St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GASTROSCOPY

Facility

$2,380.35

Service Code	HCPCS 43235
Hospital Charge Code	40000455
Hospital Revenue Code	360
Min. Negotiated Rate	$733.80
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,048.28
Rate for Payer: Aetna Government	$1,048.28
Rate for Payer: Affinity Essential Plan 1&2	$733.80
Rate for Payer: Affinity Essential Plan 3&4	$733.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$733.80
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Cash Price	$1,048.28
Rate for Payer: Cash Price	$1,048.28
Rate for Payer: Cash Price	$1,048.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,048.28
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	$1,048.28
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$891.04
Rate for Payer: Fidelis Essential Plan QHP	$932.97
Rate for Payer: Fidelis Medicare Advantage	$1,048.28
Rate for Payer: Fidelis Qualified Health Plan	$932.97
Rate for Payer: Group Health Inc Commercial	$1,048.28
Rate for Payer: Group Health Inc Medicare	$1,048.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,190.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1,048.28
Rate for Payer: Healthfirst Medicare Advantage	$891.04
Rate for Payer: Healthfirst QHP	$1,048.28
Rate for Payer: Humana Medicare	$1,069.25
Rate for Payer: Senior Whole Health Medicare Advantage	$1,048.28
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,048.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,048.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$838.62
Rate for Payer: Wellcare Medicare	$995.87

GASTROSCOPY

Facility

$2,380.35

Service Code	HCPCS 43235
Hospital Charge Code	40000455
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,048.28

Gastrostomy Tube

Facility

$211.92

Hospital Charge Code	40202000
Hospital Revenue Code	270
Min. Negotiated Rate	$74.17
Max. Negotiated Rate	$169.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.96
Rate for Payer: Aetna Government	$105.96
Rate for Payer: Brighton Health Commercial	$158.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$169.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.11
Rate for Payer: Group Health Inc Commercial	$105.96
Rate for Payer: Group Health Inc Medicare	$74.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.96
Rate for Payer: Hamaspik Choice Inc Medicare	$105.96

GASTROSTOMY TUBES 18FR

Facility

$67.68

Hospital Charge Code	40200050
Hospital Revenue Code	270
Min. Negotiated Rate	$23.69
Max. Negotiated Rate	$54.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$33.84
Rate for Payer: Aetna Government	$33.84
Rate for Payer: Brighton Health Commercial	$50.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.02
Rate for Payer: Group Health Inc Commercial	$33.84
Rate for Payer: Group Health Inc Medicare	$23.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.84
Rate for Payer: Hamaspik Choice Inc Medicare	$33.84

GAUCHER DISEASE

Facility

$118.13

Service Code	HCPCS 81251
Hospital Charge Code	40603055
Hospital Revenue Code	300
Min. Negotiated Rate	$33.08
Max. Negotiated Rate	$94.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.25
Rate for Payer: Aetna Government	$47.25
Rate for Payer: Affinity Essential Plan 1&2	$33.08
Rate for Payer: Affinity Essential Plan 3&4	$33.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$33.08
Rate for Payer: Brighton Health Commercial	$88.60
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cash Price	$47.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$47.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$94.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.33
Rate for Payer: Elderplan Medicare Advantage	$47.25
Rate for Payer: EmblemHealth Commercial	$47.25
Rate for Payer: Fidelis Essential Plan Aliesa	$40.16
Rate for Payer: Fidelis Essential Plan QHP	$42.05
Rate for Payer: Fidelis Medicare Advantage	$47.25
Rate for Payer: Fidelis Qualified Health Plan	$42.05
Rate for Payer: Group Health Inc Commercial	$47.25
Rate for Payer: Group Health Inc Medicare	$47.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.06
Rate for Payer: Hamaspik Choice Inc Medicare	$47.25
Rate for Payer: Healthfirst Medicare Advantage	$47.25
Rate for Payer: Healthfirst QHP	$47.25
Rate for Payer: Humana Medicare	$48.20
Rate for Payer: Senior Whole Health Medicare Advantage	$47.25
Rate for Payer: United Healthcare Commercial	$42.52
Rate for Payer: United Healthcare Medicare Advantage	$47.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37.80
Rate for Payer: Wellcare Medicare	$42.52

GAUCHER DISEASE

Facility

$118.13

Service Code	HCPCS 81251
Hospital Charge Code	40603055
Hospital Revenue Code	300
Rate for Payer: Cash Price	$47.25

GAUGE DEPTH FOR MINI SCREWS

Facility

$1,296.00

Service Code	HCPCS C1713
Hospital Charge Code	64901944
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,360.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$712.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$777.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$648.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$745.20
Rate for Payer: EmblemHealth Commercial	$648.00
Rate for Payer: Fidelis Medicare Advantage	$1,360.80
Rate for Payer: Group Health Inc Commercial	$648.00
Rate for Payer: Group Health Inc Medicare	$453.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$648.00
Rate for Payer: Hamaspik Choice Inc Medicare	$648.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$842.40

