Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

SALINE NASAL SPRAY 0.65 % NA SOLN

Facility

IP

$0.05

Service Code	NDC 0225038080
Hospital Charge Code	0225038080
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

SALINE NASAL SPRAY 0.65 % NA SOLN

Facility

OP

$0.08

Service Code	NDC 0225055050
Hospital Charge Code	0225055050
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: EmblemHealth Commercial	$0.04
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

SALINE NASAL SPRAY 0.65 % NA SOLN

Facility

OP

$0.05

Service Code	NDC 0225038080
Hospital Charge Code	0225038080
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
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	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.03
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	$0.03

SALINE NASAL SPRAY 0.65 % NA SOLN

Facility

IP

$0.08

Service Code	NDC 0225055050
Hospital Charge Code	0225055050
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

SALINE NASAL SPRAY 0.65 % NA SOLN

Facility

IP

$0.03

Service Code	NDC 0904386575
Hospital Charge Code	0904386575
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

SALINE NASAL SPRAY 0.65 % NA SOLN

Facility

OP

$0.09

Service Code	NDC 4580235758
Hospital Charge Code	4580235758
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	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.04
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	$0.06

SALINE NASAL SPRAY 0.65 % NA SOLN

Facility

IP

$0.09

Service Code	NDC 4580235758
Hospital Charge Code	4580235758
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

SALINE NASAL SPRAY 0.65 % NA SOLN

Facility

IP

$0.08

Service Code	NDC 9629513160
Hospital Charge Code	9629513160
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

SALINE NASAL SPRAY 0.65 % NA SOLN

Facility

OP

$0.08

Service Code	NDC 9629513160
Hospital Charge Code	9629513160
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: EmblemHealth Commercial	$0.04
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

SALSALATE 500 MG PO TABS

Facility

IP

$1.95

Service Code	NDC 6516251210
Hospital Charge Code	6516251210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98

SALSALATE 500 MG PO TABS

Facility

OP

$1.95

Service Code	NDC 6516251210
Hospital Charge Code	6516251210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.98
Rate for Payer: Aetna Government	$0.98
Rate for Payer: Brighton Health Commercial	$1.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.33
Rate for Payer: EmblemHealth Commercial	$0.98
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.27

SALSALATE 750 MG PO TABS

Facility

OP

$2.75

Service Code	NDC 4219236610
Hospital Charge Code	4219236610
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.37
Rate for Payer: Aetna Government	$1.37
Rate for Payer: Brighton Health Commercial	$2.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.87
Rate for Payer: EmblemHealth Commercial	$1.37
Rate for Payer: Group Health Inc Commercial	$1.37
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.79

SALSALATE 750 MG PO TABS

Facility

IP

$2.75

Service Code	NDC 4219236610
Hospital Charge Code	4219236610
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37

SBH INFLIXIMAB 100 MG IV SOLR (REMICADE)

Facility

IP

$1.00

Service Code	HCPCS J1745
Hospital Charge Code	5789403001
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

SBH INFLIXIMAB 100 MG IV SOLR (REMICADE)

Facility

OP

$1.00

Service Code	HCPCS J1745
Hospital Charge Code	5789403001
Hospital Revenue Code	258
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$7,766.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.09
Rate for Payer: Aetna Government	$31.09
Rate for Payer: Affinity Essential Plan 1&2	$174.74
Rate for Payer: Affinity Essential Plan 3&4	$174.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$77.66
Rate for Payer: Amida Care Medicaid	$77.66
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$31.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$31.09
Rate for Payer: EmblemHealth Commercial	$31.09
Rate for Payer: EmblemHealth Essential Plan 1&2	$174.74
Rate for Payer: EmblemHealth Essential Plan 3&4	$77.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$77.66
Rate for Payer: Fidelis Essential Plan Aliesa	$174.74
Rate for Payer: Fidelis Essential Plan QHP	$174.74
Rate for Payer: Fidelis Medicare Advantage	$31.09
Rate for Payer: Fidelis Qualified Health Plan	$81.54
Rate for Payer: Group Health Inc Commercial	$31.09
Rate for Payer: Group Health Inc Medicare	$31.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.66
Rate for Payer: Hamaspik Choice Inc Medicare	$31.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7,766.00
Rate for Payer: Healthfirst Essential Plan	$174.74
Rate for Payer: Healthfirst Medicare Advantage	$26.43
Rate for Payer: Healthfirst QHP	$126.59
Rate for Payer: Humana Medicare	$31.71
Rate for Payer: Senior Whole Health Medicare Advantage	$31.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.66
Rate for Payer: SOMOS Essential	$174.74
Rate for Payer: United Healthcare Essential Plan 1&2	$174.74
Rate for Payer: United Healthcare Essential Plan 3&4	$85.43
Rate for Payer: United Healthcare Medicaid	$77.66
Rate for Payer: United Healthcare Medicare Advantage	$31.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$77.66
Rate for Payer: Wellcare Medicare	$29.54

