate for Payer: SOMOS Essential	$7,663.86
Rate for Payer: United Healthcare Essential Plan 1&2	$7,663.86
Rate for Payer: United Healthcare Essential Plan 3&4	$7,663.86
Rate for Payer: United Healthcare Medicaid	$3,406.16

Depression except major depressive disorder

Facility

$11,233.00

Service Code	APR-DRG 7544
Min. Negotiated Rate	$3,433.49
Max. Negotiated Rate	$11,233.00
Rate for Payer: Affinity Essential Plan 1&2	$3,433.49
Rate for Payer: Affinity Essential Plan 3&4	$3,433.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,433.49
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,433.49
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,725.35
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,433.49
Rate for Payer: Fidelis Qualified Health Plan	$4,120.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,433.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,433.49
Rate for Payer: Healthfirst Commercial	$11,233.00
Rate for Payer: Healthfirst Essential Plan	$7,725.35
Rate for Payer: Healthfirst QHP	$6,248.95
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,433.49
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,725.35
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,725.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,433.49
Rate for Payer: SOMOS Essential	$7,725.35
Rate for Payer: United Healthcare Essential Plan 1&2	$7,725.35
Rate for Payer: United Healthcare Essential Plan 3&4	$7,725.35
Rate for Payer: United Healthcare Medicaid	$3,433.49

DERMAPHOR EX OINT

Facility

$0.17

Service Code	NDC 7214045231
Hospital Charge Code	7214045231
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

DERMAPHOR EX OINT

Facility

$0.13

Service Code	NDC 7214003263
Hospital Charge Code	7214003263
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

DERMAPHOR EX OINT

Facility

$0.15

Service Code	NDC 7214063377
Hospital Charge Code	7214063377
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

DERMAPHOR EX OINT

Facility

$0.17

Service Code	NDC 7214045231
Hospital Charge Code	7214045231
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

DERMAPHOR EX OINT

Facility

$0.15

Service Code	NDC 7214063377
Hospital Charge Code	7214063377
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

DERMAPHOR EX OINT

Facility

$0.05

Service Code	NDC 6192418404
Hospital Charge Code	6192418404
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

DERMAPHOR EX OINT

Facility

$0.13

Service Code	NDC 7214003263
Hospital Charge Code	7214003263
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

DERMAPHOR EX OINT

Facility

$0.05

Service Code	NDC 6192418404
Hospital Charge Code	6192418404
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

DESIPRAMINE HCL 25 MG PO TABS

Facility

$2.01

Service Code	NDC 5074211301
Hospital Charge Code	5074211301
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: EmblemHealth Commercial	$1.00
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

DESIPRAMINE HCL 25 MG PO TABS

Facility

$2.01

Service Code	NDC 5074211301
Hospital Charge Code	5074211301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

DESMOPRESSIN ACETATE 0.1 MG PO TABS

Facility

$5.29

Service Code	NDC 6991810101
Hospital Charge Code	6991810101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$2.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.64

DESMOPRESSIN ACETATE 0.1 MG PO TABS

Facility

$5.29

Service Code	NDC 2315548901
Hospital Charge Code	2315548901
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$2.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.64

DESMOPRESSIN ACETATE 0.1 MG PO TABS

Facility

$5.29

Service Code	NDC 2315548901
Hospital Charge Code	2315548901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$4.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$3.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.59
Rate for Payer: EmblemHealth Commercial	$2.64
Rate for Payer: Group Health Inc Commercial	$2.64
Rate for Payer: Group Health Inc Medicare	$1.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.64
Rate for Payer: Hamaspik Choice Inc Medicare	$2.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.44

DESMOPRESSIN ACETATE 0.1 MG PO TABS

Facility

$5.29

Service Code	NDC 6991810101
Hospital Charge Code	6991810101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$4.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$3.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.59
Rate for Payer: EmblemHealth Commercial	$2.64
Rate for Payer: Group Health Inc Commercial	$2.64
Rate for Payer: Group Health Inc Medicare	$1.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.64
Rate for Payer: Hamaspik Choice Inc Medicare	$2.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.44

DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN

Facility

$47.40

Service Code	HCPCS J2597
Hospital Charge Code	8363445110
Hospital Revenue Code	250
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.70

DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN

Facility

$63.00

Service Code	HCPCS J2597
Hospital Charge Code	7086045410
Hospital Revenue Code	250
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.50

DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN

Facility

$71.42

Service Code	HCPCS J2597
Hospital Charge Code	6991890110
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$57.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.52
Rate for Payer: Aetna Government	$3.52
Rate for Payer: Affinity Essential Plan 1&2	$2.46
Rate for Payer: Affinity Essential Plan 3&4	$2.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.46
Rate for Payer: Brighton Health Commercial	$53.57
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.57
Rate for Payer: Elderplan Medicare Advantage	$3.52
Rate for Payer: EmblemHealth Commercial	$3.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.17
Rate for Payer: Fidelis Essential Plan Aliesa	$2.99
Rate for Payer: Fidelis Essential Plan QHP	$3.13
Rate for Payer: Fidelis Medicare Advantage	$3.52
Rate for Payer: Fidelis Qualified Health Plan	$3.13
Rate for Payer: Group Health Inc Commercial	$3.52
Rate for Payer: Group Health Inc Medicare	$3.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.52
Rate for Payer: Healthfirst Medicare Advantage	$2.99
Rate for Payer: Healthfirst QHP	$3.52
Rate for Payer: Humana Medicare	$3.59
Rate for Payer: Senior Whole Health Medicare Advantage	$3.52
Rate for Payer: United Healthcare Medicare Advantage	$3.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.34
Rate for Payer: Wellcare Medicare	$3.34

DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN

Facility

$63.00

Service Code	HCPCS J2597
Hospital Charge Code	7086045441
Hospital Revenue Code	250
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.50

DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN

Facility

$63.00

Service Code	HCPCS J2597
Hospital Charge Code	4359805311
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$50.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.52
Rate for Payer: Aetna Government	$3.52
Rate for Payer: Affinity Essential Plan 1&2	$2.46
Rate for Payer: Affinity Essential Plan 3&4	$2.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.46
Rate for Payer: Brighton Health Commercial	$47.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.84
Rate for Payer: Elderplan Medicare Advantage	$3.52
Rate for Payer: EmblemHealth Commercial	$3.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.17
Rate for Payer: Fidelis Essential Plan Aliesa	$2.99
Rate for Payer: Fidelis Essential Plan QHP	$3.13
Rate for Payer: Fidelis Medicare Advantage	$3.52
Rate for Payer: Fidelis Qualified Health Plan	$3.13
Rate for Payer: Group Health Inc Commercial	$3.52
Rate for Payer: Group Health Inc Medicare	$3.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.52
Rate for Payer: Healthfirst Medicare Advantage	$2.99
Rate for Payer: Healthfirst QHP	$3.52
Rate for Payer: Humana Medicare	$3.59
Rate for Payer: Senior Whole Health Medicare Advantage	$3.52
Rate for Payer: United Healthcare Medicare Advantage	$3.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$40.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.34
Rate for Payer: Wellcare Medicare	$3.34

DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN

Facility

$71.42

Service Code	HCPCS J2597
Hospital Charge Code	0703505103
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$57.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.52
Rate for Payer: Aetna Government	$3.52
Rate for Payer: Affinity Essential Plan 1&2	$2.46
Rate for Payer: Affinity Essential Plan 3&4	$2.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.46
Rate for Payer: Brighton Health Commercial	$53.57
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.57
Rate for Payer: Elderplan Medicare Advantage	$3.52
Rate for Payer: EmblemHealth Commercial	$3.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.17
Rate for Payer: Fidelis Essential Plan Aliesa	$2.99
Rate for Payer: Fidelis Essential Plan QHP	$3.13
Rate for Payer: Fidelis Medicare Advantage	$3.52
Rate for Payer: Fidelis Qualified Health Plan	$3.13
Rate for Payer: Group Health Inc Commercial	$3.52
Rate for Payer: Group Health Inc Medicare	$3.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.52
Rate for Payer: Healthfirst Medicare Advantage	$2.99
Rate for Payer: Healthfirst QHP	$3.52
Rate for Payer: Humana Medicare	$3.59
Rate for Payer: Senior Whole Health Medicare Advantage	$3.52
Rate for Payer: United Healthcare Medicare Advantage	$3.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.34
Rate for Payer: Wellcare Medicare	$3.34

DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN

Facility

$63.00

Service Code	HCPCS J2597
Hospital Charge Code	7086045410
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$50.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.52
Rate for Payer: Aetna Government	$3.52
Rate for Payer: Affinity Essential Plan 1&2	$2.46
Rate for Payer: Affinity Essential Plan 3&4	$2.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.46
Rate for Payer: Brighton Health Commercial	$47.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.84
Rate for Payer: Elderplan Medicare Advantage	$3.52
Rate for Payer: EmblemHealth Commercial	$3.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.17
Rate for Payer: Fidelis Essential Plan Aliesa	$2.99
Rate for Payer: Fidelis Essential Plan QHP	$3.13
Rate for Payer: Fidelis Medicare Advantage	$3.52
Rate for Payer: Fidelis Qualified Health Plan	$3.13
Rate for Payer: Group Health Inc Commercial	$3.52
Rate for Payer: Group Health Inc Medicare	$3.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.52
Rate for Payer: Healthfirst Medicare Advantage	$2.99
Rate for Payer: Healthfirst QHP	$3.52
Rate for Payer: Humana Medicare	$3.59
Rate for Payer: Senior Whole Health Medicare Advantage	$3.52
Rate for Payer: United Healthcare Medicare Advantage	$3.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$40.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.34
Rate for Payer: Wellcare Medicare	$3.34

DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN

Facility

$71.32

Service Code	HCPCS J2597
Hospital Charge Code	6275652940
Hospital Revenue Code	250
Min. Negotiated Rate	$35.66
Max. Negotiated Rate	$35.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.66

DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN

Facility

$47.40

Service Code	HCPCS J2597
Hospital Charge Code	8363445141
Hospital Revenue Code	250
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.70

Know your out-of-pocket cost for care.

All Charges