St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ACETIC ACID IRRIGATION 0.25% SOLN

Facility

$4.00

Hospital Charge Code	41651274
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

ACETIC ACID OTIC 2% SOLN

Facility

$42.34

Hospital Charge Code	41643461
Hospital Revenue Code	250
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$33.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.17
Rate for Payer: Aetna Government	$21.17
Rate for Payer: Brighton Health Commercial	$31.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.79
Rate for Payer: Group Health Inc Commercial	$21.17
Rate for Payer: Group Health Inc Medicare	$14.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.17
Rate for Payer: Hamaspik Choice Inc Medicare	$21.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.52

ACETIC ACID OTIC 2% SOLN

Facility

$42.34

Hospital Charge Code	41653461
Hospital Revenue Code	250
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$33.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.17
Rate for Payer: Aetna Government	$21.17
Rate for Payer: Brighton Health Commercial	$31.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.79
Rate for Payer: Group Health Inc Commercial	$21.17
Rate for Payer: Group Health Inc Medicare	$14.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.17
Rate for Payer: Hamaspik Choice Inc Medicare	$21.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.52

ACET OSTEOTOME

Facility

$2,285.50

Hospital Charge Code	64907316
Hospital Revenue Code	279
Min. Negotiated Rate	$799.92
Max. Negotiated Rate	$1,828.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,257.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,142.75
Rate for Payer: Aetna Government	$1,142.75
Rate for Payer: Brighton Health Commercial	$1,714.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,828.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,554.14
Rate for Payer: Group Health Inc Commercial	$1,142.75
Rate for Payer: Group Health Inc Medicare	$799.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,142.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,142.75

ACETYLCHOLINE 1% OPHTHALMIC INTRAOCULAR

Facility

$68.74

Hospital Charge Code	41654578
Hospital Revenue Code	250
Min. Negotiated Rate	$24.06
Max. Negotiated Rate	$54.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.37
Rate for Payer: Aetna Government	$34.37
Rate for Payer: Brighton Health Commercial	$51.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.74
Rate for Payer: Group Health Inc Commercial	$34.37
Rate for Payer: Group Health Inc Medicare	$24.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.37
Rate for Payer: Hamaspik Choice Inc Medicare	$34.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.68

ACETYLCHOLINE 1% OPHTHALMIC INTRAOCULAR

Facility

$68.74

Hospital Charge Code	41644578
Hospital Revenue Code	250
Min. Negotiated Rate	$24.06
Max. Negotiated Rate	$54.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.37
Rate for Payer: Aetna Government	$34.37
Rate for Payer: Brighton Health Commercial	$51.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.74
Rate for Payer: Group Health Inc Commercial	$34.37
Rate for Payer: Group Health Inc Medicare	$24.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.37
Rate for Payer: Hamaspik Choice Inc Medicare	$34.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.68

ACETYLCHOLINE CHLORIDE 20 MG IO SOLR [132335]

Facility

$154.37

Service Code	NDC 24208053920
Hospital Charge Code	24208053920
Hospital Revenue Code	250
Min. Negotiated Rate	$54.03
Max. Negotiated Rate	$123.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.18
Rate for Payer: Aetna Government	$77.18
Rate for Payer: Brighton Health Commercial	$115.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$123.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.97
Rate for Payer: Group Health Inc Commercial	$77.18
Rate for Payer: Group Health Inc Medicare	$54.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.18
Rate for Payer: Hamaspik Choice Inc Medicare	$77.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.34

ACETYLCYSTEINE 10 % IN SOLN [122]

Facility

$1.60

Service Code	HCPCS J7608
Hospital Charge Code	63323069310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$9.36
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$9.92
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$9.92
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$9.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.04

ACETYLCYSTEINE 10 % IN SOLN [122]

Facility

$2.98

Service Code	HCPCS J7608
Hospital Charge Code	00517750401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$2.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.03
Rate for Payer: Group Health Inc Commercial	$1.49
Rate for Payer: Group Health Inc Medicare	$1.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.49
Rate for Payer: Hamaspik Choice Inc Medicare	$1.49
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$9.36
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$9.92
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$9.92
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$9.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.94

ACETYLCYSTEINE 10 % IN SOLN [122]

Facility

$0.73

Service Code	HCPCS J7608
Hospital Charge Code	63323069130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.50
Rate for Payer: Group Health Inc Commercial	$0.37
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37
Rate for Payer: Hamaspik Choice Inc Medicare	$0.37
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$9.36
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$9.92
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$9.92
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$9.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

