St. Barnabas Hospital

All Charges

Charge

Type

Price

CESAREAN DELIV AFTER ATTEMP VAG D

Facility OP

$2,774.75

Service Code	HCPCS 59620
Hospital Charge Code	40052242
Hospital Revenue Code	360
Min. Negotiated Rate	$971.16
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,526.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,137.59
Rate for Payer: Aetna Government	$1,137.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,124.30
Rate for Payer: Group Health Inc Commercial	$1,387.38
Rate for Payer: Group Health Inc Medicare	$971.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,387.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,387.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,249.22

CESAREAN DELIVERY ONLY

Facility OP

$9,079.36

Service Code	HCPCS 59514
Hospital Charge Code	40052238
Hospital Revenue Code	360
Min. Negotiated Rate	$1,082.05
Max. Negotiated Rate	$4,993.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,993.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,111.54
Rate for Payer: Aetna Government	$1,111.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,082.05
Rate for Payer: Group Health Inc Commercial	$4,539.68
Rate for Payer: Group Health Inc Medicare	$3,177.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,539.68
Rate for Payer: Hamaspik Choice Inc Medicare	$4,539.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,202.28

CESAREAN DELIVRY INCLD ANTE/POSTP

Facility OP

$10,441.26

Service Code	HCPCS 59510
Hospital Charge Code	40002232
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$5,742.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,742.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,295.00
Rate for Payer: Aetna Government	$2,295.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,147.34
Rate for Payer: Group Health Inc Commercial	$5,220.63
Rate for Payer: Group Health Inc Medicare	$3,654.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,220.63
Rate for Payer: Hamaspik Choice Inc Medicare	$5,220.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,497.05

CESAREAN SECTION WITHOUT STERILIZATION WITH CC

Facility IP

$22,341.92

Service Code	MS-DRG 787
Min. Negotiated Rate	$9,013.18
Max. Negotiated Rate	$22,341.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15,498.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21,903.84
Rate for Payer: Aetna Government	$21,903.84
Rate for Payer: Brighton Health Commercial	$15,240.95
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$22,341.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18,151.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,979.35
Rate for Payer: Elderplan Medicare Advantage	$20,808.65
Rate for Payer: EmblemHealth Commercial	$9,013.18
Rate for Payer: Fidelis Medicare Advantage	$21,903.84
Rate for Payer: Group Health Inc Commercial	$21,903.84
Rate for Payer: Group Health Inc Medicare	$21,903.84
Rate for Payer: Hamaspik Choice Inc Medicare	$21,903.84
Rate for Payer: Healthfirst Medicare Advantage	$10,185.29
Rate for Payer: Senior Whole Health Medicare Advantage	$21,903.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21,903.84
Rate for Payer: Wellcare Medicare	$20,808.65

CESAREAN SECTION WITHOUT STERILIZATION WITH MCC

Facility IP

$32,220.60

Service Code	MS-DRG 786
Min. Negotiated Rate	$14,688.80
Max. Negotiated Rate	$32,220.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25,796.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31,588.82
Rate for Payer: Aetna Government	$31,588.82
Rate for Payer: Brighton Health Commercial	$25,367.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$32,220.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30,212.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$24,932.33
Rate for Payer: Elderplan Medicare Advantage	$30,009.38
Rate for Payer: EmblemHealth Commercial	$15,002.00
Rate for Payer: Fidelis Medicare Advantage	$31,588.82
Rate for Payer: Group Health Inc Commercial	$31,588.82
Rate for Payer: Group Health Inc Medicare	$31,588.82
Rate for Payer: Hamaspik Choice Inc Medicare	$31,588.82
Rate for Payer: Healthfirst Medicare Advantage	$14,688.80
Rate for Payer: Senior Whole Health Medicare Advantage	$31,588.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31,588.82
Rate for Payer: Wellcare Medicare	$30,009.38

CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC

Facility IP

$19,568.15

Service Code	MS-DRG 788
Min. Negotiated Rate	$7,331.63
Max. Negotiated Rate	$19,568.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,606.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19,184.46
Rate for Payer: Aetna Government	$19,184.46
Rate for Payer: Brighton Health Commercial	$12,397.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19,568.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14,765.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,184.71
Rate for Payer: Elderplan Medicare Advantage	$18,225.24
Rate for Payer: EmblemHealth Commercial	$7,331.63
Rate for Payer: Fidelis Medicare Advantage	$19,184.46
Rate for Payer: Group Health Inc Commercial	$19,184.46
Rate for Payer: Group Health Inc Medicare	$19,184.46
Rate for Payer: Hamaspik Choice Inc Medicare	$19,184.46
Rate for Payer: Healthfirst Medicare Advantage	$8,920.77
Rate for Payer: Senior Whole Health Medicare Advantage	$19,184.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19,184.46
Rate for Payer: Wellcare Medicare	$18,225.24

