St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

EP IMPLANTABLE LOOP

Facility

$23,145.25

Service Code	HCPCS 33285
Hospital Charge Code	66574537
Hospital Revenue Code	361
Rate for Payer: Cash Price	$9,824.59

EP IMPLANTABLE LOOP

Facility

$23,145.25

Service Code	HCPCS 33285
Hospital Charge Code	66574537
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$17,358.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16,751.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9,824.59
Rate for Payer: Aetna Government	$9,824.59
Rate for Payer: Affinity Essential Plan 1&2	$6,877.21
Rate for Payer: Affinity Essential Plan 3&4	$6,877.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$6,877.21
Rate for Payer: Brighton Health Commercial	$17,358.94
Rate for Payer: Cash Price	$9,824.59
Rate for Payer: Cash Price	$9,824.59
Rate for Payer: Cash Price	$9,824.59
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$9,824.59
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: Elderplan Medicare Advantage	$9,824.59
Rate for Payer: EmblemHealth Commercial	$9,824.59
Rate for Payer: Fidelis Essential Plan Aliesa	$8,350.90
Rate for Payer: Fidelis Essential Plan QHP	$8,743.89
Rate for Payer: Fidelis Medicare Advantage	$9,824.59
Rate for Payer: Fidelis Qualified Health Plan	$8,743.89
Rate for Payer: Group Health Inc Commercial	$9,824.59
Rate for Payer: Group Health Inc Medicare	$9,824.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,572.62
Rate for Payer: Hamaspik Choice Inc Medicare	$9,824.59
Rate for Payer: Healthfirst Medicare Advantage	$8,350.90
Rate for Payer: Healthfirst QHP	$9,824.59
Rate for Payer: Humana Medicare	$10,021.08
Rate for Payer: Senior Whole Health Medicare Advantage	$9,824.59
Rate for Payer: United Healthcare Commercial	$3,190.00
Rate for Payer: United Healthcare Medicare Advantage	$9,824.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9,824.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7,859.67
Rate for Payer: Wellcare Medicare	$9,333.36

EPINASTINE 0.05% OPHTHALMIC SOLN

Facility

$155.56

Hospital Charge Code	41644686
Hospital Revenue Code	250
Min. Negotiated Rate	$54.45
Max. Negotiated Rate	$124.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.78
Rate for Payer: Aetna Government	$77.78
Rate for Payer: Brighton Health Commercial	$116.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.78
Rate for Payer: Group Health Inc Commercial	$77.78
Rate for Payer: Group Health Inc Medicare	$54.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.78
Rate for Payer: Hamaspik Choice Inc Medicare	$77.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.11

EPINASTINE 0.05% OPHTHALMIC SOLN

Facility

$155.56

Hospital Charge Code	41654686
Hospital Revenue Code	250
Min. Negotiated Rate	$54.45
Max. Negotiated Rate	$124.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.78
Rate for Payer: Aetna Government	$77.78
Rate for Payer: Brighton Health Commercial	$116.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.78
Rate for Payer: Group Health Inc Commercial	$77.78
Rate for Payer: Group Health Inc Medicare	$54.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.78
Rate for Payer: Hamaspik Choice Inc Medicare	$77.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.11

EPINASTINE HCL 0.05 % OP SOLN [37646]

Facility

$21.40

Service Code	NDC 51991083675
Hospital Charge Code	51991083675
Hospital Revenue Code	250
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$17.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.70
Rate for Payer: Aetna Government	$10.70
Rate for Payer: Brighton Health Commercial	$16.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.55
Rate for Payer: Group Health Inc Commercial	$10.70
Rate for Payer: Group Health Inc Medicare	$7.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.70
Rate for Payer: Hamaspik Choice Inc Medicare	$10.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.91

EP INC DRAIN HEM/SER/FLUID

Facility

$4,157.25

Service Code	HCPCS 10140
Hospital Charge Code	66574500
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,874.89

EP INC DRAIN HEM/SER/FLUID

Facility

$4,157.25

Service Code	HCPCS 10140
Hospital Charge Code	66574500
Hospital Revenue Code	361
Min. Negotiated Rate	$1,312.42
Max. Negotiated Rate	$3,117.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,874.89
Rate for Payer: Aetna Government	$1,874.89
Rate for Payer: Affinity Essential Plan 1&2	$1,312.42
Rate for Payer: Affinity Essential Plan 3&4	$1,312.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,312.42
Rate for Payer: Brighton Health Commercial	$3,117.94
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,874.89
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	$1,874.89
Rate for Payer: EmblemHealth Commercial	$1,874.89
Rate for Payer: Fidelis Essential Plan Aliesa	$1,593.66
Rate for Payer: Fidelis Essential Plan QHP	$1,668.65
Rate for Payer: Fidelis Medicare Advantage	$1,874.89
Rate for Payer: Fidelis Qualified Health Plan	$1,668.65
Rate for Payer: Group Health Inc Commercial	$1,874.89
Rate for Payer: Group Health Inc Medicare	$1,874.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,874.89
Rate for Payer: Healthfirst Medicare Advantage	$1,593.66
Rate for Payer: Healthfirst QHP	$1,874.89
Rate for Payer: Humana Medicare	$1,912.39
Rate for Payer: Senior Whole Health Medicare Advantage	$1,874.89
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,499.91
Rate for Payer: Wellcare Medicare	$1,781.15

