St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

IPRATROPIUM BROMIDE 0.02 % IN SOLN [12580]

Facility

$0.71

Service Code	HCPCS J7644
Hospital Charge Code	47335070649
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.33
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.35
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.35
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

IPRATROPIUM BROMIDE HFA 17 MCG/ACT IN AERS [41142]

Facility

$43.91

Service Code	NDC 00597008717
Hospital Charge Code	00597008717
Hospital Revenue Code	250
Min. Negotiated Rate	$15.37
Max. Negotiated Rate	$35.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.96
Rate for Payer: Aetna Government	$21.96
Rate for Payer: Brighton Health Commercial	$32.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.86
Rate for Payer: Group Health Inc Commercial	$21.96
Rate for Payer: Group Health Inc Medicare	$15.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.96
Rate for Payer: Hamaspik Choice Inc Medicare	$21.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.54

IPRATROPIUM METERED DOSE INHALER

Facility

$322.00

Service Code	HCPCS J3535
Hospital Charge Code	41646007
Hospital Revenue Code	636
Min. Negotiated Rate	$112.70
Max. Negotiated Rate	$209.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$177.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$161.00
Rate for Payer: Aetna Government	$161.00
Rate for Payer: Brighton Health Commercial	$193.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$161.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$185.15
Rate for Payer: Group Health Inc Commercial	$161.00
Rate for Payer: Group Health Inc Medicare	$112.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.00
Rate for Payer: Hamaspik Choice Inc Medicare	$161.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$209.30

IPRATROPIUM METERED DOSE INHALER

Facility

$322.00

Service Code	HCPCS J3535
Hospital Charge Code	41656007
Hospital Revenue Code	636
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$161.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.00
Rate for Payer: Hamaspik Choice Inc Medicare	$161.00

IPRATROPIUM METERED DOSE INHALER

Facility

$322.00

Service Code	HCPCS J3535
Hospital Charge Code	41656007
Hospital Revenue Code	636
Min. Negotiated Rate	$112.70
Max. Negotiated Rate	$209.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$177.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$161.00
Rate for Payer: Aetna Government	$161.00
Rate for Payer: Brighton Health Commercial	$193.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$161.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$185.15
Rate for Payer: Group Health Inc Commercial	$161.00
Rate for Payer: Group Health Inc Medicare	$112.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.00
Rate for Payer: Hamaspik Choice Inc Medicare	$161.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$209.30

IPRATROPIUM METERED DOSE INHALER

Facility

$322.00

Service Code	HCPCS J3535
Hospital Charge Code	41646007
Hospital Revenue Code	636
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$161.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.00
Rate for Payer: Hamaspik Choice Inc Medicare	$161.00

IRGLYE CATHETER

Facility

$12.05

Hospital Charge Code	40202716
Hospital Revenue Code	270
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$9.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.02
Rate for Payer: Aetna Government	$6.02
Rate for Payer: Brighton Health Commercial	$9.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.19
Rate for Payer: Group Health Inc Commercial	$6.02
Rate for Payer: Group Health Inc Medicare	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.02
Rate for Payer: Hamaspik Choice Inc Medicare	$6.02

IRIDECTOMY

Facility

$1,535.38

Service Code	HCPCS 66761
Hospital Charge Code	40072555
Hospital Revenue Code	360
Rate for Payer: Cash Price	$672.19

IRIDECTOMY

Facility

$1,535.38

Service Code	HCPCS 66761
Hospital Charge Code	40072555
Hospital Revenue Code	360
Min. Negotiated Rate	$537.75
Max. Negotiated Rate	$62,084.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$672.19
Rate for Payer: Aetna Government	$672.19
Rate for Payer: Affinity Essential Plan 1&2	$1,396.89
Rate for Payer: Affinity Essential Plan 3&4	$1,396.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$620.84
Rate for Payer: Amida Care Medicaid	$620.84
Rate for Payer: Brighton Health Commercial	$1,151.54
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$672.19
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	$672.19
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62,084.00
Rate for Payer: Fidelis Essential Plan Aliesa	$620.84
Rate for Payer: Fidelis Essential Plan QHP	$620.84
Rate for Payer: Fidelis Medicare Advantage	$672.19
Rate for Payer: Fidelis Qualified Health Plan	$651.88
Rate for Payer: Group Health Inc Commercial	$672.19
Rate for Payer: Group Health Inc Medicare	$672.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$620.84
Rate for Payer: Hamaspik Choice Inc Medicare	$672.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$620.84
Rate for Payer: Healthfirst Essential Plan	$1,396.89
Rate for Payer: Healthfirst Medicare Advantage	$571.36
Rate for Payer: Healthfirst QHP	$620.84
Rate for Payer: Humana Medicare	$685.63
Rate for Payer: Senior Whole Health Medicare Advantage	$672.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$620.84
Rate for Payer: SOMOS Essential	$1,396.89
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Essential Plan 1&2	$1,396.89
Rate for Payer: United Healthcare Essential Plan 3&4	$682.92
Rate for Payer: United Healthcare Medicaid	$620.84
Rate for Payer: United Healthcare Medicare Advantage	$672.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$672.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$537.75
Rate for Payer: Wellcare Medicare	$638.58

