Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

GLYCOPYRROLATE 1 MG/5ML PO SOLN

Facility

IP

$1.27

Service Code	NDC 0259050116
Hospital Charge Code	0259050116
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63

GLYCOPYRROLATE 1 MG/5ML PO SOLN

Facility

IP

$1.14

Service Code	NDC 4988404233
Hospital Charge Code	4988404233
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57

GRANISETRON HCL 1 MG/ML IV SOLN

Facility

OP

$12.00

Service Code	HCPCS J1626
Hospital Charge Code	6745786301
Hospital Revenue Code	258
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: EmblemHealth Commercial	$6.00
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

GRANISETRON HCL 1 MG/ML IV SOLN

Facility

OP

$24.00

Service Code	HCPCS J1626
Hospital Charge Code	6332331801
Hospital Revenue Code	258
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$19.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$18.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.32
Rate for Payer: EmblemHealth Commercial	$12.00
Rate for Payer: Group Health Inc Commercial	$12.00
Rate for Payer: Group Health Inc Medicare	$8.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.00
Rate for Payer: Hamaspik Choice Inc Medicare	$12.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.60

GRANISETRON HCL 1 MG/ML IV SOLN

Facility

IP

$23.58

Service Code	HCPCS J1626
Hospital Charge Code	1747854602
Hospital Revenue Code	258
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$11.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.79

GRANISETRON HCL 1 MG/ML IV SOLN

Facility

IP

$10.80

Service Code	HCPCS J1626
Hospital Charge Code	0143974410
Hospital Revenue Code	258
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.40

GRANISETRON HCL 1 MG/ML IV SOLN

Facility

IP

$24.00

Service Code	HCPCS J1626
Hospital Charge Code	6332331801
Hospital Revenue Code	258
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.00

GRANISETRON HCL 1 MG/ML IV SOLN

Facility

IP

$10.80

Service Code	HCPCS J1626
Hospital Charge Code	0143974401
Hospital Revenue Code	258
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.40

GRANISETRON HCL 1 MG/ML IV SOLN

Facility

IP

$12.00

Service Code	HCPCS J1626
Hospital Charge Code	6745786301
Hospital Revenue Code	258
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00

GRANISETRON HCL 1 MG/ML IV SOLN

Facility

OP

$10.80

Service Code	HCPCS J1626
Hospital Charge Code	0143974410
Hospital Revenue Code	258
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$8.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$8.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.34
Rate for Payer: EmblemHealth Commercial	$5.40
Rate for Payer: Group Health Inc Commercial	$5.40
Rate for Payer: Group Health Inc Medicare	$3.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.40
Rate for Payer: Hamaspik Choice Inc Medicare	$5.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.02

GRANISETRON HCL 1 MG/ML IV SOLN

Facility

OP

$10.80

Service Code	HCPCS J1626
Hospital Charge Code	0143974401
Hospital Revenue Code	258
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$8.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$8.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.34
Rate for Payer: EmblemHealth Commercial	$5.40
Rate for Payer: Group Health Inc Commercial	$5.40
Rate for Payer: Group Health Inc Medicare	$3.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.40
Rate for Payer: Hamaspik Choice Inc Medicare	$5.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.02

GRANISETRON HCL 1 MG/ML IV SOLN

Facility

OP

$23.58

Service Code	HCPCS J1626
Hospital Charge Code	1747854602
Hospital Revenue Code	258
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$18.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$17.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.03
Rate for Payer: EmblemHealth Commercial	$11.79
Rate for Payer: Group Health Inc Commercial	$11.79
Rate for Payer: Group Health Inc Medicare	$8.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.79
Rate for Payer: Hamaspik Choice Inc Medicare	$11.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.33

GRANISETRON HCL 1 MG PO TABS

Facility

IP

$59.05

Service Code	HCPCS Q0166
Hospital Charge Code	5199173599
Hospital Revenue Code	250
Min. Negotiated Rate	$29.53
Max. Negotiated Rate	$29.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.53

