St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR [35943]

Facility

$0.68

Service Code	NDC 00245531901
Hospital Charge Code	00245531901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.37
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	$0.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.46
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

POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR [35943]

Facility

$0.63

Service Code	NDC 00832532511
Hospital Charge Code	00832532511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
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

POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR [35943]

Facility

$0.68

Service Code	NDC 00245531989
Hospital Charge Code	00245531989
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.37
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	$0.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.46
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

POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR [35943]

Facility

$0.63

Service Code	NDC 00832532510
Hospital Charge Code	00832532510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
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

POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN [36046]

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	00338070434
Hospital Revenue Code	278
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN [36046]

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	00338070434
Hospital Revenue Code	278
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00

POTASSIUM CHLORIDE IN NACL 20-0.9 MEQ/L-% IV SOLN [11081]

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	00338069104
Hospital Revenue Code	278
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
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: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
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

POTASSIUM CHLORIDE IN NACL 20-0.9 MEQ/L-% IV SOLN [11081]

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	00264786500
Hospital Revenue Code	278
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00

POTASSIUM CHLORIDE IN NACL 20-0.9 MEQ/L-% IV SOLN [11081]

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	00338069104
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

POTASSIUM CHLORIDE IN NACL 20-0.9 MEQ/L-% IV SOLN [11081]

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	00264786500
Hospital Revenue Code	278
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

POTASSIUM CHLORIDE IN NACL 40-0.9 MEQ/L-% IV SOLN [11082]

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	00338069504
Hospital Revenue Code	278
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
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: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
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

POTASSIUM CHLORIDE IN NACL 40-0.9 MEQ/L-% IV SOLN [11082]

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	00338069504
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

POTASSIUM CHLORIDE LIQUID 20 MEQ / 15 ML

Facility

$0.81

Hospital Charge Code	41645283
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.41
Rate for Payer: Aetna Government	$0.41
Rate for Payer: Brighton Health Commercial	$0.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.55
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.53

POTASSIUM CHLORIDE LIQUID 20 MEQ / 15 ML

Facility

$0.81

Hospital Charge Code	41655283
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.41
Rate for Payer: Aetna Government	$0.41
Rate for Payer: Brighton Health Commercial	$0.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.55
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.53

POTASSIUM CHLORIDE POWDER 20 MEQ

Facility

$2.00

Hospital Charge Code	41651945
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

POTASSIUM CHLORIDE POWDER 20 MEQ

Facility

$2.00

Hospital Charge Code	41641945
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

POTASSIUM CITRATE + CITRIC ACID (POLYCIT

Facility

$1.00

Hospital Charge Code	41642412
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

POTASSIUM CITRATE + CITRIC ACID (POLYCIT

Facility

$1.00

Hospital Charge Code	41652412
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

POTASSIUM CITRATE + SODIUM CITRATE + CIT

Facility

$1.00

Hospital Charge Code	41642275
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

POTASSIUM CITRATE + SODIUM CITRATE + CIT

Facility

$1.00

Hospital Charge Code	41652275
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

POTASSIUM, FECAL

Facility

$165.00

Service Code	HCPCS 84999
Hospital Charge Code	40609900
Hospital Revenue Code	301
Min. Negotiated Rate	$5.31
Max. Negotiated Rate	$123.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$82.50
Rate for Payer: Aetna Government	$82.50
Rate for Payer: Brighton Health Commercial	$123.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.31
Rate for Payer: Group Health Inc Commercial	$82.50
Rate for Payer: Group Health Inc Medicare	$57.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.50
Rate for Payer: Hamaspik Choice Inc Medicare	$82.50

POTASSIUM HYDROXIDE PREPS

Facility

$14.58

Service Code	HCPCS Q0112
Hospital Charge Code	42201732
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.83

POTASSIUM HYDROXIDE PREPS

Facility

$14.58

Service Code	HCPCS Q0112
Hospital Charge Code	42201732
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$11.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.83
Rate for Payer: Aetna Government	$5.83
Rate for Payer: Affinity Essential Plan 1&2	$4.08
Rate for Payer: Affinity Essential Plan 3&4	$4.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.08
Rate for Payer: Brighton Health Commercial	$10.94
Rate for Payer: Cash Price	$5.83
Rate for Payer: Cash Price	$5.83
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.91
Rate for Payer: Elderplan Medicare Advantage	$5.83
Rate for Payer: EmblemHealth Commercial	$5.83
Rate for Payer: Fidelis Essential Plan Aliesa	$4.96
Rate for Payer: Fidelis Essential Plan QHP	$5.19
Rate for Payer: Fidelis Medicare Advantage	$5.83
Rate for Payer: Fidelis Qualified Health Plan	$5.19
Rate for Payer: Group Health Inc Commercial	$5.83
Rate for Payer: Group Health Inc Medicare	$5.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.29
Rate for Payer: Hamaspik Choice Inc Medicare	$5.83
Rate for Payer: Healthfirst Medicare Advantage	$4.96
Rate for Payer: Healthfirst QHP	$5.83
Rate for Payer: Humana Medicare	$5.95
Rate for Payer: Senior Whole Health Medicare Advantage	$5.83
Rate for Payer: United Healthcare Commercial	$5.41
Rate for Payer: United Healthcare Medicare Advantage	$5.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.66
Rate for Payer: Wellcare Medicare	$5.25

POTASSIUM IODIDE 1000 MG/ML (SSKI) SOLN

Facility

$0.64

Hospital Charge Code	41651017
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

POTASSIUM IODIDE 1000 MG/ML (SSKI) SOLN

Facility

$0.64

Hospital Charge Code	41641017
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

Know your out-of-pocket cost for care.

All Charges