St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LENS ONE 14 DIOPTER 12.5ML

Facility

$237.50

Service Code	HCPCS C1780
Hospital Charge Code	64903724
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$249.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$142.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.50
Rate for Payer: EmblemHealth Commercial	$118.75
Rate for Payer: Fidelis Medicare Advantage	$249.38
Rate for Payer: Group Health Inc Commercial	$118.75
Rate for Payer: Group Health Inc Medicare	$83.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$118.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.38

LENS ONE 14 DIOPTER 13ML

Facility

$237.50

Service Code	HCPCS C1780
Hospital Charge Code	64903720
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$249.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$142.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.50
Rate for Payer: EmblemHealth Commercial	$118.75
Rate for Payer: Fidelis Medicare Advantage	$249.38
Rate for Payer: Group Health Inc Commercial	$118.75
Rate for Payer: Group Health Inc Medicare	$83.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$118.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.38

LENS ONE 17 DIOPTER 13ML

Facility

$237.50

Service Code	HCPCS C1780
Hospital Charge Code	64903787
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$249.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$142.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.50
Rate for Payer: EmblemHealth Commercial	$118.75
Rate for Payer: Fidelis Medicare Advantage	$249.38
Rate for Payer: Group Health Inc Commercial	$118.75
Rate for Payer: Group Health Inc Medicare	$83.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$118.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.38

LENS ONE 19 DIOPTER 12.5ML

Facility

$237.50

Service Code	HCPCS C1780
Hospital Charge Code	64903726
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$249.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$142.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.50
Rate for Payer: EmblemHealth Commercial	$118.75
Rate for Payer: Fidelis Medicare Advantage	$249.38
Rate for Payer: Group Health Inc Commercial	$118.75
Rate for Payer: Group Health Inc Medicare	$83.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$118.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.38

LENS ONE 19 DIOPTER 13M

Facility

$237.50

Service Code	HCPCS C1780
Hospital Charge Code	64903721
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$249.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$142.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.50
Rate for Payer: EmblemHealth Commercial	$118.75
Rate for Payer: Fidelis Medicare Advantage	$249.38
Rate for Payer: Group Health Inc Commercial	$118.75
Rate for Payer: Group Health Inc Medicare	$83.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$118.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.38

LENS ONE 21 DIOPTER 13ML

Facility

$237.50

Service Code	HCPCS C1780
Hospital Charge Code	64903723
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$249.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$142.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.50
Rate for Payer: EmblemHealth Commercial	$118.75
Rate for Payer: Fidelis Medicare Advantage	$249.38
Rate for Payer: Group Health Inc Commercial	$118.75
Rate for Payer: Group Health Inc Medicare	$83.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$118.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.38

LENS ONE 21DIOPTER 15.5ML

Facility

$237.50

Service Code	HCPCS C1780
Hospital Charge Code	64903727
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$249.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$142.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.50
Rate for Payer: EmblemHealth Commercial	$118.75
Rate for Payer: Fidelis Medicare Advantage	$249.38
Rate for Payer: Group Health Inc Commercial	$118.75
Rate for Payer: Group Health Inc Medicare	$83.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$118.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.38

LENS TCNS ITC PRLD MON 19.5D

Facility

$130.00

Service Code	HCPCS C1780
Hospital Charge Code	64906338
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$136.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$78.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.40
Rate for Payer: EmblemHealth Commercial	$65.00
Rate for Payer: Fidelis Medicare Advantage	$136.50
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

LEPIRUDIN 50 MG INJ

Facility

$1,065.19

Service Code	HCPCS J1945
Hospital Charge Code	41642800
Hospital Revenue Code	636
Min. Negotiated Rate	$372.82
Max. Negotiated Rate	$692.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$585.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$445.66
Rate for Payer: Aetna Government	$445.66
Rate for Payer: Brighton Health Commercial	$639.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$532.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.48
Rate for Payer: Group Health Inc Commercial	$532.60
Rate for Payer: Group Health Inc Medicare	$372.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.60
Rate for Payer: Hamaspik Choice Inc Medicare	$532.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$692.37

LEPIRUDIN 50 MG INJ

Facility

$1,065.19

Service Code	HCPCS J1945
Hospital Charge Code	41642800
Hospital Revenue Code	636
Min. Negotiated Rate	$532.60
Max. Negotiated Rate	$532.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.60
Rate for Payer: Hamaspik Choice Inc Medicare	$532.60

LEPIRUDIN 50 MG INJ

Facility

$1,065.19

Service Code	HCPCS J1945
Hospital Charge Code	41652800
Hospital Revenue Code	636
Min. Negotiated Rate	$532.60
Max. Negotiated Rate	$532.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.60
Rate for Payer: Hamaspik Choice Inc Medicare	$532.60

