Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP

Facility

OP

$0.13

Service Code	NDC 0121176130
Hospital Charge Code	0121176130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.06
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP

Facility

IP

$0.13

Service Code	NDC 5723731603
Hospital Charge Code	5723731603
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP

Facility

IP

$0.01

Service Code	NDC 0536129383
Hospital Charge Code	0536129383
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP

Facility

OP

$0.13

Service Code	NDC 6668906099
Hospital Charge Code	6668906099
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.07
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	$0.09

ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP

Facility

OP

$0.01

Service Code	NDC 0536129383
Hospital Charge Code	0536129383
Hospital Revenue Code	250
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: EmblemHealth Commercial	$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

ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP

Facility

IP

$0.13

Service Code	NDC 6668906099
Hospital Charge Code	6668906099
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP

Facility

IP

$0.13

Service Code	NDC 0121176130
Hospital Charge Code	0121176130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP

Facility

OP

$0.13

Service Code	NDC 5723731603
Hospital Charge Code	5723731603
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.06
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

AMANTADINE HCL 100 MG PO CAPS

Facility

IP

$2.02

Service Code	NDC 0832101550
Hospital Charge Code	0832101550
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.01

AMANTADINE HCL 100 MG PO CAPS

Facility

OP

$1.68

Service Code	NDC 0904704206
Hospital Charge Code	0904704206
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: EmblemHealth Commercial	$0.84
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

AMANTADINE HCL 100 MG PO CAPS

Facility

OP

$2.02

Service Code	NDC 0832101550
Hospital Charge Code	0832101550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.01
Rate for Payer: Aetna Government	$1.01
Rate for Payer: Brighton Health Commercial	$1.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.37
Rate for Payer: EmblemHealth Commercial	$1.01
Rate for Payer: Group Health Inc Commercial	$1.01
Rate for Payer: Group Health Inc Medicare	$0.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.01
Rate for Payer: Hamaspik Choice Inc Medicare	$1.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.31

AMANTADINE HCL 100 MG PO CAPS

Facility

IP

$1.55

Service Code	NDC 0904704261
Hospital Charge Code	0904704261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78

AMANTADINE HCL 100 MG PO CAPS

Facility

IP

$1.68

Service Code	NDC 0904704206
Hospital Charge Code	0904704206
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84

AMANTADINE HCL 100 MG PO CAPS

Facility

OP

$1.55

Service Code	NDC 0904704261
Hospital Charge Code	0904704261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$1.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.78
Rate for Payer: Aetna Government	$0.78
Rate for Payer: Brighton Health Commercial	$1.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.06
Rate for Payer: EmblemHealth Commercial	$0.78
Rate for Payer: Group Health Inc Commercial	$0.78
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78
Rate for Payer: Hamaspik Choice Inc Medicare	$0.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.01

AMANTADINE HCL 100 MG PO TABS

Facility

IP

$2.74

Service Code	NDC 0832011103
Hospital Charge Code	0832011103
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37

AMANTADINE HCL 100 MG PO TABS

Facility

IP

$2.28

Service Code	NDC 4254349701
Hospital Charge Code	4254349701
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14

AMANTADINE HCL 100 MG PO TABS

Facility

OP

$2.74

Service Code	NDC 0832011103
Hospital Charge Code	0832011103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.37
Rate for Payer: Aetna Government	$1.37
Rate for Payer: Brighton Health Commercial	$2.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.87
Rate for Payer: EmblemHealth Commercial	$1.37
Rate for Payer: Group Health Inc Commercial	$1.37
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.78

AMANTADINE HCL 100 MG PO TABS

Facility

OP

$2.28

Service Code	NDC 4254349701
Hospital Charge Code	4254349701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.14
Rate for Payer: Aetna Government	$1.14
Rate for Payer: Brighton Health Commercial	$1.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.55
Rate for Payer: EmblemHealth Commercial	$1.14
Rate for Payer: Group Health Inc Commercial	$1.14
Rate for Payer: Group Health Inc Medicare	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.48

AMANTADINE HCL 50 MG/5ML PO SOLN

Facility

OP

$0.43

Service Code	NDC 0121064610
Hospital Charge Code	0121064610
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: EmblemHealth Commercial	$0.22
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

AMANTADINE HCL 50 MG/5ML PO SOLN

Facility

IP

$0.43

Service Code	NDC 0121064610
Hospital Charge Code	0121064610
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22

AMBULATORY PATIENT MONITORING AND RELATED ASSESSMENTS

Facility

OP

$322.92

Service Code	EAPG 00418
Min. Negotiated Rate	$233.74
Max. Negotiated Rate	$322.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$233.74
Rate for Payer: Healthfirst Commercial	$322.92

AMIKACIN SULFATE 500 MG/2ML IJ SOLN

Facility

OP

$4.80

Service Code	HCPCS J0278
Hospital Charge Code	0641616710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$3.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.26
Rate for Payer: EmblemHealth Commercial	$2.40
Rate for Payer: Group Health Inc Commercial	$2.40
Rate for Payer: Group Health Inc Medicare	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.12

AMIKACIN SULFATE 500 MG/2ML IJ SOLN

Facility

OP

$7.36

Service Code	HCPCS J0278
Hospital Charge Code	2315529031
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$5.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$5.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.00
Rate for Payer: EmblemHealth Commercial	$3.68
Rate for Payer: Group Health Inc Commercial	$3.68
Rate for Payer: Group Health Inc Medicare	$2.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.68
Rate for Payer: Hamaspik Choice Inc Medicare	$3.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.78

AMIKACIN SULFATE 500 MG/2ML IJ SOLN

Facility

OP

$4.65

Service Code	HCPCS J0278
Hospital Charge Code	2502117302
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$3.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$3.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.16
Rate for Payer: EmblemHealth Commercial	$2.33
Rate for Payer: Group Health Inc Commercial	$2.33
Rate for Payer: Group Health Inc Medicare	$1.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.33
Rate for Payer: Hamaspik Choice Inc Medicare	$2.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.02

AMIKACIN SULFATE 500 MG/2ML IJ SOLN

Facility

IP

$4.80

Service Code	HCPCS J0278
Hospital Charge Code	0641616701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40

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