St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PEN G POT 1MU/D5W 50ML

Facility

$16.00

Service Code	HCPCS J2540
Hospital Charge Code	41651956
Hospital Revenue Code	636
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.92
Rate for Payer: Aetna Government	$0.92
Rate for Payer: Brighton Health Commercial	$9.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.20
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.88
Rate for Payer: SOMOS Essential	$0.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

PEN G POT 1MU/D5W 50ML

Facility

$16.00

Service Code	HCPCS J2540
Hospital Charge Code	41651956
Hospital Revenue Code	636
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00

PEN G POT 1MU/D5W 50ML

Facility

$16.00

Service Code	HCPCS J2540
Hospital Charge Code	41641956
Hospital Revenue Code	636
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.92
Rate for Payer: Aetna Government	$0.92
Rate for Payer: Brighton Health Commercial	$9.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.20
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.88
Rate for Payer: SOMOS Essential	$0.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

PEN G POT 1MU/D5W 50ML

Facility

$16.00

Service Code	HCPCS J2540
Hospital Charge Code	41641956
Hospital Revenue Code	636
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00

PEN G POT 2MU/D5W 50ML

Facility

$1.00

Service Code	HCPCS J2540
Hospital Charge Code	41651957
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

PEN G POT 2MU/D5W 50ML

Facility

$1.00

Service Code	HCPCS J2540
Hospital Charge Code	41651957
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.92
Rate for Payer: Aetna Government	$0.92
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
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: SOMOS CHP/HARP/Medicaid	$0.88
Rate for Payer: SOMOS Essential	$0.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

PEN G POT 2MU/D5W 50ML

Facility

$1.00

Service Code	HCPCS J2540
Hospital Charge Code	41641957
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.92
Rate for Payer: Aetna Government	$0.92
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
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: SOMOS CHP/HARP/Medicaid	$0.88
Rate for Payer: SOMOS Essential	$0.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

PEN G POT 2MU/D5W 50ML

Facility

$1.00

Service Code	HCPCS J2540
Hospital Charge Code	41641957
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

PEN G POT 3MU/D5W 50ML

Facility

$1.00

Service Code	HCPCS J2540
Hospital Charge Code	41651958
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

PEN G POT 3MU/D5W 50ML

Facility

$1.00

Service Code	HCPCS J2540
Hospital Charge Code	41651958
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.92
Rate for Payer: Aetna Government	$0.92
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
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: SOMOS CHP/HARP/Medicaid	$0.88
Rate for Payer: SOMOS Essential	$0.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

PEN G POT 3MU/D5W 50ML

Facility

$1.00

Service Code	HCPCS J2540
Hospital Charge Code	41641958
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.92
Rate for Payer: Aetna Government	$0.92
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
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: SOMOS CHP/HARP/Medicaid	$0.88
Rate for Payer: SOMOS Essential	$0.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

PEN G POT 3MU/D5W 50ML

Facility

$1.00

Service Code	HCPCS J2540
Hospital Charge Code	41641958
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

PEN G POT 4ML/D5W 50ML

Facility

$1.00

Hospital Charge Code	41655879
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

PEN G POT 4 MU/D5W 50ML

Facility

$1.00

Hospital Charge Code	41645879
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

PENICILLAMINE 250 MG CAP

Facility

$12.17

Hospital Charge Code	41641402
Hospital Revenue Code	250
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$9.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$9.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.28
Rate for Payer: Group Health Inc Commercial	$6.08
Rate for Payer: Group Health Inc Medicare	$4.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.08
Rate for Payer: Hamaspik Choice Inc Medicare	$6.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.91

PENICILLAMINE 250 MG CAP

Facility

$12.17

Hospital Charge Code	41651402
Hospital Revenue Code	250
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$9.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$9.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.28
Rate for Payer: Group Health Inc Commercial	$6.08
Rate for Payer: Group Health Inc Medicare	$4.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.08
Rate for Payer: Hamaspik Choice Inc Medicare	$6.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.91

PENICILLAMINE 250 MG PO CAPS [10894]

Facility

$298.55

Service Code	NDC 00591417101
Hospital Charge Code	00591417101
Hospital Revenue Code	250
Min. Negotiated Rate	$104.49
Max. Negotiated Rate	$238.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$164.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$149.28
Rate for Payer: Aetna Government	$149.28
Rate for Payer: Brighton Health Commercial	$223.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$238.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$203.01
Rate for Payer: Group Health Inc Commercial	$149.28
Rate for Payer: Group Health Inc Medicare	$104.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.28
Rate for Payer: Hamaspik Choice Inc Medicare	$149.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$194.06

