Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

GENTAMICIN SULFATE 10 MG/ML IJ SOLN

Facility

IP

$3.25

Service Code	HCPCS J1580
Hospital Charge Code	6332317302
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.62

GENTAMICIN SULFATE 10 MG/ML IJ SOLN

Facility

OP

$3.25

Service Code	HCPCS J1580
Hospital Charge Code	6332317301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$2.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.21
Rate for Payer: EmblemHealth Commercial	$1.62
Rate for Payer: Group Health Inc Commercial	$1.62
Rate for Payer: Group Health Inc Medicare	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.11

GENTAMICIN SULFATE 40 MG/ML IJ SOLN

Facility

IP

$1.75

Service Code	HCPCS J1580
Hospital Charge Code	6332301003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.88

GENTAMICIN SULFATE 40 MG/ML IJ SOLN

Facility

IP

$1.75

Service Code	HCPCS J1580
Hospital Charge Code	6332301020
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.88

GENTAMICIN SULFATE 40 MG/ML IJ SOLN

Facility

IP

$1.65

Service Code	HCPCS J1580
Hospital Charge Code	0409120713
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.83

GENTAMICIN SULFATE 40 MG/ML IJ SOLN

Facility

OP

$2.44

Service Code	HCPCS J1580
Hospital Charge Code	6332301001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$2.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$1.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.66
Rate for Payer: EmblemHealth Commercial	$1.22
Rate for Payer: Group Health Inc Commercial	$1.22
Rate for Payer: Group Health Inc Medicare	$0.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.59

GENTAMICIN SULFATE 40 MG/ML IJ SOLN

Facility

OP

$0.73

Service Code	HCPCS J1580
Hospital Charge Code	6332301094
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$2.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

GENTAMICIN SULFATE 40 MG/ML IJ SOLN

Facility

OP

$1.65

Service Code	HCPCS J1580
Hospital Charge Code	0409120713
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$2.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$1.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.12
Rate for Payer: EmblemHealth Commercial	$0.83
Rate for Payer: Group Health Inc Commercial	$0.83
Rate for Payer: Group Health Inc Medicare	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.83
Rate for Payer: Hamaspik Choice Inc Medicare	$0.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.07

GENTAMICIN SULFATE 40 MG/ML IJ SOLN

Facility

OP

$2.44

Service Code	HCPCS J1580
Hospital Charge Code	6332301002
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$2.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$1.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.66
Rate for Payer: EmblemHealth Commercial	$1.22
Rate for Payer: Group Health Inc Commercial	$1.22
Rate for Payer: Group Health Inc Medicare	$0.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.59

GENTAMICIN SULFATE 40 MG/ML IJ SOLN

Facility

IP

$2.44

Service Code	HCPCS J1580
Hospital Charge Code	6332301001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22

GENTAMICIN SULFATE 40 MG/ML IJ SOLN

Facility

IP

$2.44

Service Code	HCPCS J1580
Hospital Charge Code	6332301002
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22

GENTAMICIN SULFATE 40 MG/ML IJ SOLN

Facility

IP

$0.73

Service Code	HCPCS J1580
Hospital Charge Code	6332301094
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

GENTAMICIN SULFATE 40 MG/ML IJ SOLN

Facility

OP

$1.75

Service Code	HCPCS J1580
Hospital Charge Code	6332301020
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$2.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$1.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.19
Rate for Payer: EmblemHealth Commercial	$0.88
Rate for Payer: Group Health Inc Commercial	$0.88
Rate for Payer: Group Health Inc Medicare	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.88
Rate for Payer: Hamaspik Choice Inc Medicare	$0.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.14

GENTAMICIN SULFATE 40 MG/ML IJ SOLN

Facility

OP

$1.75

Service Code	HCPCS J1580
Hospital Charge Code	6332301003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$2.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$1.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.19
Rate for Payer: EmblemHealth Commercial	$0.88
Rate for Payer: Group Health Inc Commercial	$0.88
Rate for Payer: Group Health Inc Medicare	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.88
Rate for Payer: Hamaspik Choice Inc Medicare	$0.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.14

