St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

VITAMIN B-12 500 MCG PO TABS [8657]

Facility

$0.19

Service Code	NDC 77333093725
Hospital Charge Code	77333093725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

VITAMIN B-12 500 MCG PO TABS [8657]

Facility

$0.19

Service Code	NDC 77333093710
Hospital Charge Code	77333093710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

VITAMIN B12 AND FOLATE

Facility

$12.95

Service Code	HCPCS 82570
Hospital Charge Code	40609821
Hospital Revenue Code	301
Rate for Payer: Cash Price	$5.18

VITAMIN B12 AND FOLATE

Facility

$12.95

Service Code	HCPCS 82570
Hospital Charge Code	40609821
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$9.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.18
Rate for Payer: Aetna Government	$5.18
Rate for Payer: Brighton Health Commercial	$9.71
Rate for Payer: Cash Price	$5.18
Rate for Payer: Cash Price	$5.18
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.96
Rate for Payer: Elderplan Medicare Advantage	$5.18
Rate for Payer: EmblemHealth Commercial	$5.18
Rate for Payer: Fidelis Essential Plan Aliesa	$4.40
Rate for Payer: Fidelis Essential Plan QHP	$4.61
Rate for Payer: Fidelis Medicare Advantage	$5.18
Rate for Payer: Fidelis Qualified Health Plan	$4.61
Rate for Payer: Group Health Inc Commercial	$5.18
Rate for Payer: Group Health Inc Medicare	$5.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.48
Rate for Payer: Hamaspik Choice Inc Medicare	$5.18
Rate for Payer: Healthfirst Medicare Advantage	$5.18
Rate for Payer: Healthfirst QHP	$5.18
Rate for Payer: Senior Whole Health Medicare Advantage	$5.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.14
Rate for Payer: Wellcare Medicare	$4.66

VITAMIN B-6 50 MG PO TABS [8667]

Facility

$0.17

Service Code	NDC 77333094010
Hospital Charge Code	77333094010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

VITAMIN B-6 50 MG PO TABS [8667]

Facility

$0.28

Service Code	NDC 50268085815
Hospital Charge Code	50268085815
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.19
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.18

VITAMIN B-6 50 MG PO TABS [8667]

Facility

$0.04

Service Code	NDC 00761043620
Hospital Charge Code	00761043620
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

VITAMIN_C

Facility

$24.73

Service Code	HCPCS 82180
Hospital Charge Code	40609700
Hospital Revenue Code	301
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$18.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.89
Rate for Payer: Aetna Government	$9.89
Rate for Payer: Brighton Health Commercial	$18.55
Rate for Payer: Cash Price	$9.89
Rate for Payer: Cash Price	$9.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$9.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.30
Rate for Payer: Elderplan Medicare Advantage	$9.89
Rate for Payer: EmblemHealth Commercial	$9.89
Rate for Payer: Fidelis Essential Plan Aliesa	$8.41
Rate for Payer: Fidelis Essential Plan QHP	$8.80
Rate for Payer: Fidelis Medicare Advantage	$9.89
Rate for Payer: Fidelis Qualified Health Plan	$8.80
Rate for Payer: Group Health Inc Commercial	$9.89
Rate for Payer: Group Health Inc Medicare	$9.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.36
Rate for Payer: Hamaspik Choice Inc Medicare	$9.89
Rate for Payer: Healthfirst Medicare Advantage	$9.89
Rate for Payer: Healthfirst QHP	$9.89
Rate for Payer: Senior Whole Health Medicare Advantage	$9.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7.91
Rate for Payer: Wellcare Medicare	$8.90

VITAMIN_C

Facility

$24.73

Service Code	HCPCS 82180
Hospital Charge Code	40609700
Hospital Revenue Code	301
Rate for Payer: Cash Price	$9.89

VITAMIN C 500 MG PO TABS [8680]

Facility

$0.07

Service Code	NDC 00904052361
Hospital Charge Code	00904052361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
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

VITAMIN C 500 MG PO TABS [8680]

Facility

$0.05

Service Code	NDC 00904052360
Hospital Charge Code	00904052360
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