GAUGE DEPTH FOR MINI SCREWS

Facility

$1,296.00

Service Code	HCPCS C1713
Hospital Charge Code	64901944
Hospital Revenue Code	278
Min. Negotiated Rate	$648.00
Max. Negotiated Rate	$648.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$648.00
Rate for Payer: Hamaspik Choice Inc Medicare	$648.00

GAUGE DEPTH MEASURING

Facility

$856.00

Hospital Charge Code	40200514
Hospital Revenue Code	270
Min. Negotiated Rate	$299.60
Max. Negotiated Rate	$684.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$470.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$428.00
Rate for Payer: Aetna Government	$428.00
Rate for Payer: Brighton Health Commercial	$642.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$684.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.08
Rate for Payer: Group Health Inc Commercial	$428.00
Rate for Payer: Group Health Inc Medicare	$299.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$428.00
Rate for Payer: Hamaspik Choice Inc Medicare	$428.00

G/C 6F MEDTRONIC LAUNCHER

Facility

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66522103
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$107.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$61.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.65
Rate for Payer: EmblemHealth Commercial	$51.00
Rate for Payer: Fidelis Medicare Advantage	$107.10
Rate for Payer: Group Health Inc Commercial	$51.00
Rate for Payer: Group Health Inc Medicare	$35.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.30

G/C 6F MEDTRONIC LAUNCHER

Facility

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66522103
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00

GD1B ANTIBODY IGG, IGM

Facility

$43.18

Service Code	HCPCS 83520
Hospital Charge Code	40609888
Hospital Revenue Code	301
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$32.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.27
Rate for Payer: Aetna Government	$17.27
Rate for Payer: Affinity Essential Plan 1&2	$12.09
Rate for Payer: Affinity Essential Plan 3&4	$12.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.09
Rate for Payer: Brighton Health Commercial	$32.38
Rate for Payer: Cash Price	$17.27
Rate for Payer: Cash Price	$17.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$17.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.41
Rate for Payer: Elderplan Medicare Advantage	$17.27
Rate for Payer: EmblemHealth Commercial	$17.27
Rate for Payer: Fidelis Essential Plan Aliesa	$14.68
Rate for Payer: Fidelis Essential Plan QHP	$15.37
Rate for Payer: Fidelis Medicare Advantage	$17.27
Rate for Payer: Fidelis Qualified Health Plan	$15.37
Rate for Payer: Group Health Inc Commercial	$17.27
Rate for Payer: Group Health Inc Medicare	$17.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.59
Rate for Payer: Hamaspik Choice Inc Medicare	$17.27
Rate for Payer: Healthfirst Medicare Advantage	$17.27
Rate for Payer: Healthfirst QHP	$17.27
Rate for Payer: Humana Medicare	$17.62
Rate for Payer: Senior Whole Health Medicare Advantage	$17.27
Rate for Payer: United Healthcare Commercial	$16.40
Rate for Payer: United Healthcare Medicare Advantage	$17.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.82
Rate for Payer: Wellcare Medicare	$15.54

GD1B ANTIBODY IGG, IGM

Facility

$43.18

Service Code	HCPCS 83520
Hospital Charge Code	40609888
Hospital Revenue Code	301
Rate for Payer: Cash Price	$17.27

GEL ADHESION CONTROL BARRIER

Facility

$1,237.50

Hospital Charge Code	64903002
Hospital Revenue Code	270
Min. Negotiated Rate	$433.12
Max. Negotiated Rate	$990.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$680.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$618.75
Rate for Payer: Aetna Government	$618.75
Rate for Payer: Brighton Health Commercial	$928.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$990.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$841.50
Rate for Payer: Group Health Inc Commercial	$618.75
Rate for Payer: Group Health Inc Medicare	$433.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$618.75
Rate for Payer: Hamaspik Choice Inc Medicare	$618.75

GEL-E-DONUT

Facility

$16.66

Hospital Charge Code	40200486
Hospital Revenue Code	270
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$13.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.33
Rate for Payer: Aetna Government	$8.33
Rate for Payer: Brighton Health Commercial	$12.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.33
Rate for Payer: Group Health Inc Commercial	$8.33
Rate for Payer: Group Health Inc Medicare	$5.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.33
Rate for Payer: Hamaspik Choice Inc Medicare	$8.33

GEL EXPANDER

Facility

$1,900.00

Hospital Charge Code	40203155
Hospital Revenue Code	270
Min. Negotiated Rate	$665.00
Max. Negotiated Rate	$1,520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,045.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$950.00
Rate for Payer: Aetna Government	$950.00
Rate for Payer: Brighton Health Commercial	$1,425.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,292.00
Rate for Payer: Group Health Inc Commercial	$950.00
Rate for Payer: Group Health Inc Medicare	$665.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$950.00

GELFOAM 12-7MM

Facility

$292.73

Hospital Charge Code	64903141
Hospital Revenue Code	270
Min. Negotiated Rate	$102.46
Max. Negotiated Rate	$234.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$161.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$146.36
Rate for Payer: Aetna Government	$146.36
Rate for Payer: Brighton Health Commercial	$219.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$234.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$199.06
Rate for Payer: Group Health Inc Commercial	$146.36
Rate for Payer: Group Health Inc Medicare	$102.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.36
Rate for Payer: Hamaspik Choice Inc Medicare	$146.36