GENTIAN VIOLET 1 % EX SOLN

Facility

OP

$0.14

Service Code	NDC 0395100392
Hospital Charge Code	0395100392
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
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	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
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

GENTIAN VIOLET 1 % EX SOLN

Facility

IP

$0.14

Service Code	NDC 0395100392
Hospital Charge Code	0395100392
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

GENTIAN VIOLET 1 % EX SOLN

Facility

IP

$0.04

Service Code	NDC 2428615361
Hospital Charge Code	2428615361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

GENTIAN VIOLET 1 % EX SOLN

Facility

OP

$0.04

Service Code	NDC 2428615361
Hospital Charge Code	2428615361
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	$0.03
Rate for Payer: EmblemHealth Commercial	$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	$0.03

GLATIRAMER ACETATE 20 MG/ML SC SOSY

Facility

IP

$284.56

Service Code	HCPCS J1595
Hospital Charge Code	6854631730
Hospital Revenue Code	250
Min. Negotiated Rate	$142.28
Max. Negotiated Rate	$142.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.28

GLATIRAMER ACETATE 20 MG/ML SC SOSY

Facility

OP

$284.56

Service Code	HCPCS J1595
Hospital Charge Code	6854631730
Hospital Revenue Code	250
Min. Negotiated Rate	$117.12
Max. Negotiated Rate	$227.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$167.31
Rate for Payer: Aetna Government	$167.31
Rate for Payer: Affinity Essential Plan 1&2	$117.12
Rate for Payer: Affinity Essential Plan 3&4	$117.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$117.12
Rate for Payer: Brighton Health Commercial	$213.42
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$167.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$227.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$193.50
Rate for Payer: Elderplan Medicare Advantage	$167.31
Rate for Payer: EmblemHealth Commercial	$167.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$150.58
Rate for Payer: Fidelis Essential Plan Aliesa	$142.21
Rate for Payer: Fidelis Essential Plan QHP	$148.91
Rate for Payer: Fidelis Medicare Advantage	$167.31
Rate for Payer: Fidelis Qualified Health Plan	$148.91
Rate for Payer: Group Health Inc Commercial	$167.31
Rate for Payer: Group Health Inc Medicare	$167.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.31
Rate for Payer: Hamaspik Choice Inc Medicare	$167.31
Rate for Payer: Healthfirst Medicare Advantage	$142.21
Rate for Payer: Healthfirst QHP	$167.31
Rate for Payer: Humana Medicare	$170.66
Rate for Payer: Senior Whole Health Medicare Advantage	$167.31
Rate for Payer: United Healthcare Medicare Advantage	$167.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$184.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$158.94
Rate for Payer: Wellcare Medicare	$158.94

GLAUCOMA

Facility

OP

$215.55

Service Code	EAPG 00552
Min. Negotiated Rate	$157.37
Max. Negotiated Rate	$215.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$157.37
Rate for Payer: Healthfirst Commercial	$215.55

GLIMEPIRIDE 1 MG PO TABS

Facility

OP

$1.01

Service Code	NDC 5026835811
Hospital Charge Code	5026835811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.81
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	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: EmblemHealth Commercial	$0.50
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

GLIMEPIRIDE 1 MG PO TABS

Facility

IP

$1.01

Service Code	NDC 5026835811
Hospital Charge Code	5026835811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

GLIMEPIRIDE 1 MG PO TABS

Facility

IP

$1.01

Service Code	NDC 5026835815
Hospital Charge Code	5026835815
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

GLIMEPIRIDE 1 MG PO TABS

Facility

OP

$1.01

Service Code	NDC 5026835815
Hospital Charge Code	5026835815
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.81
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	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: EmblemHealth Commercial	$0.50
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

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