IRIDOPLASTY BY PHOTOCOAGULTON 1>

Facility

$1,535.38

Service Code	HCPCS 66762
Hospital Charge Code	30307789
Hospital Revenue Code	510
Rate for Payer: Cash Price	$672.19

IRIDOPLASTY BY PHOTOCOAGULTON 1>

Facility

$1,535.38

Service Code	HCPCS 66762
Hospital Charge Code	30307789
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$62,084.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$672.19
Rate for Payer: Aetna Government	$672.19
Rate for Payer: Affinity Essential Plan 1&2	$1,396.89
Rate for Payer: Affinity Essential Plan 3&4	$1,396.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$620.84
Rate for Payer: Amida Care Medicaid	$620.84
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$672.19
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	$672.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62,084.00
Rate for Payer: Fidelis Essential Plan Aliesa	$620.84
Rate for Payer: Fidelis Essential Plan QHP	$620.84
Rate for Payer: Fidelis Medicare Advantage	$672.19
Rate for Payer: Fidelis Qualified Health Plan	$651.88
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$620.84
Rate for Payer: Hamaspik Choice Inc Medicare	$672.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$620.84
Rate for Payer: Healthfirst Essential Plan	$1,396.89
Rate for Payer: Healthfirst Medicare Advantage	$571.36
Rate for Payer: Healthfirst QHP	$620.84
Rate for Payer: Humana Medicare	$685.63
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$672.19
Rate for Payer: Senior Whole Health Medicare Advantage	$672.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$620.84
Rate for Payer: SOMOS Essential	$1,396.89
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$1,396.89
Rate for Payer: United Healthcare Essential Plan 3&4	$682.92
Rate for Payer: United Healthcare Medicaid	$620.84
Rate for Payer: United Healthcare Medicare Advantage	$672.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$672.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$537.75
Rate for Payer: Wellcare Medicare	$638.58

IRIGATION PRBE TIP SCTN 5MM NONCO

Facility

$468.00

Hospital Charge Code	40200826
Hospital Revenue Code	270
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$374.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$257.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$234.00
Rate for Payer: Aetna Government	$234.00
Rate for Payer: Brighton Health Commercial	$351.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$374.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$318.24
Rate for Payer: Group Health Inc Commercial	$234.00
Rate for Payer: Group Health Inc Medicare	$163.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$234.00
Rate for Payer: Hamaspik Choice Inc Medicare	$234.00

IRIG PROBE TIP SUCTN 5MM NONCONDU

Facility

$116.68

Hospital Charge Code	64902947
Hospital Revenue Code	270
Min. Negotiated Rate	$40.84
Max. Negotiated Rate	$93.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$58.34
Rate for Payer: Aetna Government	$58.34
Rate for Payer: Brighton Health Commercial	$87.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$93.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$79.34
Rate for Payer: Group Health Inc Commercial	$58.34
Rate for Payer: Group Health Inc Medicare	$40.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.34
Rate for Payer: Hamaspik Choice Inc Medicare	$58.34

IRINOTECAN 20 MG/ML INJ 2 ML

Facility

$7.74

Service Code	HCPCS J9206
Hospital Charge Code	41652876
Hospital Revenue Code	636
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$3.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.87
Rate for Payer: Hamaspik Choice Inc Medicare	$3.87

IRINOTECAN 20 MG/ML INJ 2 ML

Facility

$7.74

Service Code	HCPCS J9206
Hospital Charge Code	41642876
Hospital Revenue Code	636
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$5.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.35
Rate for Payer: Aetna Government	$2.35
Rate for Payer: Brighton Health Commercial	$4.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.45
Rate for Payer: Group Health Inc Commercial	$3.87
Rate for Payer: Group Health Inc Medicare	$2.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.87
Rate for Payer: Hamaspik Choice Inc Medicare	$3.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.72
Rate for Payer: SOMOS Essential	$3.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.03