CESAREAN SECTION WITH STERILIZATION WITH CC

Facility IP

$21,960.02

Service Code	MS-DRG 784
Min. Negotiated Rate	$8,781.66
Max. Negotiated Rate	$21,960.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15,100.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21,529.43
Rate for Payer: Aetna Government	$21,529.43
Rate for Payer: Brighton Health Commercial	$14,849.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21,960.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17,685.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,594.57
Rate for Payer: Elderplan Medicare Advantage	$20,452.96
Rate for Payer: EmblemHealth Commercial	$8,781.66
Rate for Payer: Fidelis Medicare Advantage	$21,529.43
Rate for Payer: Group Health Inc Commercial	$21,529.43
Rate for Payer: Group Health Inc Medicare	$21,529.43
Rate for Payer: Hamaspik Choice Inc Medicare	$21,529.43
Rate for Payer: Healthfirst Medicare Advantage	$10,011.18
Rate for Payer: Senior Whole Health Medicare Advantage	$21,529.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21,529.43
Rate for Payer: Wellcare Medicare	$20,452.96

CESAREAN SECTION WITH STERILIZATION WITH MCC

Facility IP

$32,536.05

Service Code	MS-DRG 783
Min. Negotiated Rate	$14,832.61
Max. Negotiated Rate	$32,536.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26,125.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31,898.09
Rate for Payer: Aetna Government	$31,898.09
Rate for Payer: Brighton Health Commercial	$25,691.10
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$32,536.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30,597.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$25,250.13
Rate for Payer: Elderplan Medicare Advantage	$30,303.19
Rate for Payer: EmblemHealth Commercial	$15,193.20
Rate for Payer: Fidelis Medicare Advantage	$31,898.09
Rate for Payer: Group Health Inc Commercial	$31,898.09
Rate for Payer: Group Health Inc Medicare	$31,898.09
Rate for Payer: Hamaspik Choice Inc Medicare	$31,898.09
Rate for Payer: Healthfirst Medicare Advantage	$14,832.61
Rate for Payer: Senior Whole Health Medicare Advantage	$31,898.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31,898.09
Rate for Payer: Wellcare Medicare	$30,303.19

CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC

Facility IP

$19,727.98

Service Code	MS-DRG 785
Min. Negotiated Rate	$7,428.52
Max. Negotiated Rate	$19,727.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,773.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19,341.16
Rate for Payer: Aetna Government	$19,341.16
Rate for Payer: Brighton Health Commercial	$12,561.35
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19,727.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14,960.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,345.75
Rate for Payer: Elderplan Medicare Advantage	$18,374.10
Rate for Payer: EmblemHealth Commercial	$7,428.52
Rate for Payer: Fidelis Medicare Advantage	$19,341.16
Rate for Payer: Group Health Inc Commercial	$19,341.16
Rate for Payer: Group Health Inc Medicare	$19,341.16
Rate for Payer: Hamaspik Choice Inc Medicare	$19,341.16
Rate for Payer: Healthfirst Medicare Advantage	$8,993.64
Rate for Payer: Senior Whole Health Medicare Advantage	$19,341.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19,341.16
Rate for Payer: Wellcare Medicare	$18,374.10

CESSJ THERAPY CATH REMOVAL

Facility OP

$4,940.28

Service Code	HCPCS 37214
Hospital Charge Code	41102604
Hospital Revenue Code	361
Min. Negotiated Rate	$134.11
Max. Negotiated Rate	$3,686.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,686.08
Rate for Payer: Aetna Government	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,686.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$3,686.08
Rate for Payer: EmblemHealth Commercial	$3,686.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$134.11
Rate for Payer: Fidelis Essential Plan Aliesa	$3,133.17
Rate for Payer: Fidelis Essential Plan QHP	$3,280.61
Rate for Payer: Fidelis Medicare Advantage	$3,686.08
Rate for Payer: Fidelis Qualified Health Plan	$3,280.61
Rate for Payer: Group Health Inc Commercial	$3,686.08
Rate for Payer: Group Health Inc Medicare	$3,686.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$3,686.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$149.01
Rate for Payer: Healthfirst Medicare Advantage	$3,133.17
Rate for Payer: Healthfirst QHP	$3,686.08
Rate for Payer: Senior Whole Health Medicare Advantage	$3,686.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,686.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,948.86
Rate for Payer: Wellcare Medicare	$3,501.78

