St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NEOMYCIN 500 MG TAB

Facility

$3.00

Hospital Charge Code	41640601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

NEOMYCIN + BACITRACIN + POLYMYXIN B OPHT

Facility

$84.00

Hospital Charge Code	41650440
Hospital Revenue Code	250
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$67.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.00
Rate for Payer: Aetna Government	$42.00
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.12
Rate for Payer: Group Health Inc Commercial	$42.00
Rate for Payer: Group Health Inc Medicare	$29.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.00
Rate for Payer: Hamaspik Choice Inc Medicare	$42.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$54.60

NEOMYCIN + BACITRACIN + POLYMYXIN B OPHT

Facility

$84.00

Hospital Charge Code	41640440
Hospital Revenue Code	250
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$67.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.00
Rate for Payer: Aetna Government	$42.00
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.12
Rate for Payer: Group Health Inc Commercial	$42.00
Rate for Payer: Group Health Inc Medicare	$29.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.00
Rate for Payer: Hamaspik Choice Inc Medicare	$42.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$54.60

NEOMYCIN-BACITRACIN ZN-POLYMYX 5-400-10000 OP OINT [38701]

Facility

$16.27

Service Code	NDC 24208078055
Hospital Charge Code	24208078055
Hospital Revenue Code	250
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$13.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.14
Rate for Payer: Aetna Government	$8.14
Rate for Payer: Brighton Health Commercial	$12.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.06
Rate for Payer: Group Health Inc Commercial	$8.14
Rate for Payer: Group Health Inc Medicare	$5.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.14
Rate for Payer: Hamaspik Choice Inc Medicare	$8.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.58

NEOMYCIN/POLYMYX/DEX OPHTH OINT

Facility

$3.00

Hospital Charge Code	41655758
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

NEOMYCIN/POLYMYX/DEX OPHTH SUSP

Facility

$3.00

Hospital Charge Code	41645757
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

NEOMYCIN/POLYMYX/DEX OPHTH SUSP

Facility

$3.00

Hospital Charge Code	41655757
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

NEOMYCIN + POLYMYXIN B + BACITRACIN + HC

Facility

$102.00

Hospital Charge Code	41652299
Hospital Revenue Code	250
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$81.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
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

NEOMYCIN + POLYMYXIN B + BACITRACIN + HC

Facility

$102.00

Hospital Charge Code	41642299
Hospital Revenue Code	250
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$81.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
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

NEOMYCIN + POLYMYXIN B + GRAMICIDIN OPHT

Facility

$12.34

Hospital Charge Code	41643481
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$9.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.17
Rate for Payer: Aetna Government	$6.17
Rate for Payer: Brighton Health Commercial	$9.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.39
Rate for Payer: Group Health Inc Commercial	$6.17
Rate for Payer: Group Health Inc Medicare	$4.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.17
Rate for Payer: Hamaspik Choice Inc Medicare	$6.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.02

NEOMYCIN + POLYMYXIN B + GRAMICIDIN OPHT

Facility

$12.34

Hospital Charge Code	41653481
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$9.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.17
Rate for Payer: Aetna Government	$6.17
Rate for Payer: Brighton Health Commercial	$9.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.39
Rate for Payer: Group Health Inc Commercial	$6.17
Rate for Payer: Group Health Inc Medicare	$4.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.17
Rate for Payer: Hamaspik Choice Inc Medicare	$6.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.02

NEOMYCIN + POLYMYXIN B + HYDROCORTISONE

Facility

$113.00

Hospital Charge Code	41653400
Hospital Revenue Code	250
Min. Negotiated Rate	$39.55
Max. Negotiated Rate	$90.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.50
Rate for Payer: Aetna Government	$56.50
Rate for Payer: Brighton Health Commercial	$84.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.84
Rate for Payer: Group Health Inc Commercial	$56.50
Rate for Payer: Group Health Inc Medicare	$39.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.50
Rate for Payer: Hamaspik Choice Inc Medicare	$56.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.45

NEOMYCIN + POLYMYXIN B + HYDROCORTISONE

Facility

$11.06

Hospital Charge Code	41653403
Hospital Revenue Code	250
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$8.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.53
Rate for Payer: Aetna Government	$5.53
Rate for Payer: Brighton Health Commercial	$8.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.52
Rate for Payer: Group Health Inc Commercial	$5.53
Rate for Payer: Group Health Inc Medicare	$3.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.53
Rate for Payer: Hamaspik Choice Inc Medicare	$5.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.19

NEOMYCIN + POLYMYXIN B + HYDROCORTISONE

Facility

$113.00

Hospital Charge Code	41643400
Hospital Revenue Code	250
Min. Negotiated Rate	$39.55
Max. Negotiated Rate	$90.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.50
Rate for Payer: Aetna Government	$56.50
Rate for Payer: Brighton Health Commercial	$84.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.84
Rate for Payer: Group Health Inc Commercial	$56.50
Rate for Payer: Group Health Inc Medicare	$39.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.50
Rate for Payer: Hamaspik Choice Inc Medicare	$56.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.45

