Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FAMOTIDINE 20 MG PO TABS

Facility

OP

$0.15

Service Code	NDC 0904719306
Hospital Charge Code	0904719306
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	$0.08
Rate for Payer: Aetna Government	$0.08
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: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

FAMOTIDINE 20 MG PO TABS

Facility

IP

$0.12

Service Code	NDC 0536129801
Hospital Charge Code	0536129801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

FAMOTIDINE 40 MG/5ML PO SUSR

Facility

OP

$3.54

Service Code	NDC 0832604510
Hospital Charge Code	0832604510
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$2.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$2.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.41
Rate for Payer: EmblemHealth Commercial	$1.77
Rate for Payer: Group Health Inc Commercial	$1.77
Rate for Payer: Group Health Inc Medicare	$1.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.77
Rate for Payer: Hamaspik Choice Inc Medicare	$1.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.30

FAMOTIDINE 40 MG/5ML PO SUSR

Facility

IP

$3.54

Service Code	NDC 0832604510
Hospital Charge Code	0832604510
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.77

FAMOTIDINE (PF) 20 MG/2ML IV SOLN

Facility

OP

$0.54

Service Code	NDC 6332373912
Hospital Charge Code	6332373912
Hospital Revenue Code	258
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

FAMOTIDINE (PF) 20 MG/2ML IV SOLN

Facility

IP

$0.54

Service Code	NDC 6332373912
Hospital Charge Code	6332373912
Hospital Revenue Code	258
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

FAMOTIDINE (PF) 20 MG/2ML IV SOLN

Facility

OP

$0.53

Service Code	NDC 6745743322
Hospital Charge Code	6745743322
Hospital Revenue Code	258
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

FAMOTIDINE (PF) 20 MG/2ML IV SOLN

Facility

IP

$0.53

Service Code	NDC 6745743322
Hospital Charge Code	6745743322
Hospital Revenue Code	258
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

FAMOTIDINE (PF) 20 MG/2ML IV SOLN

Facility

OP

$0.53

Service Code	NDC 6745743300
Hospital Charge Code	6745743300
Hospital Revenue Code	258
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

FAMOTIDINE (PF) 20 MG/2ML IV SOLN

Facility

IP

$0.52

Service Code	NDC 7086075102
Hospital Charge Code	7086075102
Hospital Revenue Code	258
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26

FAMOTIDINE (PF) 20 MG/2ML IV SOLN

Facility

IP

$0.53

Service Code	NDC 6745743300
Hospital Charge Code	6745743300
Hospital Revenue Code	258
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

FAMOTIDINE (PF) 20 MG/2ML IV SOLN

Facility

OP

$0.52

Service Code	NDC 7086075102
Hospital Charge Code	7086075102
Hospital Revenue Code	258
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: EmblemHealth Commercial	$0.26
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

FAMOTIDINE PREMIXED 20-0.9 MG/50ML-% IV SOLN

Facility

OP

$0.13

Service Code	NDC 0338519741
Hospital Charge Code	0338519741
Hospital Revenue Code	258
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

FAMOTIDINE PREMIXED 20-0.9 MG/50ML-% IV SOLN

Facility

IP

$0.13

Service Code	NDC 0338519741
Hospital Charge Code	0338519741
Hospital Revenue Code	258
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

FAM-TRASTUZUMAB DERUXTEC-NXKI 100 MG IV SOLR

Facility

OP

$3.00

Service Code	HCPCS J9358
Hospital Charge Code	6559740601
Hospital Revenue Code	258
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$30.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.98
Rate for Payer: Aetna Government	$29.98
Rate for Payer: Affinity Essential Plan 1&2	$20.99
Rate for Payer: Affinity Essential Plan 3&4	$20.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$20.99
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$29.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Elderplan Medicare Advantage	$29.98
Rate for Payer: EmblemHealth Commercial	$29.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26.98
Rate for Payer: Fidelis Essential Plan Aliesa	$25.48
Rate for Payer: Fidelis Essential Plan QHP	$26.68
Rate for Payer: Fidelis Medicare Advantage	$29.98
Rate for Payer: Fidelis Qualified Health Plan	$26.68
Rate for Payer: Group Health Inc Commercial	$29.98
Rate for Payer: Group Health Inc Medicare	$29.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.98
Rate for Payer: Hamaspik Choice Inc Medicare	$29.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.98
Rate for Payer: Healthfirst Medicare Advantage	$25.48
Rate for Payer: Healthfirst QHP	$29.98
Rate for Payer: Humana Medicare	$30.58
Rate for Payer: Senior Whole Health Medicare Advantage	$29.98
Rate for Payer: United Healthcare Medicare Advantage	$29.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28.48
Rate for Payer: Wellcare Medicare	$28.48

FAM-TRASTUZUMAB DERUXTEC-NXKI 100 MG IV SOLR

Facility

IP

$3.00

Service Code	HCPCS J9358
Hospital Charge Code	6559740601
Hospital Revenue Code	258
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50

FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL

Facility

OP

$0.23

Service Code	NDC 0338051909
Hospital Charge Code	0338051909
Hospital Revenue Code	258
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: EmblemHealth Commercial	$0.11
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

FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL

Facility

IP

$0.23

Service Code	NDC 0338051909
Hospital Charge Code	0338051909
Hospital Revenue Code	258
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL

Facility

OP

$0.23

Service Code	NDC 0338954006
Hospital Charge Code	0338954006
Hospital Revenue Code	258
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: EmblemHealth Commercial	$0.11
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

FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL

Facility

OP

$0.41

Service Code	NDC 0338954005
Hospital Charge Code	0338954005
Hospital Revenue Code	258
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.28
Rate for Payer: EmblemHealth Commercial	$0.21
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL

Facility

OP

$0.23

Service Code	NDC 0338954002
Hospital Charge Code	0338954002
Hospital Revenue Code	258
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: EmblemHealth Commercial	$0.11
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

FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL

Facility

IP

$0.41

Service Code	NDC 0338954005
Hospital Charge Code	0338954005
Hospital Revenue Code	258
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21

FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL

Facility

IP

$0.23

Service Code	NDC 0338954006
Hospital Charge Code	0338954006
Hospital Revenue Code	258
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL

Facility

IP

$0.23

Service Code	NDC 0338954002
Hospital Charge Code	0338954002
Hospital Revenue Code	258
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

FE FUMARATE-B12-VIT C-FA-IFC PO CAPS

Facility

IP

$0.39

Service Code	NDC 6304463510
Hospital Charge Code	6304463510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

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