LEPIRUDIN 50 MG INJ

Facility

$1,065.19

Service Code	HCPCS J1945
Hospital Charge Code	41652800
Hospital Revenue Code	636
Min. Negotiated Rate	$372.82
Max. Negotiated Rate	$692.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$585.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$445.66
Rate for Payer: Aetna Government	$445.66
Rate for Payer: Brighton Health Commercial	$639.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$532.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.48
Rate for Payer: Group Health Inc Commercial	$532.60
Rate for Payer: Group Health Inc Medicare	$372.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.60
Rate for Payer: Hamaspik Choice Inc Medicare	$532.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$692.37

LEPTOSPERMUM HONEY 15ML GEL

Facility

$10.30

Service Code	HCPCS A6261
Hospital Charge Code	41656484
Hospital Revenue Code	272
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$8.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.84
Rate for Payer: Aetna Government	$1.84
Rate for Payer: Brighton Health Commercial	$7.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.00
Rate for Payer: Group Health Inc Commercial	$5.15
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.15
Rate for Payer: Hamaspik Choice Inc Medicare	$5.15

LEPTOSPERMUM HONEY 45ML GEL

Facility

$28.29

Service Code	HCPCS A6261
Hospital Charge Code	41656486
Hospital Revenue Code	272
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$22.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.84
Rate for Payer: Aetna Government	$1.84
Rate for Payer: Brighton Health Commercial	$21.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.24
Rate for Payer: Group Health Inc Commercial	$14.14
Rate for Payer: Group Health Inc Medicare	$9.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.14
Rate for Payer: Hamaspik Choice Inc Medicare	$14.14

LEPTOSPERMUM HONEY 45ML GEL

Facility

$28.29

Service Code	HCPCS A6261
Hospital Charge Code	41646486
Hospital Revenue Code	272
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$22.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.84
Rate for Payer: Aetna Government	$1.84
Rate for Payer: Brighton Health Commercial	$21.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.24
Rate for Payer: Group Health Inc Commercial	$14.14
Rate for Payer: Group Health Inc Medicare	$9.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.14
Rate for Payer: Hamaspik Choice Inc Medicare	$14.14

LEPTOSPIRA IGM

Facility

$40.50

Service Code	HCPCS 86720
Hospital Charge Code	40619174
Hospital Revenue Code	300
Min. Negotiated Rate	$11.34
Max. Negotiated Rate	$30.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.20
Rate for Payer: Aetna Government	$16.20
Rate for Payer: Affinity Essential Plan 1&2	$11.34
Rate for Payer: Affinity Essential Plan 3&4	$11.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.34
Rate for Payer: Brighton Health Commercial	$30.38
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cash Price	$16.20
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.73
Rate for Payer: Elderplan Medicare Advantage	$16.20
Rate for Payer: EmblemHealth Commercial	$16.20
Rate for Payer: Fidelis Essential Plan Aliesa	$13.77
Rate for Payer: Fidelis Essential Plan QHP	$14.42
Rate for Payer: Fidelis Medicare Advantage	$16.20
Rate for Payer: Fidelis Qualified Health Plan	$14.42
Rate for Payer: Group Health Inc Commercial	$16.20
Rate for Payer: Group Health Inc Medicare	$16.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.25
Rate for Payer: Hamaspik Choice Inc Medicare	$16.20
Rate for Payer: Healthfirst Medicare Advantage	$16.20
Rate for Payer: Healthfirst QHP	$16.20
Rate for Payer: Humana Medicare	$16.52
Rate for Payer: Senior Whole Health Medicare Advantage	$16.20
Rate for Payer: United Healthcare Commercial	$16.70
Rate for Payer: United Healthcare Medicare Advantage	$16.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.96
Rate for Payer: Wellcare Medicare	$14.58

LEPTOSPIRA IGM

Facility

$40.50

Service Code	HCPCS 86720
Hospital Charge Code	40619174
Hospital Revenue Code	300
Rate for Payer: Cash Price	$16.20

LESION REMOVE COLONOSCOPY

Facility

$3,041.53

Service Code	HCPCS 45384
Hospital Charge Code	41118210
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,364.66

