St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SILVER NITRATE-POT NITRATE 75-25 % EX MISC [11359]

Facility

$0.24

Service Code	NDC 12165010001
Hospital Charge Code	12165010001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

SILVER NITRATE-POT NITRATE 75-25 % EX MISC [11359]

Facility

$0.91

Service Code	NDC 12870000101
Hospital Charge Code	12870000101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.62
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

SILVER NITRATE TOPICAL STICK

Facility

$1.00

Hospital Charge Code	41640491
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

SILVER NITRATE TOPICAL STICK

Facility

$1.00

Hospital Charge Code	41650491
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

SILVER PTX STENT

Facility

$3,737.50

Service Code	HCPCS C1874
Hospital Charge Code	64903949
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,924.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,055.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,242.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,868.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,149.06
Rate for Payer: EmblemHealth Commercial	$1,868.75
Rate for Payer: Fidelis Medicare Advantage	$3,924.38
Rate for Payer: Group Health Inc Commercial	$1,868.75
Rate for Payer: Group Health Inc Medicare	$1,308.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,868.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,429.38

SILVER PTX STENT

Facility

$3,737.50

Service Code	HCPCS C1874
Hospital Charge Code	64903949
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.75
Max. Negotiated Rate	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,868.75

SILVER SULFADIAZINE 1% CREAM 400 GRAMS

Facility

$34.90

Hospital Charge Code	41643443
Hospital Revenue Code	250
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$27.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.45
Rate for Payer: Aetna Government	$17.45
Rate for Payer: Brighton Health Commercial	$26.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.73
Rate for Payer: Group Health Inc Commercial	$17.45
Rate for Payer: Group Health Inc Medicare	$12.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.45
Rate for Payer: Hamaspik Choice Inc Medicare	$17.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.68

SILVER SULFADIAZINE 1% CREAM 400 GRAMS

Facility

$34.90

Hospital Charge Code	41653443
Hospital Revenue Code	250
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$27.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.45
Rate for Payer: Aetna Government	$17.45
Rate for Payer: Brighton Health Commercial	$26.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.73
Rate for Payer: Group Health Inc Commercial	$17.45
Rate for Payer: Group Health Inc Medicare	$12.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.45
Rate for Payer: Hamaspik Choice Inc Medicare	$17.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.68

SILVER SULFADIAZINE 1% CREAM 50 GRAMS

Facility

$2.18

Hospital Charge Code	41642371
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.09
Rate for Payer: Aetna Government	$1.09
Rate for Payer: Brighton Health Commercial	$1.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.48
Rate for Payer: Group Health Inc Commercial	$1.09
Rate for Payer: Group Health Inc Medicare	$0.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.09
Rate for Payer: Hamaspik Choice Inc Medicare	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.42

SILVER SULFADIAZINE 1% CREAM 50 GRAMS

Facility

$2.18

Hospital Charge Code	41652371
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.09
Rate for Payer: Aetna Government	$1.09
Rate for Payer: Brighton Health Commercial	$1.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.48
Rate for Payer: Group Health Inc Commercial	$1.09
Rate for Payer: Group Health Inc Medicare	$0.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.09
Rate for Payer: Hamaspik Choice Inc Medicare	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.42

SILVER SULFADIAZINE 1 % EX CREA [7224]

Facility

$0.35

Service Code	NDC 61570013150
Hospital Charge Code	61570013150
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

SILVER SULFADIAZINE 1 % EX CREA [7224]

Facility

$0.15

Service Code	NDC 61570013140
Hospital Charge Code	61570013140
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

SILVER SULFADIAZINE 1 % EX CREA [7224]

Facility

$0.30

Service Code	NDC 67877012405
Hospital Charge Code	67877012405
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

SILVER SULFADIAZINE 1 % EX CREA [7224]

Facility

$0.30

Service Code	NDC 43598021055
Hospital Charge Code	43598021055
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

SILVER SULFADIAZINE 1 % EX CREA [7224]

Facility

$0.30

Service Code	NDC 67877012450
Hospital Charge Code	67877012450
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

SILVER SULFADIAZINE 1 % EX CREA [7224]

Facility

$0.30

Service Code	NDC 59762013106
Hospital Charge Code	59762013106
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

SIM- 3/OR > TREAT AREAS

Facility

$1,015.13

Service Code	HCPCS 77290 TC
Hospital Charge Code	66542997
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$812.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$558.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$507.56
Rate for Payer: Aetna Government	$507.56
Rate for Payer: Brighton Health Commercial	$761.35
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$812.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$507.56
Rate for Payer: Group Health Inc Medicare	$355.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$507.56
Rate for Payer: Hamaspik Choice Inc Medicare	$507.56

SIM- 3/OR > TREAT AREAS

Facility

$1,015.13

Service Code	HCPCS 77290 TC
Hospital Charge Code	66542997
Hospital Revenue Code	333
Rate for Payer: Cash Price	$427.29

SIM-3/OR > TREAT AREAS

Facility

$241.73

Service Code	HCPCS 77290
Hospital Charge Code	66542929
Hospital Revenue Code	333
Min. Negotiated Rate	$120.86
Max. Negotiated Rate	$427.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$427.29
Rate for Payer: Aetna Government	$427.29
Rate for Payer: Brighton Health Commercial	$181.30
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$427.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$193.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.38
Rate for Payer: Elderplan Medicare Advantage	$427.29
Rate for Payer: EmblemHealth Commercial	$427.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Medicare Advantage	$427.29
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$427.29
Rate for Payer: Group Health Inc Medicare	$427.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.86
Rate for Payer: Hamaspik Choice Inc Medicare	$427.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$384.56
Rate for Payer: Healthfirst Medicare Advantage	$427.29
Rate for Payer: Healthfirst QHP	$427.29
Rate for Payer: Senior Whole Health Medicare Advantage	$427.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$427.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$341.83
Rate for Payer: Wellcare Medicare	$405.93

SIM-3/OR > TREAT AREAS

Facility

$241.73

Service Code	HCPCS 77290
Hospital Charge Code	66542929
Hospital Revenue Code	333
Rate for Payer: Cash Price	$427.29

SIMETHICONE 125 MG PO CHEW [7226]

Facility

$0.10

Service Code	NDC 00536122308
Hospital Charge Code	00536122308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

SIMETHICONE 125 MG PO CHEW [7226]

Facility

$0.06

Service Code	NDC 69618003206
Hospital Charge Code	69618003206
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
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	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
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	$0.04

SIMETHICONE 40 MG/0.6 ML LIQUID

Facility

$1.00

Hospital Charge Code	41640344
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

SIMETHICONE 40 MG/0.6 ML LIQUID

Facility

$1.00

Hospital Charge Code	41650344
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

SIMETHICONE 40 MG/0.6ML PO SUSP [7228]

Facility

$0.09

Service Code	NDC 00536130375
Hospital Charge Code	00536130375
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: 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

Know your out-of-pocket cost for care.

All Charges