Schizophrenia

Facility

IP

$18,936.00

Service Code	APR-DRG 7504
Min. Negotiated Rate	$3,416.10
Max. Negotiated Rate	$18,936.00
Rate for Payer: Affinity Essential Plan 1&2	$3,416.10
Rate for Payer: Affinity Essential Plan 3&4	$3,416.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,416.10
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,416.10
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,686.23
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,416.10
Rate for Payer: Fidelis Qualified Health Plan	$4,099.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,416.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,416.10
Rate for Payer: Healthfirst Commercial	$18,936.00
Rate for Payer: Healthfirst Essential Plan	$7,686.23
Rate for Payer: Healthfirst QHP	$6,217.30
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,416.10
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,686.23
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,686.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,416.10
Rate for Payer: SOMOS Essential	$7,686.23
Rate for Payer: United Healthcare Essential Plan 1&2	$7,686.23
Rate for Payer: United Healthcare Essential Plan 3&4	$7,686.23
Rate for Payer: United Healthcare Medicaid	$3,416.10

Schizophrenia

Facility

IP

$18,936.00

Service Code	APR-DRG 7503
Min. Negotiated Rate	$3,397.09
Max. Negotiated Rate	$18,936.00
Rate for Payer: Affinity Essential Plan 1&2	$3,397.09
Rate for Payer: Affinity Essential Plan 3&4	$3,397.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,397.09
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,397.09
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,643.45
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,397.09
Rate for Payer: Fidelis Qualified Health Plan	$4,076.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,397.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,397.09
Rate for Payer: Healthfirst Commercial	$18,936.00
Rate for Payer: Healthfirst Essential Plan	$7,643.45
Rate for Payer: Healthfirst QHP	$6,182.70
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,397.09
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,643.45
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,643.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,397.09
Rate for Payer: SOMOS Essential	$7,643.45
Rate for Payer: United Healthcare Essential Plan 1&2	$7,643.45
Rate for Payer: United Healthcare Essential Plan 3&4	$7,643.45
Rate for Payer: United Healthcare Medicaid	$3,397.09

Schizophrenia

Facility

IP

$18,936.00

Service Code	APR-DRG 7501
Min. Negotiated Rate	$3,280.14
Max. Negotiated Rate	$18,936.00
Rate for Payer: Affinity Essential Plan 1&2	$3,280.14
Rate for Payer: Affinity Essential Plan 3&4	$3,280.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,280.14
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,280.14
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,380.31
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,280.14
Rate for Payer: Fidelis Qualified Health Plan	$3,936.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,280.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,280.14
Rate for Payer: Healthfirst Commercial	$18,936.00
Rate for Payer: Healthfirst Essential Plan	$7,380.31
Rate for Payer: Healthfirst QHP	$5,969.85
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,280.14
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,380.31
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,380.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,280.14
Rate for Payer: SOMOS Essential	$7,380.31
Rate for Payer: United Healthcare Essential Plan 1&2	$7,380.31
Rate for Payer: United Healthcare Essential Plan 3&4	$7,380.31
Rate for Payer: United Healthcare Medicaid	$3,280.14

Schizophrenia

Facility

IP

$18,936.00

Service Code	APR-DRG 7502
Min. Negotiated Rate	$3,333.48
Max. Negotiated Rate	$18,936.00
Rate for Payer: Affinity Essential Plan 1&2	$3,333.48
Rate for Payer: Affinity Essential Plan 3&4	$3,333.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,333.48
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,333.48
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,500.33
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,333.48
Rate for Payer: Fidelis Qualified Health Plan	$4,000.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,333.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,333.48
Rate for Payer: Healthfirst Commercial	$18,936.00
Rate for Payer: Healthfirst Essential Plan	$7,500.33
Rate for Payer: Healthfirst QHP	$6,066.93
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,333.48
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,500.33
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,500.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,333.48
Rate for Payer: SOMOS Essential	$7,500.33
Rate for Payer: United Healthcare Essential Plan 1&2	$7,500.33
Rate for Payer: United Healthcare Essential Plan 3&4	$7,500.33
Rate for Payer: United Healthcare Medicaid	$3,333.48

SCHIZOPHRENIA

Facility

OP

$211.05

Service Code	EAPG 00820
Min. Negotiated Rate	$152.74
Max. Negotiated Rate	$211.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.74
Rate for Payer: Healthfirst Commercial	$211.05

SCIATICA

Facility

OP

$267.84

Service Code	EAPG 00658
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$267.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$194.40
Rate for Payer: Healthfirst Commercial	$267.84

SCOPOLAMINE 1 MG/3DAYS TD PT72

Facility

OP

$20.20

Service Code	NDC 5074250504
Hospital Charge Code	5074250504
Hospital Revenue Code	250
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$16.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.10
Rate for Payer: Aetna Government	$10.10
Rate for Payer: Brighton Health Commercial	$15.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.74
Rate for Payer: EmblemHealth Commercial	$10.10
Rate for Payer: Group Health Inc Commercial	$10.10
Rate for Payer: Group Health Inc Medicare	$7.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.10
Rate for Payer: Hamaspik Choice Inc Medicare	$10.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.13

SCOPOLAMINE 1 MG/3DAYS TD PT72

Facility

IP

$22.97

Service Code	NDC 5074250524
Hospital Charge Code	5074250524
Hospital Revenue Code	250
Min. Negotiated Rate	$11.49
Max. Negotiated Rate	$11.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.49

SCOPOLAMINE 1 MG/3DAYS TD PT72

Facility

IP

$20.20

Service Code	NDC 5074250504
Hospital Charge Code	5074250504
Hospital Revenue Code	250
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.10

SCOPOLAMINE 1 MG/3DAYS TD PT72

Facility

IP

$23.00

Service Code	NDC 4580258062
Hospital Charge Code	4580258062
Hospital Revenue Code	250
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$11.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.50