GELFOAM-SPONGE 12-7 N

Facility

$27.29

Hospital Charge Code	40000210
Hospital Revenue Code	272
Min. Negotiated Rate	$9.55
Max. Negotiated Rate	$21.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.64
Rate for Payer: Aetna Government	$13.64
Rate for Payer: Brighton Health Commercial	$20.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.56
Rate for Payer: Group Health Inc Commercial	$13.64
Rate for Payer: Group Health Inc Medicare	$9.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.64
Rate for Payer: Hamaspik Choice Inc Medicare	$13.64

GELFOAM-SPONGE SIZE 100

Facility

$78.68

Hospital Charge Code	40000205
Hospital Revenue Code	272
Min. Negotiated Rate	$27.54
Max. Negotiated Rate	$62.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$43.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.34
Rate for Payer: Aetna Government	$39.34
Rate for Payer: Brighton Health Commercial	$59.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.50
Rate for Payer: Group Health Inc Commercial	$39.34
Rate for Payer: Group Health Inc Medicare	$27.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.34
Rate for Payer: Hamaspik Choice Inc Medicare	$39.34

GEL GRAFTON 5CC SYRINGE

Facility

$1,703.25

Hospital Charge Code	64904654
Hospital Revenue Code	270
Min. Negotiated Rate	$596.14
Max. Negotiated Rate	$1,362.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$936.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$851.62
Rate for Payer: Aetna Government	$851.62
Rate for Payer: Brighton Health Commercial	$1,277.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,362.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,158.21
Rate for Payer: Group Health Inc Commercial	$851.62
Rate for Payer: Group Health Inc Medicare	$596.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$851.62
Rate for Payer: Hamaspik Choice Inc Medicare	$851.62

GEL IODOSORB

Facility

$75.40

Hospital Charge Code	64903413
Hospital Revenue Code	270
Min. Negotiated Rate	$26.39
Max. Negotiated Rate	$60.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.70
Rate for Payer: Aetna Government	$37.70
Rate for Payer: Brighton Health Commercial	$56.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.27
Rate for Payer: Group Health Inc Commercial	$37.70
Rate for Payer: Group Health Inc Medicare	$26.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.70
Rate for Payer: Hamaspik Choice Inc Medicare	$37.70

GEL SIZER 425CC

Facility

$562.50

Hospital Charge Code	64904905
Hospital Revenue Code	270
Min. Negotiated Rate	$196.88
Max. Negotiated Rate	$450.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$281.25
Rate for Payer: Aetna Government	$281.25
Rate for Payer: Brighton Health Commercial	$421.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$450.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$382.50
Rate for Payer: Group Health Inc Commercial	$281.25
Rate for Payer: Group Health Inc Medicare	$196.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.25
Rate for Payer: Hamaspik Choice Inc Medicare	$281.25

GEL WOUND CARE MULTIDEX

Facility

$12.08

Hospital Charge Code	64901046
Hospital Revenue Code	270
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$9.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.04
Rate for Payer: Aetna Government	$6.04
Rate for Payer: Brighton Health Commercial	$9.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.21
Rate for Payer: Group Health Inc Commercial	$6.04
Rate for Payer: Group Health Inc Medicare	$4.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.04
Rate for Payer: Hamaspik Choice Inc Medicare	$6.04

GEMCITABINE 1000 MG INJ

Facility

$31.94

Service Code	HCPCS J9201
Hospital Charge Code	41641644
Hospital Revenue Code	636
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$828.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.82
Rate for Payer: Aetna Government	$3.82
Rate for Payer: Affinity Essential Plan 1&2	$18.63
Rate for Payer: Affinity Essential Plan 3&4	$18.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.28
Rate for Payer: Amida Care Medicaid	$8.28
Rate for Payer: Brighton Health Commercial	$19.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$828.00
Rate for Payer: Fidelis Essential Plan Aliesa	$8.28
Rate for Payer: Fidelis Essential Plan QHP	$8.28
Rate for Payer: Fidelis Qualified Health Plan	$8.69
Rate for Payer: Group Health Inc Commercial	$15.97
Rate for Payer: Group Health Inc Medicare	$11.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.28
Rate for Payer: Hamaspik Choice Inc Medicare	$15.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.28
Rate for Payer: Healthfirst Essential Plan	$18.63
Rate for Payer: Healthfirst QHP	$8.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.28
Rate for Payer: SOMOS Essential	$8.28
Rate for Payer: United Healthcare Essential Plan 1&2	$18.63
Rate for Payer: United Healthcare Essential Plan 3&4	$9.11
Rate for Payer: United Healthcare Medicaid	$8.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.28

GEMCITABINE 1000 MG INJ

Facility

$31.94

Service Code	HCPCS J9201
Hospital Charge Code	41651644
Hospital Revenue Code	636
Min. Negotiated Rate	$15.97
Max. Negotiated Rate	$15.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.97
Rate for Payer: Hamaspik Choice Inc Medicare	$15.97

Know your out-of-pocket cost for care.

All Charges