St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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% INJ

Facility

$11.00

Service Code	HCPCS J7608
Hospital Charge Code	41653560
Hospital Revenue Code	636
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50

ACETYLCYSTEINE 20% INJ

Facility

$11.00

Service Code	HCPCS J7608
Hospital Charge Code	41643560
Hospital Revenue Code	636
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$6.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.33
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
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	$7.15

ACETYLCYSTEINE 20% INJ

Facility

$11.00

Service Code	HCPCS J7608
Hospital Charge Code	41643560
Hospital Revenue Code	636
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50

ACETYLCYSTEINE 20% INJ

Facility

$11.00

Service Code	HCPCS J7608
Hospital Charge Code	41653560
Hospital Revenue Code	636
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$6.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.33
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
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	$7.15

ACETYLCYSTEINE 20 % IN SOLN [123]

Facility

$1.80

Service Code	HCPCS J7608
Hospital Charge Code	63323069441
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$1.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.22
Rate for Payer: Group Health Inc Commercial	$0.90
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90
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	$1.17

ACETYLCYSTEINE 20 % IN SOLN [123]

Facility

$3.96

Service Code	HCPCS J7608
Hospital Charge Code	00517760425
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.69
Rate for Payer: Group Health Inc Commercial	$1.98
Rate for Payer: Group Health Inc Medicare	$1.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1.98
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	$2.57

ACETYLCYSTEINE 20 % IN SOLN [123]

Facility

$1.60

Service Code	HCPCS J7608
Hospital Charge Code	63323069210
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 20 % IN SOLN [123]

Facility

$0.26

Service Code	HCPCS J7608
Hospital Charge Code	63323069041
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
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	$0.17

ACETYLCYSTEINE 20 % IN SOLN [123]

Facility

$4.20

Service Code	HCPCS J7608
Hospital Charge Code	63323069404
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$3.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.86
Rate for Payer: Group Health Inc Commercial	$2.10
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2.10
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	$2.73

ACETYLCYSTEINE 20 % IN SOLN [123]

Facility

$1.80

Service Code	HCPCS J7608
Hospital Charge Code	63323069444
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$1.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.22
Rate for Payer: Group Health Inc Commercial	$0.90
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90
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	$1.17

ACETYLCYSTEINE 20 % IN SOLN [123]

Facility

$0.26

Service Code	HCPCS J7608
Hospital Charge Code	63323069044
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
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	$0.17

ACETYLCYSTEINE 20% SOLN 10 ML

Facility

$1.21

Service Code	HCPCS J7608
Hospital Charge Code	41642248
Hospital Revenue Code	636
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$0.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.70
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
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	$0.79

ACETYLCYSTEINE 20% SOLN 10 ML

Facility

$1.21

Service Code	HCPCS J7608
Hospital Charge Code	41642248
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61

ACETYLCYSTEINE 20% SOLN 10 ML

Facility

$1.21

Service Code	HCPCS J7608
Hospital Charge Code	41652248
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61

ACETYLCYSTEINE 20% SOLN 10 ML

Facility

$1.21

Service Code	HCPCS J7608
Hospital Charge Code	41652248
Hospital Revenue Code	636
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$0.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.70
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
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	$0.79

ACETYLCYSTEINE 20% SOLN 30 ML

Facility

$1.93

Service Code	HCPCS J7608
Hospital Charge Code	41653316
Hospital Revenue Code	636
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$1.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.11
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
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	$1.25

ACETYLCYSTEINE 20% SOLN 30 ML

Facility

$1.93

Service Code	HCPCS J7608
Hospital Charge Code	41653316
Hospital Revenue Code	636
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97

ACETYLCYSTEINE 20% SOLN 30 ML

Facility

$1.93

Service Code	HCPCS J7608
Hospital Charge Code	41643316
Hospital Revenue Code	636
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$1.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.11
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
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	$1.25

ACETYLCYSTEINE 20% SOLN 30 ML

Facility

$1.93

Service Code	HCPCS J7608
Hospital Charge Code	41643316
Hospital Revenue Code	636
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97

ACETYLCYSTEINE 20% SOLN 4 ML

Facility

$1.54

Service Code	HCPCS J7608
Hospital Charge Code	41643441
Hospital Revenue Code	636
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.89
Rate for Payer: Group Health Inc Commercial	$0.77
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77
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	$1.00

ACETYLCYSTEINE 20% SOLN 4 ML

Facility

$1.54

Service Code	HCPCS J7608
Hospital Charge Code	41653441
Hospital Revenue Code	636
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77

ACETYLCYSTEINE 20% SOLN 4 ML

Facility

$1.54

Service Code	HCPCS J7608
Hospital Charge Code	41653441
Hospital Revenue Code	636
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.89
Rate for Payer: Group Health Inc Commercial	$0.77
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77
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	$1.00

ACETYLCYSTEINE 20% SOLN 4 ML

Facility

$1.54

Service Code	HCPCS J7608
Hospital Charge Code	41643441
Hospital Revenue Code	636
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77

ACHR BINDING ABS, SERUM

Facility

$46.00

Service Code	HCPCS 83519
Hospital Charge Code	40609089
Hospital Revenue Code	300
Rate for Payer: Cash Price	$18.40

Know your out-of-pocket cost for care.

All Charges