St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PHENOBARBITAL 4 MG/ML ELIX PEDIATRIC

Facility

$1.00

Hospital Charge Code	41655378
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

PHENOBARBITAL 60 MG/ML INJ

Facility

$6.00

Hospital Charge Code	41644441
Hospital Revenue Code	636
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00

PHENOBARBITAL 60 MG/ML INJ

Facility

$6.00

Hospital Charge Code	41644441
Hospital Revenue Code	636
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$3.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.45
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

PHENOBARBITAL 60 MG/ML INJ

Facility

$6.00

Hospital Charge Code	41654441
Hospital Revenue Code	636
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$3.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.45
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

PHENOBARBITAL 60 MG/ML INJ

Facility

$6.00

Hospital Charge Code	41654441
Hospital Revenue Code	636
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00

PHENOBARBITAL 65MG 1ML INJ

Facility

$3.00

Service Code	HCPCS J2560
Hospital Charge Code	41658003
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$45.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.22
Rate for Payer: Aetna Government	$40.22
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: SOMOS CHP/HARP/Medicaid	$34.77
Rate for Payer: SOMOS Essential	$34.77
Rate for Payer: United Healthcare Commercial	$45.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

PHENOBARBITAL 65MG 1ML INJ

Facility

$3.00

Service Code	HCPCS J2560
Hospital Charge Code	41648003
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

PHENOBARBITAL 65MG 1ML INJ

Facility

$3.00

Service Code	HCPCS J2560
Hospital Charge Code	41648003
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$45.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.22
Rate for Payer: Aetna Government	$40.22
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: SOMOS CHP/HARP/Medicaid	$34.77
Rate for Payer: SOMOS Essential	$34.77
Rate for Payer: United Healthcare Commercial	$45.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

PHENOBARBITAL 65MG 1ML INJ

Facility

$3.00

Service Code	HCPCS J2560
Hospital Charge Code	41658003
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

PHENOBARBITAL SODIUM 10 MG/ML INJECTION [701183]

Facility

$40.22

Service Code	HCPCS J2560
Hospital Revenue Code	250
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$40.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.22
Rate for Payer: Aetna Government	$40.22
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$32.80
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$34.77
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$34.77
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$34.77

PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN [6221]

Facility

$82.08

Service Code	HCPCS J2560
Hospital Charge Code	00641047725
Hospital Revenue Code	250
Min. Negotiated Rate	$28.73
Max. Negotiated Rate	$65.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.22
Rate for Payer: Aetna Government	$40.22
Rate for Payer: Brighton Health Commercial	$61.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.81
Rate for Payer: Group Health Inc Commercial	$41.04
Rate for Payer: Group Health Inc Medicare	$28.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.04
Rate for Payer: Hamaspik Choice Inc Medicare	$41.04
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$32.80
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$34.77
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$34.77
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$34.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.35

PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN [6221]

Facility

$82.08

Service Code	HCPCS J2560
Hospital Charge Code	00641047721
Hospital Revenue Code	250
Min. Negotiated Rate	$28.73
Max. Negotiated Rate	$65.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.22
Rate for Payer: Aetna Government	$40.22
Rate for Payer: Brighton Health Commercial	$61.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.81
Rate for Payer: Group Health Inc Commercial	$41.04
Rate for Payer: Group Health Inc Medicare	$28.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.04
Rate for Payer: Hamaspik Choice Inc Medicare	$41.04
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$32.80
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$34.77
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$34.77
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$34.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.35

PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN [6224]

Facility

$26.18

Service Code	HCPCS J2560
Hospital Charge Code	42494041525
Hospital Revenue Code	250
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$40.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.22
Rate for Payer: Aetna Government	$40.22
Rate for Payer: Brighton Health Commercial	$19.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.81
Rate for Payer: Group Health Inc Commercial	$13.09
Rate for Payer: Group Health Inc Medicare	$9.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.09
Rate for Payer: Hamaspik Choice Inc Medicare	$13.09
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$32.80
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$34.77
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$34.77
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$34.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.02

PHENOBARBITAL-U

Facility

$38.25

Service Code	HCPCS 80184
Hospital Charge Code	40607006
Hospital Revenue Code	301
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$28.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.30
Rate for Payer: Aetna Government	$15.30
Rate for Payer: Affinity Essential Plan 1&2	$10.71
Rate for Payer: Affinity Essential Plan 3&4	$10.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.71
Rate for Payer: Brighton Health Commercial	$28.69
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.41
Rate for Payer: Elderplan Medicare Advantage	$15.30
Rate for Payer: EmblemHealth Commercial	$15.30
Rate for Payer: Fidelis Essential Plan Aliesa	$13.00
Rate for Payer: Fidelis Essential Plan QHP	$13.62
Rate for Payer: Fidelis Medicare Advantage	$15.30
Rate for Payer: Fidelis Qualified Health Plan	$13.62
Rate for Payer: Group Health Inc Commercial	$15.30
Rate for Payer: Group Health Inc Medicare	$15.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.12
Rate for Payer: Hamaspik Choice Inc Medicare	$15.30
Rate for Payer: Healthfirst Medicare Advantage	$15.30
Rate for Payer: Healthfirst QHP	$15.30
Rate for Payer: Humana Medicare	$15.61
Rate for Payer: Senior Whole Health Medicare Advantage	$15.30
Rate for Payer: United Healthcare Commercial	$14.51
Rate for Payer: United Healthcare Medicare Advantage	$15.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.24
Rate for Payer: Wellcare Medicare	$13.77