CETIRIIZINE 10 MG TABLET

Facility OP

$0.10

Hospital Charge Code	41646085
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
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	$0.07

CETIRIIZINE 1 MG/1ML SYRUP

Facility OP

$0.04

Hospital Charge Code	41656083
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
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

CETIRIIZINE 1MG/1ML SYRUP

Facility OP

$0.04

Hospital Charge Code	41646083
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
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

CETIRIIZINE 5 MG TABLET

Facility OP

$0.13

Hospital Charge Code	41646084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.10
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: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
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	$0.08

CETIRIZINE 10 MG TABLET

Facility OP

$0.10

Hospital Charge Code	41656085
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
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	$0.07

CETUXIMAB 2 MG/ML INJ 100 ML

Facility IP

$100.40

Service Code	HCPCS J9055
Hospital Charge Code	41654923
Hospital Revenue Code	636
Min. Negotiated Rate	$50.20
Max. Negotiated Rate	$50.20
Rate for Payer: Cash Price	$73.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.20
Rate for Payer: Hamaspik Choice Inc Medicare	$50.20

CETUXIMAB 2 MG/ML INJ 100 ML

Facility IP

$100.40

Service Code	HCPCS J9055
Hospital Charge Code	41644923
Hospital Revenue Code	636
Min. Negotiated Rate	$50.20
Max. Negotiated Rate	$50.20
Rate for Payer: Cash Price	$73.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.20
Rate for Payer: Hamaspik Choice Inc Medicare	$50.20

CETUXIMAB 2 MG/ML INJ 100 ML

Facility OP

$100.40

Service Code	HCPCS J9055
Hospital Charge Code	41654923
Hospital Revenue Code	636
Min. Negotiated Rate	$50.20
Max. Negotiated Rate	$77.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.72
Rate for Payer: Aetna Government	$73.72
Rate for Payer: Cash Price	$73.72
Rate for Payer: Cash Price	$73.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$73.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.73
Rate for Payer: Elderplan Medicare Advantage	$73.72
Rate for Payer: EmblemHealth Commercial	$73.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$73.72
Rate for Payer: Fidelis Essential Plan Aliesa	$73.72
Rate for Payer: Fidelis Essential Plan QHP	$77.41
Rate for Payer: Fidelis Medicare Advantage	$73.72
Rate for Payer: Fidelis Qualified Health Plan	$77.41
Rate for Payer: Group Health Inc Commercial	$73.72
Rate for Payer: Group Health Inc Medicare	$73.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.20
Rate for Payer: Hamaspik Choice Inc Medicare	$50.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$72.08
Rate for Payer: Healthfirst Medicare Advantage	$62.66
Rate for Payer: Healthfirst QHP	$73.72
Rate for Payer: Senior Whole Health Medicare Advantage	$73.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.90
Rate for Payer: SOMOS Essential	$77.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58.98
Rate for Payer: Wellcare Medicare	$70.03

CETUXIMAB 2 MG/ML INJ 100 ML

Facility OP

$100.40

Service Code	HCPCS J9055
Hospital Charge Code	41644923
Hospital Revenue Code	636
Min. Negotiated Rate	$50.20
Max. Negotiated Rate	$77.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.72
Rate for Payer: Aetna Government	$73.72
Rate for Payer: Cash Price	$73.72
Rate for Payer: Cash Price	$73.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$73.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.73
Rate for Payer: Elderplan Medicare Advantage	$73.72
Rate for Payer: EmblemHealth Commercial	$73.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$73.72
Rate for Payer: Fidelis Essential Plan Aliesa	$73.72
Rate for Payer: Fidelis Essential Plan QHP	$77.41
Rate for Payer: Fidelis Medicare Advantage	$73.72
Rate for Payer: Fidelis Qualified Health Plan	$77.41
Rate for Payer: Group Health Inc Commercial	$73.72
Rate for Payer: Group Health Inc Medicare	$73.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.20
Rate for Payer: Hamaspik Choice Inc Medicare	$50.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$72.08
Rate for Payer: Healthfirst Medicare Advantage	$62.66
Rate for Payer: Healthfirst QHP	$73.72
Rate for Payer: Senior Whole Health Medicare Advantage	$73.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.90
Rate for Payer: SOMOS Essential	$77.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58.98
Rate for Payer: Wellcare Medicare	$70.03

