St. Barnabas Hospital

All Charges

Charge

Type

Price

COCR 12/14 FEM HEAD 36MM )

Facility OP

$2,314.75

Service Code	HCPCS C1713
Hospital Charge Code	64902656
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,430.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,273.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,157.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,330.98
Rate for Payer: Fidelis Medicare Advantage	$2,430.49
Rate for Payer: Group Health Inc Commercial	$1,157.38
Rate for Payer: Group Health Inc Medicare	$810.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,157.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,157.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,504.59

COCR 12/14 FEM HEAD 36MM )

Facility IP

$2,314.75

Service Code	HCPCS C1713
Hospital Charge Code	64902656
Hospital Revenue Code	278
Min. Negotiated Rate	$1,157.38
Max. Negotiated Rate	$1,157.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,157.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,157.38

COCR SHELL W/ LINER 28MM 47

Facility OP

$2,085.63

Service Code	HCPCS C1776
Hospital Charge Code	64903678
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,189.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,147.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,042.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,199.24
Rate for Payer: Fidelis Medicare Advantage	$2,189.91
Rate for Payer: Group Health Inc Commercial	$1,042.82
Rate for Payer: Group Health Inc Medicare	$729.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,042.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1,042.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,355.66

COCR SHELL W/ LINER 28MM 47

Facility IP

$2,085.63

Service Code	HCPCS C1776
Hospital Charge Code	64903678
Hospital Revenue Code	278
Min. Negotiated Rate	$1,042.82
Max. Negotiated Rate	$1,042.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,042.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1,042.82

CODEINE 15 MG TAB

Facility OP

$0.60

Hospital Charge Code	41651377
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

CODEINE 15 MG TAB

Facility OP

$0.60

Hospital Charge Code	41641377
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

CO DIFFUSING CAPACITY

Facility OP

$173.43

Service Code	HCPCS 94729 TC
Hospital Charge Code	30301406
Hospital Revenue Code	460
Min. Negotiated Rate	$53.19
Max. Negotiated Rate	$138.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$95.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$86.72
Rate for Payer: Aetna Government	$86.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$138.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$117.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53.19
Rate for Payer: Group Health Inc Commercial	$86.72
Rate for Payer: Group Health Inc Medicare	$60.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.72
Rate for Payer: Hamaspik Choice Inc Medicare	$86.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59.10

CODMAN BACTISEALEVD CATH SET

Facility IP

$1,240.00

Service Code	HCPCS C1725
Hospital Charge Code	40206257
Hospital Revenue Code	278
Min. Negotiated Rate	$620.00
Max. Negotiated Rate	$620.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$620.00
Rate for Payer: Hamaspik Choice Inc Medicare	$620.00

CODMAN BACTISEALEVD CATH SET

Facility OP

$1,240.00

Service Code	HCPCS C1725
Hospital Charge Code	40206257
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,302.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$682.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$620.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$713.00
Rate for Payer: Fidelis Medicare Advantage	$1,302.00
Rate for Payer: Group Health Inc Commercial	$620.00
Rate for Payer: Group Health Inc Medicare	$434.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$620.00
Rate for Payer: Hamaspik Choice Inc Medicare	$620.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$806.00

CODMAN BIPOLAR CON

Facility OP

$31.25

Hospital Charge Code	64905979
Hospital Revenue Code	270
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$25.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.62
Rate for Payer: Aetna Government	$15.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.25
Rate for Payer: Group Health Inc Commercial	$15.62
Rate for Payer: Group Health Inc Medicare	$10.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.62
Rate for Payer: Hamaspik Choice Inc Medicare	$15.62

COIL PUSHER 76-177 CM

Facility OP

$462.50

Hospital Charge Code	64903560
Hospital Revenue Code	270
Min. Negotiated Rate	$161.88
Max. Negotiated Rate	$370.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$254.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.25
Rate for Payer: Aetna Government	$231.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$370.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$314.50
Rate for Payer: Group Health Inc Commercial	$231.25
Rate for Payer: Group Health Inc Medicare	$161.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.25
Rate for Payer: Hamaspik Choice Inc Medicare	$231.25

