St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LIPOPROTEIN_(A)

Facility

$35.80

Service Code	HCPCS 83695
Hospital Charge Code	40609740
Hospital Revenue Code	301
Rate for Payer: Cash Price	$14.32

LIPOPROTEIN ELECTRO

Facility

$28.15

Service Code	HCPCS 83700
Hospital Charge Code	40608152
Hospital Revenue Code	301
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$21.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.26
Rate for Payer: Aetna Government	$11.26
Rate for Payer: Affinity Essential Plan 1&2	$7.88
Rate for Payer: Affinity Essential Plan 3&4	$7.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$7.88
Rate for Payer: Brighton Health Commercial	$21.11
Rate for Payer: Cash Price	$11.26
Rate for Payer: Cash Price	$11.26
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.15
Rate for Payer: Elderplan Medicare Advantage	$11.26
Rate for Payer: EmblemHealth Commercial	$11.26
Rate for Payer: Fidelis Essential Plan Aliesa	$9.57
Rate for Payer: Fidelis Essential Plan QHP	$10.02
Rate for Payer: Fidelis Medicare Advantage	$11.26
Rate for Payer: Fidelis Qualified Health Plan	$10.02
Rate for Payer: Group Health Inc Commercial	$11.26
Rate for Payer: Group Health Inc Medicare	$11.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.08
Rate for Payer: Hamaspik Choice Inc Medicare	$11.26
Rate for Payer: Healthfirst Medicare Advantage	$11.26
Rate for Payer: Healthfirst QHP	$11.26
Rate for Payer: Humana Medicare	$11.49
Rate for Payer: Senior Whole Health Medicare Advantage	$11.26
Rate for Payer: United Healthcare Commercial	$14.26
Rate for Payer: United Healthcare Medicare Advantage	$11.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.01
Rate for Payer: Wellcare Medicare	$10.13

LIPOPROTEIN ELECTRO

Facility

$28.15

Service Code	HCPCS 83700
Hospital Charge Code	40608152
Hospital Revenue Code	301
Rate for Payer: Cash Price	$11.26

LIPOPROTEIN FRACTIONATION

Facility

$20.42

Service Code	HCPCS 82465
Hospital Charge Code	40608329
Hospital Revenue Code	301
Rate for Payer: Cash Price	$4.35

LIPOPROTEIN FRACTIONATION

Facility

$20.42

Service Code	HCPCS 82465
Hospital Charge Code	40608329
Hospital Revenue Code	301
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$15.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.35
Rate for Payer: Aetna Government	$4.35
Rate for Payer: Affinity Essential Plan 1&2	$3.04
Rate for Payer: Affinity Essential Plan 3&4	$3.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.04
Rate for Payer: Brighton Health Commercial	$15.32
Rate for Payer: Cash Price	$4.35
Rate for Payer: Cash Price	$4.35
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.85
Rate for Payer: Elderplan Medicare Advantage	$4.35
Rate for Payer: EmblemHealth Commercial	$4.35
Rate for Payer: Fidelis Essential Plan Aliesa	$3.70
Rate for Payer: Fidelis Essential Plan QHP	$3.87
Rate for Payer: Fidelis Medicare Advantage	$4.35
Rate for Payer: Fidelis Qualified Health Plan	$3.87
Rate for Payer: Group Health Inc Commercial	$4.35
Rate for Payer: Group Health Inc Medicare	$4.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.21
Rate for Payer: Hamaspik Choice Inc Medicare	$4.35
Rate for Payer: Healthfirst Medicare Advantage	$4.35
Rate for Payer: Healthfirst QHP	$4.35
Rate for Payer: Humana Medicare	$4.44
Rate for Payer: Senior Whole Health Medicare Advantage	$4.35
Rate for Payer: United Healthcare Commercial	$5.52
Rate for Payer: United Healthcare Medicare Advantage	$4.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.48
Rate for Payer: Wellcare Medicare	$3.92

LIPOPROTEIN PHENOTYPING

Facility

$33.48

Service Code	HCPCS 80061
Hospital Charge Code	40609856
Hospital Revenue Code	301
Rate for Payer: Cash Price	$13.39