EPINEPHRINE 0.1 MG/ML INJ SYRINGE 10 ML

Facility

$9.00

Service Code	HCPCS J0153
Hospital Charge Code	41653818
Hospital Revenue Code	636
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50

EPINEPHRINE 0.1 MG/ML INJ SYRINGE 10 ML

Facility

$9.00

Service Code	HCPCS J0153
Hospital Charge Code	41653818
Hospital Revenue Code	636
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$5.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.18
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.59
Rate for Payer: SOMOS Essential	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

EPINEPHRINE 0.1 MG/ML INJ SYRINGE 10 ML

Facility

$9.00

Service Code	HCPCS J0153
Hospital Charge Code	41643818
Hospital Revenue Code	636
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$5.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.18
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.59
Rate for Payer: SOMOS Essential	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

EPINEPHRINE 0.1 MG/ML INJ SYRINGE 10 ML

Facility

$9.00

Service Code	HCPCS J0153
Hospital Charge Code	41643818
Hospital Revenue Code	636
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50

EPINEPHRINE 1 MG/10ML IJ SOSY [162620]

Facility

$1.18

Service Code	HCPCS J0171
Hospital Charge Code	76329331601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.74
Rate for Payer: Aetna Government	$0.74
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.80
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.81
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.86
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.86
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

EPINEPHRINE 1 MG/10ML SOSY (WRAPPED) [401259]

Facility

$1.01

Service Code	HCPCS J0171
Hospital Charge Code	00409493301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.74
Rate for Payer: Aetna Government	$0.74
Rate for Payer: Brighton Health Commercial	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.69
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.81
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.86
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.86
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

EPINEPHRINE 1 MG/10ML SOSY (WRAPPED) [401259]

Facility

$1.18

Service Code	HCPCS J0171
Hospital Charge Code	76329331601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.74
Rate for Payer: Aetna Government	$0.74
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.80
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.81
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.86
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.86
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

EPINEPHRINE 1 MG/ML INJ 1 ML

Facility

$2.54

Service Code	HCPCS J0171
Hospital Charge Code	41644230
Hospital Revenue Code	636
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.27
Rate for Payer: Hamaspik Choice Inc Medicare	$1.27

EPINEPHRINE 1 MG/ML INJ 1 ML

Facility

$2.54

Service Code	HCPCS J0171
Hospital Charge Code	41654230
Hospital Revenue Code	636
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.27
Rate for Payer: Hamaspik Choice Inc Medicare	$1.27

EPINEPHRINE 1 MG/ML INJ 1 ML

Facility

$2.54

Service Code	HCPCS J0171
Hospital Charge Code	41644230
Hospital Revenue Code	636
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.74
Rate for Payer: Aetna Government	$0.74
Rate for Payer: Brighton Health Commercial	$1.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.46
Rate for Payer: Group Health Inc Commercial	$1.27
Rate for Payer: Group Health Inc Medicare	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.27
Rate for Payer: Hamaspik Choice Inc Medicare	$1.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.65

EPINEPHRINE 1 MG/ML INJ 1 ML

Facility

$2.54

Service Code	HCPCS J0171
Hospital Charge Code	41654230
Hospital Revenue Code	636
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.74
Rate for Payer: Aetna Government	$0.74
Rate for Payer: Brighton Health Commercial	$1.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.46
Rate for Payer: Group Health Inc Commercial	$1.27
Rate for Payer: Group Health Inc Medicare	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.27
Rate for Payer: Hamaspik Choice Inc Medicare	$1.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.65

EPINEPHRINE 1 MG/ML INJ 30 ML

Facility

$0.01

Service Code	HCPCS J0171
Hospital Charge Code	41640403
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

EPINEPHRINE 1 MG/ML INJ 30 ML

Facility

$0.01

Service Code	HCPCS J0171
Hospital Charge Code	41650403
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

EPINEPHRINE 1 MG/ML INJ 30 ML

Facility

$0.01

Service Code	HCPCS J0171
Hospital Charge Code	41640403
Hospital Revenue Code	636
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.74
Rate for Payer: Aetna Government	$0.74
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
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	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

EPINEPHRINE 1 MG/ML INJ 30 ML

Facility

$0.01

Service Code	HCPCS J0171
Hospital Charge Code	41650403
Hospital Revenue Code	636
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.74
Rate for Payer: Aetna Government	$0.74
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
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	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

EPINEPHRINE 4MG/D5W 250ML INF

Facility

$11.00

Hospital Charge Code	41657120
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

EPINEPHRINE 4MG/D5W 250ML INF

Facility

$11.00

Hospital Charge Code	41647120
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

EPINEPHRINE 4MG/NS 250 ML

Facility

$0.26

Service Code	HCPCS J0171
Hospital Charge Code	41649533
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.74
Rate for Payer: Aetna Government	$0.74
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
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: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

Know your out-of-pocket cost for care.

All Charges