COLCHICINE 0.6 MG TAB

Facility OP

$9.60

Hospital Charge Code	41643530
Hospital Revenue Code	250
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$7.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.80
Rate for Payer: Aetna Government	$4.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.53
Rate for Payer: Group Health Inc Commercial	$4.80
Rate for Payer: Group Health Inc Medicare	$3.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.80
Rate for Payer: Hamaspik Choice Inc Medicare	$4.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.24

COLCHICINE 0.6 MG TAB

Facility OP

$9.60

Hospital Charge Code	41653530
Hospital Revenue Code	250
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$7.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.80
Rate for Payer: Aetna Government	$4.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.53
Rate for Payer: Group Health Inc Commercial	$4.80
Rate for Payer: Group Health Inc Medicare	$3.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.80
Rate for Payer: Hamaspik Choice Inc Medicare	$4.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.24

COLD AGGLUTININS ( SEROLOGY)

Facility OP

$20.15

Service Code	HCPCS 86157
Hospital Charge Code	40721340
Hospital Revenue Code	300
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$12.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.06
Rate for Payer: Aetna Government	$8.06
Rate for Payer: Cash Price	$8.06
Rate for Payer: Cash Price	$8.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.86
Rate for Payer: Elderplan Medicare Advantage	$8.06
Rate for Payer: EmblemHealth Commercial	$8.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.25
Rate for Payer: Fidelis Essential Plan Aliesa	$6.85
Rate for Payer: Fidelis Essential Plan QHP	$7.17
Rate for Payer: Fidelis Medicare Advantage	$8.06
Rate for Payer: Fidelis Qualified Health Plan	$7.17
Rate for Payer: Group Health Inc Commercial	$8.06
Rate for Payer: Group Health Inc Medicare	$8.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.08
Rate for Payer: Hamaspik Choice Inc Medicare	$8.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.06
Rate for Payer: Healthfirst Medicare Advantage	$8.06
Rate for Payer: Healthfirst QHP	$8.06
Rate for Payer: Senior Whole Health Medicare Advantage	$8.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.45
Rate for Payer: Wellcare Medicare	$7.25

COLD AGGLUTININ TITER, QUANT

Facility OP

$20.15

Service Code	HCPCS 86157
Hospital Charge Code	40729327
Hospital Revenue Code	300
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$12.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.06
Rate for Payer: Aetna Government	$8.06
Rate for Payer: Cash Price	$8.06
Rate for Payer: Cash Price	$8.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.86
Rate for Payer: Elderplan Medicare Advantage	$8.06
Rate for Payer: EmblemHealth Commercial	$8.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.25
Rate for Payer: Fidelis Essential Plan Aliesa	$6.85
Rate for Payer: Fidelis Essential Plan QHP	$7.17
Rate for Payer: Fidelis Medicare Advantage	$8.06
Rate for Payer: Fidelis Qualified Health Plan	$7.17
Rate for Payer: Group Health Inc Commercial	$8.06
Rate for Payer: Group Health Inc Medicare	$8.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.08
Rate for Payer: Hamaspik Choice Inc Medicare	$8.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.06
Rate for Payer: Healthfirst Medicare Advantage	$8.06
Rate for Payer: Healthfirst QHP	$8.06
Rate for Payer: Senior Whole Health Medicare Advantage	$8.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.45
Rate for Payer: Wellcare Medicare	$7.25

COLD PACK

Facility OP

$9.57

Hospital Charge Code	40204801
Hospital Revenue Code	270
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$7.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.78
Rate for Payer: Aetna Government	$4.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.51
Rate for Payer: Group Health Inc Commercial	$4.78
Rate for Payer: Group Health Inc Medicare	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.78
Rate for Payer: Hamaspik Choice Inc Medicare	$4.78

