St. Barnabas Hospital

All Charges

Charge

Type

Price

CUTTER LINR ENDO THORAC 45MM THIK

Facility OP

$1,608.48

Hospital Charge Code	40200408
Hospital Revenue Code	270
Min. Negotiated Rate	$562.97
Max. Negotiated Rate	$1,286.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$884.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$804.24
Rate for Payer: Aetna Government	$804.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,286.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,093.77
Rate for Payer: Group Health Inc Commercial	$804.24
Rate for Payer: Group Health Inc Medicare	$562.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$804.24
Rate for Payer: Hamaspik Choice Inc Medicare	$804.24

CUTTER SMALL JOINT AG

Facility OP

$500.00

Hospital Charge Code	64905884
Hospital Revenue Code	270
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$250.00
Rate for Payer: Aetna Government	$250.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

CUTTER VASCULAR RED

Facility OP

$257.60

Hospital Charge Code	64902995
Hospital Revenue Code	270
Min. Negotiated Rate	$90.16
Max. Negotiated Rate	$206.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$141.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$128.80
Rate for Payer: Aetna Government	$128.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$175.17
Rate for Payer: Group Health Inc Commercial	$128.80
Rate for Payer: Group Health Inc Medicare	$90.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$128.80
Rate for Payer: Hamaspik Choice Inc Medicare	$128.80

CUTTING & BENDING PLIERS

Facility OP

$318.00

Hospital Charge Code	40200643
Hospital Revenue Code	270
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$254.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$174.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$159.00
Rate for Payer: Aetna Government	$159.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$254.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$216.24
Rate for Payer: Group Health Inc Commercial	$159.00
Rate for Payer: Group Health Inc Medicare	$111.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.00
Rate for Payer: Hamaspik Choice Inc Medicare	$159.00

CVP INSERTION

Facility OP

$1,909.65

Service Code	HCPCS 36568
Hospital Charge Code	40000030
Hospital Revenue Code	360
Min. Negotiated Rate	$98.49
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,852.05
Rate for Payer: Aetna Government	$1,852.05
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,852.05
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	$1,852.05
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$98.49
Rate for Payer: Fidelis Essential Plan Aliesa	$1,574.24
Rate for Payer: Fidelis Essential Plan QHP	$1,648.32
Rate for Payer: Fidelis Medicare Advantage	$1,852.05
Rate for Payer: Fidelis Qualified Health Plan	$1,648.32
Rate for Payer: Group Health Inc Commercial	$1,852.05
Rate for Payer: Group Health Inc Medicare	$1,852.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1,852.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$109.43
Rate for Payer: Healthfirst Medicare Advantage	$1,574.24
Rate for Payer: Healthfirst QHP	$1,852.05
Rate for Payer: Senior Whole Health Medicare Advantage	$1,852.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,852.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,481.64
Rate for Payer: Wellcare Medicare	$1,759.45

CVP Monitor

Facility OP

$53.51

Hospital Charge Code	40200980
Hospital Revenue Code	270
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$42.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.76
Rate for Payer: Aetna Government	$26.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.39
Rate for Payer: Group Health Inc Commercial	$26.76
Rate for Payer: Group Health Inc Medicare	$18.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.76
Rate for Payer: Hamaspik Choice Inc Medicare	$26.76

CVR BURRHOLE LW PROF 14MM W/TAB

Facility OP

$473.35

Hospital Charge Code	64904587
Hospital Revenue Code	270
Min. Negotiated Rate	$165.67
Max. Negotiated Rate	$378.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$260.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$236.68
Rate for Payer: Aetna Government	$236.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$378.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$321.88
Rate for Payer: Group Health Inc Commercial	$236.68
Rate for Payer: Group Health Inc Medicare	$165.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.68
Rate for Payer: Hamaspik Choice Inc Medicare	$236.68

CYANIDE OCC EXPOSURE, BI

Facility OP

$48.50

Service Code	HCPCS 82600
Hospital Charge Code	40609890
Hospital Revenue Code	301
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$30.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.40
Rate for Payer: Aetna Government	$19.40
Rate for Payer: Cash Price	$19.40
Rate for Payer: Cash Price	$19.40
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.10
Rate for Payer: Elderplan Medicare Advantage	$19.40
Rate for Payer: EmblemHealth Commercial	$19.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17.46
Rate for Payer: Fidelis Essential Plan Aliesa	$16.49
Rate for Payer: Fidelis Essential Plan QHP	$17.27
Rate for Payer: Fidelis Medicare Advantage	$19.40
Rate for Payer: Fidelis Qualified Health Plan	$17.27
Rate for Payer: Group Health Inc Commercial	$19.40
Rate for Payer: Group Health Inc Medicare	$19.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.25
Rate for Payer: Hamaspik Choice Inc Medicare	$19.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19.40
Rate for Payer: Healthfirst Medicare Advantage	$19.40
Rate for Payer: Healthfirst QHP	$19.40
Rate for Payer: Senior Whole Health Medicare Advantage	$19.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.52
Rate for Payer: Wellcare Medicare	$17.46