LIPOPROTEIN PHENOTYPING

Facility

$33.48

Service Code	HCPCS 80061
Hospital Charge Code	40609856
Hospital Revenue Code	301
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$25.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.39
Rate for Payer: Aetna Government	$13.39
Rate for Payer: Affinity Essential Plan 1&2	$9.37
Rate for Payer: Affinity Essential Plan 3&4	$9.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.37
Rate for Payer: Brighton Health Commercial	$25.11
Rate for Payer: Cash Price	$13.39
Rate for Payer: Cash Price	$13.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.51
Rate for Payer: Elderplan Medicare Advantage	$13.39
Rate for Payer: EmblemHealth Commercial	$13.39
Rate for Payer: Fidelis Essential Plan Aliesa	$11.38
Rate for Payer: Fidelis Essential Plan QHP	$11.92
Rate for Payer: Fidelis Medicare Advantage	$13.39
Rate for Payer: Fidelis Qualified Health Plan	$11.92
Rate for Payer: Group Health Inc Commercial	$13.39
Rate for Payer: Group Health Inc Medicare	$13.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.74
Rate for Payer: Hamaspik Choice Inc Medicare	$13.39
Rate for Payer: Healthfirst Medicare Advantage	$13.39
Rate for Payer: Healthfirst QHP	$13.39
Rate for Payer: Humana Medicare	$13.66
Rate for Payer: Senior Whole Health Medicare Advantage	$13.39
Rate for Payer: United Healthcare Commercial	$16.96
Rate for Payer: United Healthcare Medicare Advantage	$13.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.71
Rate for Payer: Wellcare Medicare	$12.05

LIQUID NITROGEN 50 LITER TANK

Facility

$168.75

Hospital Charge Code	64902589
Hospital Revenue Code	270
Min. Negotiated Rate	$59.06
Max. Negotiated Rate	$135.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$92.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$84.38
Rate for Payer: Aetna Government	$84.38
Rate for Payer: Brighton Health Commercial	$126.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$114.75
Rate for Payer: Group Health Inc Commercial	$84.38
Rate for Payer: Group Health Inc Medicare	$59.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.38
Rate for Payer: Hamaspik Choice Inc Medicare	$84.38

LISINOPRIL 10 MG PO TABS [10449]

Facility

$0.15

Service Code	NDC 60687032511
Hospital Charge Code	60687032511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

LISINOPRIL 10 MG PO TABS [10449]

Facility

$0.98

Service Code	NDC 68180098003
Hospital Charge Code	68180098003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.67
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.64

LISINOPRIL 10 MG PO TABS [10449]

Facility

$0.98

Service Code	NDC 00591040710
Hospital Charge Code	00591040710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.67
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.64

LISINOPRIL 10 MG PO TABS [10449]

Facility

$0.06

Service Code	NDC 00904679861
Hospital Charge Code	00904679861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

LISINOPRIL 10 MG PO TABS [10449]

Facility

$0.99

Service Code	NDC 68180098001
Hospital Charge Code	68180098001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

LISINOPRIL 10 MG TAB

Facility

$1.00

Hospital Charge Code	41640311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

LISINOPRIL 10 MG TAB

Facility

$1.00

Hospital Charge Code	41650311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

LISINOPRIL 20 MG PO TABS [4526]

Facility

$0.08

Service Code	NDC 00904679961
Hospital Charge Code	00904679961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

LISINOPRIL 20 MG PO TABS [4526]

Facility

$0.15

Service Code	NDC 60687033301
Hospital Charge Code	60687033301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

LISINOPRIL 20 MG PO TABS [4526]

Facility

$1.05

Service Code	NDC 68180098103
Hospital Charge Code	68180098103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.72
Rate for Payer: Group Health Inc Commercial	$0.53
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53
Rate for Payer: Hamaspik Choice Inc Medicare	$0.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.68

LISINOPRIL 20 MG PO TABS [4526]

Facility

$1.06

Service Code	NDC 68180098101
Hospital Charge Code	68180098101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$0.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.72
Rate for Payer: Group Health Inc Commercial	$0.53
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53
Rate for Payer: Hamaspik Choice Inc Medicare	$0.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.69

LISINOPRIL 20 MG TAB

Facility

$0.06

Hospital Charge Code	41642153
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

LISINOPRIL 20 MG TAB

Facility

$0.06

Hospital Charge Code	41652153
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

LISINOPRIL 2.5 MG PO TABS [13089]

Facility

$0.64

Service Code	NDC 68180051202
Hospital Charge Code	68180051202
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: Group Health Inc Commercial	$0.32
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32
Rate for Payer: Hamaspik Choice Inc Medicare	$0.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

LISINOPRIL 2.5 MG PO TABS [13089]

Facility

$0.63

Service Code	NDC 00591040505
Hospital Charge Code	00591040505
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.43
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.41

LISINOPRIL 2.5 MG PO TABS [13089]

Facility

$0.68

Service Code	NDC 68084076521
Hospital Charge Code	68084076521
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.34
Rate for Payer: Aetna Government	$0.34
Rate for Payer: Brighton Health Commercial	$0.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
Rate for Payer: Group Health Inc Commercial	$0.34
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.44

LISINOPRIL 2.5 MG PO TABS [13089]

Facility

$0.65

Service Code	NDC 68180051201
Hospital Charge Code	68180051201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: Group Health Inc Commercial	$0.32
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32
Rate for Payer: Hamaspik Choice Inc Medicare	$0.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

Know your out-of-pocket cost for care.

All Charges