GRANISETRON HCL 1 MG PO TABS

Facility

IP

$59.05

Service Code	HCPCS Q0166
Hospital Charge Code	5199173520
Hospital Revenue Code	250
Min. Negotiated Rate	$29.53
Max. Negotiated Rate	$29.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.53

GRANISETRON HCL 1 MG PO TABS

Facility

OP

$59.05

Service Code	HCPCS Q0166
Hospital Charge Code	6945235060
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$47.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.98
Rate for Payer: Aetna Government	$2.98
Rate for Payer: Brighton Health Commercial	$44.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.16
Rate for Payer: EmblemHealth Commercial	$29.53
Rate for Payer: Group Health Inc Commercial	$29.53
Rate for Payer: Group Health Inc Medicare	$20.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.53
Rate for Payer: Hamaspik Choice Inc Medicare	$29.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.39

GRANISETRON HCL 1 MG PO TABS

Facility

IP

$59.05

Service Code	HCPCS Q0166
Hospital Charge Code	6945235060
Hospital Revenue Code	250
Min. Negotiated Rate	$29.53
Max. Negotiated Rate	$29.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.53

GRANISETRON HCL 1 MG PO TABS

Facility

OP

$59.05

Service Code	HCPCS Q0166
Hospital Charge Code	5199173599
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$47.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.98
Rate for Payer: Aetna Government	$2.98
Rate for Payer: Brighton Health Commercial	$44.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.16
Rate for Payer: EmblemHealth Commercial	$29.53
Rate for Payer: Group Health Inc Commercial	$29.53
Rate for Payer: Group Health Inc Medicare	$20.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.53
Rate for Payer: Hamaspik Choice Inc Medicare	$29.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.39

GRANISETRON HCL 1 MG PO TABS

Facility

OP

$59.05

Service Code	HCPCS Q0166
Hospital Charge Code	5199173520
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$47.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.98
Rate for Payer: Aetna Government	$2.98
Rate for Payer: Brighton Health Commercial	$44.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.16
Rate for Payer: EmblemHealth Commercial	$29.53
Rate for Payer: Group Health Inc Commercial	$29.53
Rate for Payer: Group Health Inc Medicare	$20.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.53
Rate for Payer: Hamaspik Choice Inc Medicare	$29.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.39

GRANISETRON HCL 4 MG/4ML IV SOLN

Facility

IP

$10.80

Service Code	HCPCS J1626
Hospital Charge Code	0143974501
Hospital Revenue Code	258
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.40

GRANISETRON HCL 4 MG/4ML IV SOLN

Facility

OP

$10.80

Service Code	HCPCS J1626
Hospital Charge Code	0143974501
Hospital Revenue Code	258
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$8.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$8.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.34
Rate for Payer: EmblemHealth Commercial	$5.40
Rate for Payer: Group Health Inc Commercial	$5.40
Rate for Payer: Group Health Inc Medicare	$3.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.40
Rate for Payer: Hamaspik Choice Inc Medicare	$5.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.02

GRISEOFULVIN MICROSIZE 125 MG/5ML PO SUSP

Facility

OP

$0.65

Service Code	NDC 6909736108
Hospital Charge Code	6909736108
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

GRISEOFULVIN MICROSIZE 125 MG/5ML PO SUSP

Facility

IP

$0.65

Service Code	NDC 6909736108
Hospital Charge Code	6909736108
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

GRISEOFULVIN ULTRAMICROSIZE 250 MG PO TABS

Facility

OP

$6.00

Service Code	NDC 4279401408
Hospital Charge Code	4279401408
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: EmblemHealth Commercial	$3.00
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

GRISEOFULVIN ULTRAMICROSIZE 250 MG PO TABS

Facility

IP

$6.00

Service Code	NDC 4279401408
Hospital Charge Code	4279401408
Hospital Revenue Code	250
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00

GROUP PSYCHOTHERAPY

Facility

OP

$102.23

Service Code	EAPG 00318
Min. Negotiated Rate	$74.06
Max. Negotiated Rate	$102.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$74.06
Rate for Payer: Healthfirst Commercial	$102.23

<<
<
285
286
287
288
289
290
291
292
293
294
>
>>