CETUXIMAB 2 MG/ML INJ 50 ML

Facility IP

$100.40

Service Code	HCPCS J9055
Hospital Charge Code	41653412
Hospital Revenue Code	636
Min. Negotiated Rate	$50.20
Max. Negotiated Rate	$50.20
Rate for Payer: Cash Price	$73.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.20
Rate for Payer: Hamaspik Choice Inc Medicare	$50.20

CETUXIMAB 2 MG/ML INJ 50 ML

Facility OP

$100.40

Service Code	HCPCS J9055
Hospital Charge Code	41643412
Hospital Revenue Code	636
Min. Negotiated Rate	$50.20
Max. Negotiated Rate	$77.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.72
Rate for Payer: Aetna Government	$73.72
Rate for Payer: Cash Price	$73.72
Rate for Payer: Cash Price	$73.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$73.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.73
Rate for Payer: Elderplan Medicare Advantage	$73.72
Rate for Payer: EmblemHealth Commercial	$73.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$73.72
Rate for Payer: Fidelis Essential Plan Aliesa	$73.72
Rate for Payer: Fidelis Essential Plan QHP	$77.41
Rate for Payer: Fidelis Medicare Advantage	$73.72
Rate for Payer: Fidelis Qualified Health Plan	$77.41
Rate for Payer: Group Health Inc Commercial	$73.72
Rate for Payer: Group Health Inc Medicare	$73.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.20
Rate for Payer: Hamaspik Choice Inc Medicare	$50.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$72.08
Rate for Payer: Healthfirst Medicare Advantage	$62.66
Rate for Payer: Healthfirst QHP	$73.72
Rate for Payer: Senior Whole Health Medicare Advantage	$73.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.90
Rate for Payer: SOMOS Essential	$77.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58.98
Rate for Payer: Wellcare Medicare	$70.03

CETUXIMAB 2 MG/ML INJ 50 ML

Facility OP

$100.40

Service Code	HCPCS J9055
Hospital Charge Code	41653412
Hospital Revenue Code	636
Min. Negotiated Rate	$50.20
Max. Negotiated Rate	$77.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.72
Rate for Payer: Aetna Government	$73.72
Rate for Payer: Cash Price	$73.72
Rate for Payer: Cash Price	$73.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$73.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.73
Rate for Payer: Elderplan Medicare Advantage	$73.72
Rate for Payer: EmblemHealth Commercial	$73.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$73.72
Rate for Payer: Fidelis Essential Plan Aliesa	$73.72
Rate for Payer: Fidelis Essential Plan QHP	$77.41
Rate for Payer: Fidelis Medicare Advantage	$73.72
Rate for Payer: Fidelis Qualified Health Plan	$77.41
Rate for Payer: Group Health Inc Commercial	$73.72
Rate for Payer: Group Health Inc Medicare	$73.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.20
Rate for Payer: Hamaspik Choice Inc Medicare	$50.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$72.08
Rate for Payer: Healthfirst Medicare Advantage	$62.66
Rate for Payer: Healthfirst QHP	$73.72
Rate for Payer: Senior Whole Health Medicare Advantage	$73.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.90
Rate for Payer: SOMOS Essential	$77.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58.98
Rate for Payer: Wellcare Medicare	$70.03

CETUXIMAB 2 MG/ML INJ 50 ML

Facility IP

$100.40

Service Code	HCPCS J9055
Hospital Charge Code	41643412
Hospital Revenue Code	636
Min. Negotiated Rate	$50.20
Max. Negotiated Rate	$50.20
Rate for Payer: Cash Price	$73.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.20
Rate for Payer: Hamaspik Choice Inc Medicare	$50.20

CFEPIME 500MG IM

Facility IP

$8.00

Service Code	HCPCS J0692
Hospital Charge Code	41655917
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00

CFEPIME 500MG IM

Facility OP

$8.00

Service Code	HCPCS J0692
Hospital Charge Code	41655917
Hospital Revenue Code	636
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.85
Rate for Payer: Aetna Government	$1.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1.10
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.42
Rate for Payer: SOMOS Essential	$1.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

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