PENICILLIN/BETA LACTAM ALLERGY SKIN TEST

Facility

$1.00

Hospital Charge Code	41651597
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

PENICILLIN/BETA LACTAM ALLERGY SKIN TEST

Facility

$1.00

Hospital Charge Code	41641597
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

PENICILLIN/BETA LACTAM DESENSITIZATION I

Facility

$1.00

Hospital Charge Code	41641596
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

PENICILLIN/BETA LACTAM DESENSITIZATION I

Facility

$1.00

Hospital Charge Code	41651596
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

PENICILLIN G BENZATHIN 600,000 UNITS/ML

Facility

$25.00

Service Code	HCPCS J0561
Hospital Charge Code	41644649
Hospital Revenue Code	636
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$23.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.73
Rate for Payer: Aetna Government	$21.73
Rate for Payer: Affinity Essential Plan 1&2	$15.21
Rate for Payer: Affinity Essential Plan 3&4	$15.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$15.21
Rate for Payer: Brighton Health Commercial	$15.00
Rate for Payer: Cash Price	$21.73
Rate for Payer: Cash Price	$21.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.38
Rate for Payer: Elderplan Medicare Advantage	$21.73
Rate for Payer: EmblemHealth Commercial	$21.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21.73
Rate for Payer: Fidelis Essential Plan Aliesa	$21.73
Rate for Payer: Fidelis Essential Plan QHP	$22.82
Rate for Payer: Fidelis Medicare Advantage	$21.73
Rate for Payer: Fidelis Qualified Health Plan	$22.82
Rate for Payer: Group Health Inc Commercial	$21.73
Rate for Payer: Group Health Inc Medicare	$21.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: Healthfirst Medicare Advantage	$18.47
Rate for Payer: Healthfirst QHP	$21.73
Rate for Payer: Humana Medicare	$22.16
Rate for Payer: Senior Whole Health Medicare Advantage	$21.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.32
Rate for Payer: SOMOS Essential	$23.32
Rate for Payer: United Healthcare Commercial	$18.11
Rate for Payer: United Healthcare Medicare Advantage	$21.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.38
Rate for Payer: Wellcare Medicare	$20.64

PENICILLIN G BENZATHIN 600,000 UNITS/ML

Facility

$25.00

Service Code	HCPCS J0561
Hospital Charge Code	41654649
Hospital Revenue Code	636
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$12.50
Rate for Payer: Cash Price	$21.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50

PENICILLIN G BENZATHIN 600,000 UNITS/ML

Facility

$25.00

Service Code	HCPCS J0561
Hospital Charge Code	41654649
Hospital Revenue Code	636
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$23.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.73
Rate for Payer: Aetna Government	$21.73
Rate for Payer: Affinity Essential Plan 1&2	$15.21
Rate for Payer: Affinity Essential Plan 3&4	$15.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$15.21
Rate for Payer: Brighton Health Commercial	$15.00
Rate for Payer: Cash Price	$21.73
Rate for Payer: Cash Price	$21.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.38
Rate for Payer: Elderplan Medicare Advantage	$21.73
Rate for Payer: EmblemHealth Commercial	$21.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21.73
Rate for Payer: Fidelis Essential Plan Aliesa	$21.73
Rate for Payer: Fidelis Essential Plan QHP	$22.82
Rate for Payer: Fidelis Medicare Advantage	$21.73
Rate for Payer: Fidelis Qualified Health Plan	$22.82
Rate for Payer: Group Health Inc Commercial	$21.73
Rate for Payer: Group Health Inc Medicare	$21.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: Healthfirst Medicare Advantage	$18.47
Rate for Payer: Healthfirst QHP	$21.73
Rate for Payer: Humana Medicare	$22.16
Rate for Payer: Senior Whole Health Medicare Advantage	$21.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.32
Rate for Payer: SOMOS Essential	$23.32
Rate for Payer: United Healthcare Commercial	$18.11
Rate for Payer: United Healthcare Medicare Advantage	$21.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.38
Rate for Payer: Wellcare Medicare	$20.64

PENICILLIN G BENZATHIN 600,000 UNITS/ML

Facility

$25.00

Service Code	HCPCS J0561
Hospital Charge Code	41644649
Hospital Revenue Code	636
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$12.50
Rate for Payer: Cash Price	$21.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50

Know your out-of-pocket cost for care.

All Charges