COLECTOMY

Facility OP

$3,992.25

Service Code	HCPCS 44140
Hospital Charge Code	40010655
Hospital Revenue Code	360
Min. Negotiated Rate	$1,397.29
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,195.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,591.50
Rate for Payer: Aetna Government	$1,591.50
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	$1,543.93
Rate for Payer: Group Health Inc Commercial	$1,996.12
Rate for Payer: Group Health Inc Medicare	$1,397.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,996.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,996.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,715.48

COLECTOMY W/ ILEOSTOMY

Facility OP

$6,782.60

Service Code	HCPCS 44155
Hospital Charge Code	40019880
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$3,730.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,730.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,452.71
Rate for Payer: Aetna Government	$2,452.71
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	$2,331.53
Rate for Payer: Group Health Inc Commercial	$3,391.30
Rate for Payer: Group Health Inc Medicare	$2,373.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,391.30
Rate for Payer: Hamaspik Choice Inc Medicare	$3,391.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,590.59

COLFLEX PARAD SPINE INTERLAM SZ10

Facility IP

$10,500.00

Service Code	HCPCS C1821
Hospital Charge Code	40004710
Hospital Revenue Code	278
Min. Negotiated Rate	$5,250.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00

COLFLEX PARAD SPINE INTERLAM SZ10

Facility OP

$10,500.00

Service Code	HCPCS C1821
Hospital Charge Code	40004710
Hospital Revenue Code	278
Min. Negotiated Rate	$1,609.27
Max. Negotiated Rate	$11,025.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,775.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,609.27
Rate for Payer: Aetna Government	$1,609.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,037.50
Rate for Payer: Fidelis Medicare Advantage	$11,025.00
Rate for Payer: Group Health Inc Commercial	$5,250.00
Rate for Payer: Group Health Inc Medicare	$3,675.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,825.00

COLFLEX PARAD SPINE INTERLAM SZ12

Facility OP

$10,500.00

Service Code	HCPCS C1821
Hospital Charge Code	40004711
Hospital Revenue Code	278
Min. Negotiated Rate	$1,609.27
Max. Negotiated Rate	$11,025.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,775.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,609.27
Rate for Payer: Aetna Government	$1,609.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,037.50
Rate for Payer: Fidelis Medicare Advantage	$11,025.00
Rate for Payer: Group Health Inc Commercial	$5,250.00
Rate for Payer: Group Health Inc Medicare	$3,675.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,825.00

COLFLEX PARAD SPINE INTERLAM SZ12

Facility IP

$10,500.00

Service Code	HCPCS C1821
Hospital Charge Code	40004711
Hospital Revenue Code	278
Min. Negotiated Rate	$5,250.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00

COLISTIMETHATE 150 MG INJ

Facility OP

$21.86

Service Code	HCPCS J0770
Hospital Charge Code	41652826
Hospital Revenue Code	636
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$15.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.78
Rate for Payer: Aetna Government	$15.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$11.05
Rate for Payer: Group Health Inc Commercial	$10.93
Rate for Payer: Group Health Inc Medicare	$7.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.93
Rate for Payer: Hamaspik Choice Inc Medicare	$10.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$13.61
Rate for Payer: SOMOS Essential	$13.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.21

COLISTIMETHATE 150 MG INJ

Facility OP

$21.86

Service Code	HCPCS J0770
Hospital Charge Code	41642826
Hospital Revenue Code	636
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$15.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.78
Rate for Payer: Aetna Government	$15.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$11.05
Rate for Payer: Group Health Inc Commercial	$10.93
Rate for Payer: Group Health Inc Medicare	$7.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.93
Rate for Payer: Hamaspik Choice Inc Medicare	$10.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$13.61
Rate for Payer: SOMOS Essential	$13.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.21

COLISTIMETHATE 150 MG INJ

Facility IP

$21.86

Service Code	HCPCS J0770
Hospital Charge Code	41652826
Hospital Revenue Code	636
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.93
Rate for Payer: Hamaspik Choice Inc Medicare	$10.93

Price Transparency.

All Charges