ACETYLCYSTEINE 10% SOLN 10 ML

Facility

$0.97

Service Code	HCPCS J7608
Hospital Charge Code	41642247
Hospital Revenue Code	636
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49

ACETYLCYSTEINE 10% SOLN 10 ML

Facility

$0.97

Service Code	HCPCS J7608
Hospital Charge Code	41652247
Hospital Revenue Code	636
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49

ACETYLCYSTEINE 10% SOLN 10 ML

Facility

$0.97

Service Code	HCPCS J7608
Hospital Charge Code	41642247
Hospital Revenue Code	636
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.56
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.92
Rate for Payer: SOMOS Essential	$9.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.63

ACETYLCYSTEINE 10% SOLN 10 ML

Facility

$0.97

Service Code	HCPCS J7608
Hospital Charge Code	41652247
Hospital Revenue Code	636
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.56
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.92
Rate for Payer: SOMOS Essential	$9.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.63

ACETYLCYSTEINE 10% SOLN 4 ML

Facility

$1.49

Service Code	HCPCS J7608
Hospital Charge Code	41643626
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.92
Rate for Payer: SOMOS Essential	$9.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.97

ACETYLCYSTEINE 10% SOLN 4 ML

Facility

$1.49

Service Code	HCPCS J7608
Hospital Charge Code	41653626
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75

ACETYLCYSTEINE 10% SOLN 4 ML

Facility

$1.49

Service Code	HCPCS J7608
Hospital Charge Code	41653626
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.92
Rate for Payer: SOMOS Essential	$9.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.97

ACETYLCYSTEINE 10% SOLN 4 ML

Facility

$1.49

Service Code	HCPCS J7608
Hospital Charge Code	41643626
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75

ACETYLCYSTEINE 200 MG/ML IV SOLN [38303]

Facility

$11.67

Service Code	HCPCS J0132
Hospital Charge Code	55150025930
Hospital Revenue Code	278
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$12.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.83
Rate for Payer: Aetna Government	$0.83
Rate for Payer: Brighton Health Commercial	$7.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.71
Rate for Payer: EmblemHealth Commercial	$5.83
Rate for Payer: Fidelis Medicare Advantage	$12.25
Rate for Payer: Group Health Inc Commercial	$5.83
Rate for Payer: Group Health Inc Medicare	$4.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.83
Rate for Payer: Hamaspik Choice Inc Medicare	$5.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.58

ACETYLCYSTEINE 200 MG/ML IV SOLN [38303]

Facility

$4.40

Service Code	HCPCS J0132
Hospital Charge Code	63323096330
Hospital Revenue Code	278
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$4.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.83
Rate for Payer: Aetna Government	$0.83
Rate for Payer: Brighton Health Commercial	$2.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.53
Rate for Payer: EmblemHealth Commercial	$2.20
Rate for Payer: Fidelis Medicare Advantage	$4.62
Rate for Payer: Group Health Inc Commercial	$2.20
Rate for Payer: Group Health Inc Medicare	$1.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.20
Rate for Payer: Hamaspik Choice Inc Medicare	$2.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.86

ACETYLCYSTEINE 200 MG/ML IV SOLN [38303]

Facility

$4.40

Service Code	HCPCS J0132
Hospital Charge Code	63323096330
Hospital Revenue Code	278
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$2.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.20
Rate for Payer: Hamaspik Choice Inc Medicare	$2.20

ACETYLCYSTEINE 200 MG/ML IV SOLN [38303]

Facility

$11.67

Service Code	HCPCS J0132
Hospital Charge Code	55150025930
Hospital Revenue Code	278
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$5.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.83
Rate for Payer: Hamaspik Choice Inc Medicare	$5.83

ACETYLCYSTEINE 20% 3ML PER 100MG

Facility

$6.00

Service Code	HCPCS J0132
Hospital Charge Code	41648039
Hospital Revenue Code	636
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$3.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.83
Rate for Payer: Aetna Government	$0.83
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.45
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.82
Rate for Payer: SOMOS Essential	$0.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

ACETYLCYSTEINE 20% 3ML PER 100MG

Facility

$6.00

Service Code	HCPCS J0132
Hospital Charge Code	41658039
Hospital Revenue Code	636
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$3.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.83
Rate for Payer: Aetna Government	$0.83
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.45
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.82
Rate for Payer: SOMOS Essential	$0.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

ACETYLCYSTEINE 20% 3ML PER 100MG

Facility

$6.00

Service Code	HCPCS J0132
Hospital Charge Code	41658039
Hospital Revenue Code	636
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00

Know your out-of-pocket cost for care.

All Charges