IRINOTECAN 20 MG/ML INJ 2 ML

Facility

$7.74

Service Code	HCPCS J9206
Hospital Charge Code	41652876
Hospital Revenue Code	636
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$5.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.35
Rate for Payer: Aetna Government	$2.35
Rate for Payer: Brighton Health Commercial	$4.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.45
Rate for Payer: Group Health Inc Commercial	$3.87
Rate for Payer: Group Health Inc Medicare	$2.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.87
Rate for Payer: Hamaspik Choice Inc Medicare	$3.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.72
Rate for Payer: SOMOS Essential	$3.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.03

IRINOTECAN 20 MG/ML INJ 2 ML

Facility

$7.74

Service Code	HCPCS J9206
Hospital Charge Code	41642876
Hospital Revenue Code	636
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$3.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.87
Rate for Payer: Hamaspik Choice Inc Medicare	$3.87

IRINOTECAN 20 MG/ML INJ 5 ML

Facility

$3.35

Service Code	HCPCS J9206
Hospital Charge Code	41651097
Hospital Revenue Code	636
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1.68

IRINOTECAN 20 MG/ML INJ 5 ML

Facility

$3.35

Service Code	HCPCS J9206
Hospital Charge Code	41651097
Hospital Revenue Code	636
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$3.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.35
Rate for Payer: Aetna Government	$2.35
Rate for Payer: Brighton Health Commercial	$2.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.93
Rate for Payer: Group Health Inc Commercial	$1.68
Rate for Payer: Group Health Inc Medicare	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.72
Rate for Payer: SOMOS Essential	$3.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.18

IRINOTECAN 20 MG/ML INJ 5 ML

Facility

$3.35

Service Code	HCPCS J9206
Hospital Charge Code	41641097
Hospital Revenue Code	636
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1.68

IRINOTECAN 20 MG/ML INJ 5 ML

Facility

$3.35

Service Code	HCPCS J9206
Hospital Charge Code	41641097
Hospital Revenue Code	636
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$3.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.35
Rate for Payer: Aetna Government	$2.35
Rate for Payer: Brighton Health Commercial	$2.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.93
Rate for Payer: Group Health Inc Commercial	$1.68
Rate for Payer: Group Health Inc Medicare	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.72
Rate for Payer: SOMOS Essential	$3.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.18

IRINOTECAN HCL 100 MG/5ML IV SOLN [91054]

Facility

$7.21

Service Code	HCPCS J9206
Hospital Charge Code	70700017022
Hospital Revenue Code	278
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$7.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.35
Rate for Payer: Aetna Government	$2.35
Rate for Payer: Brighton Health Commercial	$4.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.15
Rate for Payer: EmblemHealth Commercial	$3.61
Rate for Payer: Fidelis Medicare Advantage	$7.57
Rate for Payer: Group Health Inc Commercial	$3.61
Rate for Payer: Group Health Inc Medicare	$2.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.61
Rate for Payer: Hamaspik Choice Inc Medicare	$3.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.69

IRINOTECAN HCL 100 MG/5ML IV SOLN [91054]

Facility

$15.00

Service Code	HCPCS J9206
Hospital Charge Code	00143970101
Hospital Revenue Code	278
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50

IRINOTECAN HCL 100 MG/5ML IV SOLN [91054]

Facility

$15.00

Service Code	HCPCS J9206
Hospital Charge Code	00143970101
Hospital Revenue Code	278
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$15.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.35
Rate for Payer: Aetna Government	$2.35
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.62
Rate for Payer: EmblemHealth Commercial	$7.50
Rate for Payer: Fidelis Medicare Advantage	$15.75
Rate for Payer: Group Health Inc Commercial	$7.50
Rate for Payer: Group Health Inc Medicare	$5.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.75

IRINOTECAN HCL 100 MG/5ML IV SOLN [91054]

Facility

$7.21

Service Code	HCPCS J9206
Hospital Charge Code	60505612801
Hospital Revenue Code	278
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$3.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.61
Rate for Payer: Hamaspik Choice Inc Medicare	$3.61

Know your out-of-pocket cost for care.

All Charges