LESION REMOVE COLONOSCOPY

Facility

$3,041.53

Service Code	HCPCS 45384
Hospital Charge Code	41118210
Hospital Revenue Code	360
Min. Negotiated Rate	$955.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,364.66
Rate for Payer: Aetna Government	$1,364.66
Rate for Payer: Affinity Essential Plan 1&2	$955.26
Rate for Payer: Affinity Essential Plan 3&4	$955.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$955.26
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,364.66
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	$1,364.66
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,159.96
Rate for Payer: Fidelis Essential Plan QHP	$1,214.55
Rate for Payer: Fidelis Medicare Advantage	$1,364.66
Rate for Payer: Fidelis Qualified Health Plan	$1,214.55
Rate for Payer: Group Health Inc Commercial	$1,364.66
Rate for Payer: Group Health Inc Medicare	$1,364.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,520.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1,364.66
Rate for Payer: Healthfirst Medicare Advantage	$1,159.96
Rate for Payer: Healthfirst QHP	$1,364.66
Rate for Payer: Humana Medicare	$1,391.95
Rate for Payer: Senior Whole Health Medicare Advantage	$1,364.66
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,364.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,364.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,091.73
Rate for Payer: Wellcare Medicare	$1,296.43

LESION REMOVE COLONOSCOPY/BALLOON

Facility

$3,041.53

Service Code	HCPCS 45386
Hospital Charge Code	41118925
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,364.66

LESION REMOVE COLONOSCOPY/BALLOON

Facility

$3,041.53

Service Code	HCPCS 45386
Hospital Charge Code	41118925
Hospital Revenue Code	360
Min. Negotiated Rate	$955.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,364.66
Rate for Payer: Aetna Government	$1,364.66
Rate for Payer: Affinity Essential Plan 1&2	$955.26
Rate for Payer: Affinity Essential Plan 3&4	$955.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$955.26
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,364.66
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	$1,364.66
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,159.96
Rate for Payer: Fidelis Essential Plan QHP	$1,214.55
Rate for Payer: Fidelis Medicare Advantage	$1,364.66
Rate for Payer: Fidelis Qualified Health Plan	$1,214.55
Rate for Payer: Group Health Inc Commercial	$1,364.66
Rate for Payer: Group Health Inc Medicare	$1,364.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,520.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1,364.66
Rate for Payer: Healthfirst Medicare Advantage	$1,159.96
Rate for Payer: Healthfirst QHP	$1,364.66
Rate for Payer: Humana Medicare	$1,391.95
Rate for Payer: Senior Whole Health Medicare Advantage	$1,364.66
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,364.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,364.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,091.73
Rate for Payer: Wellcare Medicare	$1,296.43

LESION REMOVE COLONOSCOPY BY SNAR

Facility

$3,041.53

Service Code	HCPCS 45385
Hospital Charge Code	41118215
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,364.66

LESION REMOVE COLONOSCOPY BY SNAR

Facility

$3,041.53

Service Code	HCPCS 45385
Hospital Charge Code	41118215
Hospital Revenue Code	360
Min. Negotiated Rate	$955.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,364.66
Rate for Payer: Aetna Government	$1,364.66
Rate for Payer: Affinity Essential Plan 1&2	$955.26
Rate for Payer: Affinity Essential Plan 3&4	$955.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$955.26
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,364.66
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	$1,364.66
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,159.96
Rate for Payer: Fidelis Essential Plan QHP	$1,214.55
Rate for Payer: Fidelis Medicare Advantage	$1,364.66
Rate for Payer: Fidelis Qualified Health Plan	$1,214.55
Rate for Payer: Group Health Inc Commercial	$1,364.66
Rate for Payer: Group Health Inc Medicare	$1,364.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,520.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1,364.66
Rate for Payer: Healthfirst Medicare Advantage	$1,159.96
Rate for Payer: Healthfirst QHP	$1,364.66
Rate for Payer: Humana Medicare	$1,391.95
Rate for Payer: Senior Whole Health Medicare Advantage	$1,364.66
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,364.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,364.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,091.73
Rate for Payer: Wellcare Medicare	$1,296.43

LETROZOLE 2.5 MG PO TABS [21509]

Facility

$18.05

Service Code	NDC 50268047615
Hospital Charge Code	50268047615
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$14.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.03
Rate for Payer: Aetna Government	$9.03
Rate for Payer: Brighton Health Commercial	$13.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.28
Rate for Payer: Group Health Inc Commercial	$9.03
Rate for Payer: Group Health Inc Medicare	$6.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.03
Rate for Payer: Hamaspik Choice Inc Medicare	$9.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.73

LETROZOLE 2.5 MG PO TABS [21509]

Facility

$18.05

Service Code	NDC 50268047611
Hospital Charge Code	50268047611
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$14.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.03
Rate for Payer: Aetna Government	$9.03
Rate for Payer: Brighton Health Commercial	$13.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.28
Rate for Payer: Group Health Inc Commercial	$9.03
Rate for Payer: Group Health Inc Medicare	$6.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.03
Rate for Payer: Hamaspik Choice Inc Medicare	$9.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.73

Know your out-of-pocket cost for care.

All Charges