VITAMIN D 25-HYDROXY

Facility

$74.00

Service Code	HCPCS 82306
Hospital Charge Code	40609731
Hospital Revenue Code	301
Min. Negotiated Rate	$23.68
Max. Negotiated Rate	$55.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.60
Rate for Payer: Aetna Government	$29.60
Rate for Payer: Brighton Health Commercial	$55.50
Rate for Payer: Cash Price	$29.60
Rate for Payer: Cash Price	$29.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$29.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.82
Rate for Payer: Elderplan Medicare Advantage	$29.60
Rate for Payer: EmblemHealth Commercial	$29.60
Rate for Payer: Fidelis Essential Plan Aliesa	$25.16
Rate for Payer: Fidelis Essential Plan QHP	$26.34
Rate for Payer: Fidelis Medicare Advantage	$29.60
Rate for Payer: Fidelis Qualified Health Plan	$26.34
Rate for Payer: Group Health Inc Commercial	$29.60
Rate for Payer: Group Health Inc Medicare	$29.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.00
Rate for Payer: Hamaspik Choice Inc Medicare	$29.60
Rate for Payer: Healthfirst Medicare Advantage	$29.60
Rate for Payer: Healthfirst QHP	$29.60
Rate for Payer: Senior Whole Health Medicare Advantage	$29.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23.68
Rate for Payer: Wellcare Medicare	$26.64

VITAMIN D 25-HYDROXY

Facility

$74.00

Service Code	HCPCS 82306
Hospital Charge Code	40609731
Hospital Revenue Code	301
Rate for Payer: Cash Price	$29.60

VITAMIN D, 25 OH

Facility

$74.00

Service Code	HCPCS 82306
Hospital Charge Code	40602687
Hospital Revenue Code	300
Min. Negotiated Rate	$23.68
Max. Negotiated Rate	$55.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.60
Rate for Payer: Aetna Government	$29.60
Rate for Payer: Brighton Health Commercial	$55.50
Rate for Payer: Cash Price	$29.60
Rate for Payer: Cash Price	$29.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$29.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.82
Rate for Payer: Elderplan Medicare Advantage	$29.60
Rate for Payer: EmblemHealth Commercial	$29.60
Rate for Payer: Fidelis Essential Plan Aliesa	$25.16
Rate for Payer: Fidelis Essential Plan QHP	$26.34
Rate for Payer: Fidelis Medicare Advantage	$29.60
Rate for Payer: Fidelis Qualified Health Plan	$26.34
Rate for Payer: Group Health Inc Commercial	$29.60
Rate for Payer: Group Health Inc Medicare	$29.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.00
Rate for Payer: Hamaspik Choice Inc Medicare	$29.60
Rate for Payer: Healthfirst Medicare Advantage	$29.60
Rate for Payer: Healthfirst QHP	$29.60
Rate for Payer: Senior Whole Health Medicare Advantage	$29.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23.68
Rate for Payer: Wellcare Medicare	$26.64

VITAMIN D, 25 OH

Facility

$74.00

Service Code	HCPCS 82306
Hospital Charge Code	40602687
Hospital Revenue Code	300
Rate for Payer: Cash Price	$29.60

VITAMIN D3 10 MCG (400 UNIT) PO TABS [13108]

Facility

$0.23

Service Code	NDC 77333094825
Hospital Charge Code	77333094825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

VITAMIN D3 10 MCG (400 UNIT) PO TABS [13108]

Facility

$0.23

Service Code	NDC 77333094810
Hospital Charge Code	77333094810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

VITAMIN D3 10 MCG (400 UNIT) PO TABS [13108]

Facility

$0.02

Service Code	NDC 00904582360
Hospital Charge Code	00904582360
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

VITAMIN D3 10 MCG (400 UNIT) PO TABS [13108]

Facility

$0.19

Service Code	NDC 48433010901
Hospital Charge Code	48433010901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

VITAMIN D3 25 MCG (1000 UT) PO TABS [76997]

Facility

$0.21

Service Code	NDC 48433010401
Hospital Charge Code	48433010401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

VITAMIN D TABLET 1000 UNITS

Facility

$0.07

Hospital Charge Code	41656008
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.02
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	$0.05

VITAMIN D TABLETS 1000 UNITS

Facility

$0.07

Hospital Charge Code	41646008
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.02
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	$0.05

VITAMIN E 180 MG (400 UNIT) PO CAPS [177894]

Facility

$0.08

Service Code	NDC 57896075201
Hospital Charge Code	57896075201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
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	$0.05

VITAMIN E 400 INTL UNITS CAP

Facility

$1.00

Hospital Charge Code	41650939
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

VITAMIN E 400 INTL UNITS CAP

Facility

$1.00

Hospital Charge Code	41640939
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

Know your out-of-pocket cost for care.

All Charges