NEOMYCIN + POLYMYXIN B + HYDROCORTISONE

Facility

$11.06

Hospital Charge Code	41643403
Hospital Revenue Code	250
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$8.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.53
Rate for Payer: Aetna Government	$5.53
Rate for Payer: Brighton Health Commercial	$8.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.52
Rate for Payer: Group Health Inc Commercial	$5.53
Rate for Payer: Group Health Inc Medicare	$3.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.53
Rate for Payer: Hamaspik Choice Inc Medicare	$5.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.19

NEOMYCIN + POLYMYXIN B + PREDNISOLONE OP

Facility

$45.38

Hospital Charge Code	41655403
Hospital Revenue Code	250
Min. Negotiated Rate	$15.88
Max. Negotiated Rate	$36.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.69
Rate for Payer: Aetna Government	$22.69
Rate for Payer: Brighton Health Commercial	$34.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.86
Rate for Payer: Group Health Inc Commercial	$22.69
Rate for Payer: Group Health Inc Medicare	$15.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.69
Rate for Payer: Hamaspik Choice Inc Medicare	$22.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.50

NEOMYCIN + POLYMYXIN B + PREDNISOLONE OP

Facility

$45.38

Hospital Charge Code	41645403
Hospital Revenue Code	250
Min. Negotiated Rate	$15.88
Max. Negotiated Rate	$36.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.69
Rate for Payer: Aetna Government	$22.69
Rate for Payer: Brighton Health Commercial	$34.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.86
Rate for Payer: Group Health Inc Commercial	$22.69
Rate for Payer: Group Health Inc Medicare	$15.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.69
Rate for Payer: Hamaspik Choice Inc Medicare	$22.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.50

NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP [10708]

Facility

$3.97

Service Code	NDC 24208083060
Hospital Charge Code	24208083060
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$3.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.99
Rate for Payer: Aetna Government	$1.99
Rate for Payer: Brighton Health Commercial	$2.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.70
Rate for Payer: Group Health Inc Commercial	$1.99
Rate for Payer: Group Health Inc Medicare	$1.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.99
Rate for Payer: Hamaspik Choice Inc Medicare	$1.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.58

NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP [10708]

Facility

$27.13

Service Code	NDC 00998063006
Hospital Charge Code	00998063006
Hospital Revenue Code	250
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$21.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.56
Rate for Payer: Aetna Government	$13.56
Rate for Payer: Brighton Health Commercial	$20.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.45
Rate for Payer: Group Health Inc Commercial	$13.56
Rate for Payer: Group Health Inc Medicare	$9.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.56
Rate for Payer: Hamaspik Choice Inc Medicare	$13.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.63

NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP [10708]

Facility

$8.80

Service Code	NDC 61314063006
Hospital Charge Code	61314063006
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$7.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.40
Rate for Payer: Aetna Government	$4.40
Rate for Payer: Brighton Health Commercial	$6.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.98
Rate for Payer: Group Health Inc Commercial	$4.40
Rate for Payer: Group Health Inc Medicare	$3.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.40
Rate for Payer: Hamaspik Choice Inc Medicare	$4.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.72

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT [106249]

Facility

$77.11

Service Code	NDC 00078077101
Hospital Charge Code	00078077101
Hospital Revenue Code	250
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$61.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.55
Rate for Payer: Aetna Government	$38.55
Rate for Payer: Brighton Health Commercial	$57.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$61.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$52.43
Rate for Payer: Group Health Inc Commercial	$38.55
Rate for Payer: Group Health Inc Medicare	$26.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.55
Rate for Payer: Hamaspik Choice Inc Medicare	$38.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.12

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT [106249]

Facility

$5.67

Service Code	NDC 24208079535
Hospital Charge Code	24208079535
Hospital Revenue Code	250
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$4.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$4.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.86
Rate for Payer: Group Health Inc Commercial	$2.84
Rate for Payer: Group Health Inc Medicare	$1.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.84
Rate for Payer: Hamaspik Choice Inc Medicare	$2.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.69

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT [106249]

Facility

$12.57

Service Code	NDC 61314063136
Hospital Charge Code	61314063136
Hospital Revenue Code	250
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$10.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.29
Rate for Payer: Aetna Government	$6.29
Rate for Payer: Brighton Health Commercial	$9.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.55
Rate for Payer: Group Health Inc Commercial	$6.29
Rate for Payer: Group Health Inc Medicare	$4.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.29
Rate for Payer: Hamaspik Choice Inc Medicare	$6.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.17

NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SOLN [34814]

Facility

$10.07

Service Code	NDC 24208063110
Hospital Charge Code	24208063110
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$8.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.03
Rate for Payer: Aetna Government	$5.03
Rate for Payer: Brighton Health Commercial	$7.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.85
Rate for Payer: Group Health Inc Commercial	$5.03
Rate for Payer: Group Health Inc Medicare	$3.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.03
Rate for Payer: Hamaspik Choice Inc Medicare	$5.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.54

NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP [28810]

Facility

$10.49

Service Code	NDC 61314064511
Hospital Charge Code	61314064511
Hospital Revenue Code	250
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$8.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.24
Rate for Payer: Aetna Government	$5.24
Rate for Payer: Brighton Health Commercial	$7.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.13
Rate for Payer: Group Health Inc Commercial	$5.24
Rate for Payer: Group Health Inc Medicare	$3.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.24
Rate for Payer: Hamaspik Choice Inc Medicare	$5.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.82

Know your out-of-pocket cost for care.

All Charges