CYANOCOBALAMIN 1000 MCG INJ

Facility OP

$3.04

Service Code	HCPCS J3420
Hospital Charge Code	41654513
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.12
Rate for Payer: Aetna Government	$2.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1.18
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.51
Rate for Payer: SOMOS Essential	$1.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.98

CYANOCOBALAMIN 1000 MCG INJ

Facility OP

$3.04

Service Code	HCPCS J3420
Hospital Charge Code	41644513
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.12
Rate for Payer: Aetna Government	$2.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1.18
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.51
Rate for Payer: SOMOS Essential	$1.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.98

CYANOCOBALAMIN 1000 MCG INJ

Facility IP

$3.04

Service Code	HCPCS J3420
Hospital Charge Code	41644513
Hospital Revenue Code	636
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$1.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52

CYANOCOBALAMIN 1000 MCG INJ

Facility IP

$3.04

Service Code	HCPCS J3420
Hospital Charge Code	41654513
Hospital Revenue Code	636
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$1.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52

CYANOCOBALAMIN 100 MCG TAB

Facility OP

$0.02

Hospital Charge Code	41653293
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

CYANOCOBALAMIN 100 MCG TAB

Facility OP

$0.02

Hospital Charge Code	41643293
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

CYANOCOBALAMIN 500 MCG TAB

Facility OP

$0.03

Hospital Charge Code	41644768
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
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	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
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	$0.02

CYANOCOBALAMIN 500 MCG TAB

Facility OP

$0.03

Hospital Charge Code	41654768
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
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	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
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	$0.02

CYCLER TUBING SET

Facility OP

$17.72

Hospital Charge Code	42905220
Hospital Revenue Code	801
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$14.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.86
Rate for Payer: Aetna Government	$8.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.05
Rate for Payer: Group Health Inc Commercial	$8.86
Rate for Payer: Group Health Inc Medicare	$6.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.86
Rate for Payer: Hamaspik Choice Inc Medicare	$8.86

CYCLOBENZAPRINE 10 MG TAB

Facility OP

$0.12

Hospital Charge Code	41651054
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

CYCLOBENZAPRINE 10 MG TAB

Facility OP

$0.12

Hospital Charge Code	41641054
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

CYCLOBENZAPRINE 5 MG TAB

Facility OP

$0.08

Hospital Charge Code	41654743
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

CYCLOBENZAPRINE 5 MG TAB

Facility OP

$0.08

Hospital Charge Code	41644743
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

CYCLOPENTOLATE 0.2% + PHENYLEPHRINE 1% O

Facility OP

$35.35

Hospital Charge Code	41654690
Hospital Revenue Code	250
Min. Negotiated Rate	$12.37
Max. Negotiated Rate	$28.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.68
Rate for Payer: Aetna Government	$17.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.04
Rate for Payer: Group Health Inc Commercial	$17.68
Rate for Payer: Group Health Inc Medicare	$12.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.68
Rate for Payer: Hamaspik Choice Inc Medicare	$17.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.98

CYCLOPENTOLATE 0.2% + PHENYLEPHRINE 1% O

Facility OP

$35.35

Hospital Charge Code	41644690
Hospital Revenue Code	250
Min. Negotiated Rate	$12.37
Max. Negotiated Rate	$28.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.68
Rate for Payer: Aetna Government	$17.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.04
Rate for Payer: Group Health Inc Commercial	$17.68
Rate for Payer: Group Health Inc Medicare	$12.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.68
Rate for Payer: Hamaspik Choice Inc Medicare	$17.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.98

CYCLOPENTOLATE 0.5% OPHTHALMIC SOLN 15 M

Facility OP

$96.64

Hospital Charge Code	41652337
Hospital Revenue Code	250
Min. Negotiated Rate	$33.82
Max. Negotiated Rate	$77.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.32
Rate for Payer: Aetna Government	$48.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$77.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.72
Rate for Payer: Group Health Inc Commercial	$48.32
Rate for Payer: Group Health Inc Medicare	$33.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.32
Rate for Payer: Hamaspik Choice Inc Medicare	$48.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.82

CYCLOPENTOLATE 0.5% OPHTHALMIC SOLN 15 M

Facility OP

$96.64

Hospital Charge Code	41642337
Hospital Revenue Code	250
Min. Negotiated Rate	$33.82
Max. Negotiated Rate	$77.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.32
Rate for Payer: Aetna Government	$48.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$77.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.72
Rate for Payer: Group Health Inc Commercial	$48.32
Rate for Payer: Group Health Inc Medicare	$33.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.32
Rate for Payer: Hamaspik Choice Inc Medicare	$48.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.82

Price Transparency.

All Charges