PHENOBARBITAL-U

Facility

$38.25

Service Code	HCPCS 80184
Hospital Charge Code	40607006
Hospital Revenue Code	301
Rate for Payer: Cash Price	$15.30

PHENOBARBITOL

Facility

$38.25

Service Code	HCPCS 80184
Hospital Charge Code	40602025
Hospital Revenue Code	301
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$28.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.30
Rate for Payer: Aetna Government	$15.30
Rate for Payer: Affinity Essential Plan 1&2	$10.71
Rate for Payer: Affinity Essential Plan 3&4	$10.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.71
Rate for Payer: Brighton Health Commercial	$28.69
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.41
Rate for Payer: Elderplan Medicare Advantage	$15.30
Rate for Payer: EmblemHealth Commercial	$15.30
Rate for Payer: Fidelis Essential Plan Aliesa	$13.00
Rate for Payer: Fidelis Essential Plan QHP	$13.62
Rate for Payer: Fidelis Medicare Advantage	$15.30
Rate for Payer: Fidelis Qualified Health Plan	$13.62
Rate for Payer: Group Health Inc Commercial	$15.30
Rate for Payer: Group Health Inc Medicare	$15.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.12
Rate for Payer: Hamaspik Choice Inc Medicare	$15.30
Rate for Payer: Healthfirst Medicare Advantage	$15.30
Rate for Payer: Healthfirst QHP	$15.30
Rate for Payer: Humana Medicare	$15.61
Rate for Payer: Senior Whole Health Medicare Advantage	$15.30
Rate for Payer: United Healthcare Commercial	$14.51
Rate for Payer: United Healthcare Medicare Advantage	$15.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.24
Rate for Payer: Wellcare Medicare	$13.77

PHENOBARBITOL

Facility

$38.25

Service Code	HCPCS 80184
Hospital Charge Code	40602025
Hospital Revenue Code	301
Rate for Payer: Cash Price	$15.30

PHENOBARBITOL 130MG/1ML - 120MG

Facility

$7.20

Service Code	HCPCS J2560
Hospital Charge Code	41648053
Hospital Revenue Code	636
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$45.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.22
Rate for Payer: Aetna Government	$40.22
Rate for Payer: Brighton Health Commercial	$4.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: Group Health Inc Commercial	$3.60
Rate for Payer: Group Health Inc Medicare	$2.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60
Rate for Payer: Hamaspik Choice Inc Medicare	$3.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34.77
Rate for Payer: SOMOS Essential	$34.77
Rate for Payer: United Healthcare Commercial	$45.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.68

PHENOBARBITOL 130MG/1ML - 120MG

Facility

$7.20

Service Code	HCPCS J2560
Hospital Charge Code	41648053
Hospital Revenue Code	636
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60
Rate for Payer: Hamaspik Choice Inc Medicare	$3.60

PHENOBARBITOL 130MG/1ML - 250MG

Facility

$7.20

Service Code	HCPCS J2560
Hospital Charge Code	41658053
Hospital Revenue Code	636
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60
Rate for Payer: Hamaspik Choice Inc Medicare	$3.60

PHENOBARBITOL 130MG/1ML - 250MG

Facility

$7.20

Service Code	HCPCS J2560
Hospital Charge Code	41658053
Hospital Revenue Code	636
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$45.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.22
Rate for Payer: Aetna Government	$40.22
Rate for Payer: Brighton Health Commercial	$4.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: Group Health Inc Commercial	$3.60
Rate for Payer: Group Health Inc Medicare	$2.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60
Rate for Payer: Hamaspik Choice Inc Medicare	$3.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34.77
Rate for Payer: SOMOS Essential	$34.77
Rate for Payer: United Healthcare Commercial	$45.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.68

PHENOL 1.4 % MT LIQD [36976]

Facility

$0.02

Service Code	NDC 00904630521
Hospital Charge Code	00904630521
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

PHENOL 89 % EX SWAB [39587]

Facility

$5.46

Service Code	NDC 00884629730
Hospital Charge Code	00884629730
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$4.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.73
Rate for Payer: Aetna Government	$2.73
Rate for Payer: Brighton Health Commercial	$4.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.71
Rate for Payer: Group Health Inc Commercial	$2.73
Rate for Payer: Group Health Inc Medicare	$1.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.73
Rate for Payer: Hamaspik Choice Inc Medicare	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.55

PHENOL (ORAL) SPRAY

Facility

$5.00

Hospital Charge Code	41640612
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

PHENOL (ORAL) SPRAY

Facility

$5.00

Hospital Charge Code	41650612
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

Know your out-of-pocket cost for care.

All Charges