St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CARBAMAZEPINE 200 MG TAB

Facility

$2.00

Hospital Charge Code	41644970
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

CARBAMIDE PEROXIDE 6.5 % OT SOLN [1359]

Facility

$0.15

Service Code	NDC 00904662735
Hospital Charge Code	00904662735
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: 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

CARBAMIDE PEROXIDE OTIC SOLN

Facility

$3.00

Hospital Charge Code	41650903
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

CARBAMIDE PEROXIDE OTIC SOLN

Facility

$3.00

Hospital Charge Code	41640903
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

CARB-EDGE MYO OP 6-3/4 17.1CM

Facility

$92.10

Hospital Charge Code	64905678
Hospital Revenue Code	270
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$73.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$50.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.05
Rate for Payer: Aetna Government	$46.05
Rate for Payer: Brighton Health Commercial	$69.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.63
Rate for Payer: Group Health Inc Commercial	$46.05
Rate for Payer: Group Health Inc Medicare	$32.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.05
Rate for Payer: Hamaspik Choice Inc Medicare	$46.05

CARBIDOPA-LEVODOPA 10-100 MG PO TABS [9406]

Facility

$0.77

Service Code	NDC 69367033801
Hospital Charge Code	69367033801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.50

CARBIDOPA-LEVODOPA 10-100 MG PO TABS [9406]

Facility

$0.71

Service Code	NDC 62756051788
Hospital Charge Code	62756051788
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Brighton Health Commercial	$0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

CARBIDOPA-LEVODOPA 10-100 MG PO TABS [9406]

Facility

$0.77

Service Code	NDC 00378007801
Hospital Charge Code	00378007801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.50

CARBIDOPA + LEVODOPA 10 MG-100 MG TAB

Facility

$1.71

Hospital Charge Code	41654436
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.86
Rate for Payer: Aetna Government	$0.86
Rate for Payer: Brighton Health Commercial	$1.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.16
Rate for Payer: Group Health Inc Commercial	$0.86
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.11

CARBIDOPA + LEVODOPA 10 MG-100 MG TAB

Facility

$1.71

Hospital Charge Code	41644436
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.86
Rate for Payer: Aetna Government	$0.86
Rate for Payer: Brighton Health Commercial	$1.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.16
Rate for Payer: Group Health Inc Commercial	$0.86
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.11

CARBIDOPA-LEVODOPA 25-100 MG PO TABS [9407]

Facility

$0.87

Service Code	NDC 00228253910
Hospital Charge Code	00228253910
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.44
Rate for Payer: Aetna Government	$0.44
Rate for Payer: Brighton Health Commercial	$0.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.59
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.57

CARBIDOPA-LEVODOPA 25-100 MG PO TABS [9407]

Facility

$0.87

Service Code	NDC 00093970201
Hospital Charge Code	00093970201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.44
Rate for Payer: Aetna Government	$0.44
Rate for Payer: Brighton Health Commercial	$0.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.59
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.57

CARBIDOPA-LEVODOPA 25-100 MG PO TABS [9407]

Facility

$0.85

Service Code	NDC 51862085605
Hospital Charge Code	51862085605
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

CARBIDOPA-LEVODOPA 25-100 MG PO TABS [9407]

Facility

$0.60

Service Code	NDC 00904623761
Hospital Charge Code	00904623761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Brighton Health Commercial	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

CARBIDOPA-LEVODOPA 25-100 MG PO TABS [9407]

Facility

$0.44

Service Code	NDC 63739010810
Hospital Charge Code	63739010810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.35
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	$0.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.30
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	$0.29

CARBIDOPA-LEVODOPA 25-250 MG PO TABS [9408]

Facility

$0.95

Service Code	NDC 68084009401
Hospital Charge Code	68084009401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.47
Rate for Payer: Aetna Government	$0.47
Rate for Payer: Brighton Health Commercial	$0.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.64
Rate for Payer: Group Health Inc Commercial	$0.47
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

CARBIDOPA-LEVODOPA 25-250 MG PO TABS [9408]

Facility

$0.95

Service Code	NDC 68084009411
Hospital Charge Code	68084009411
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.65
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

CARBIDOPA-LEVODOPA 25-250 MG PO TABS [9408]

Facility

$1.11

Service Code	NDC 00228254010
Hospital Charge Code	00228254010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.56
Rate for Payer: Aetna Government	$0.56
Rate for Payer: Brighton Health Commercial	$0.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.76
Rate for Payer: Group Health Inc Commercial	$0.56
Rate for Payer: Group Health Inc Medicare	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56
Rate for Payer: Hamaspik Choice Inc Medicare	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.72

CARBIDOPA-LEVODOPA 25-250 MG PO TABS [9408]

Facility

$0.86

Service Code	NDC 00904623861
Hospital Charge Code	00904623861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.43
Rate for Payer: Aetna Government	$0.43
Rate for Payer: Brighton Health Commercial	$0.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: Group Health Inc Commercial	$0.43
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.43
Rate for Payer: Hamaspik Choice Inc Medicare	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.56

CARBIDOPA + LEVODOPA 25 MG-100 MG TAB

Facility

$1.93

Hospital Charge Code	41654439
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$1.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.31
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.25

CARBIDOPA + LEVODOPA 25 MG-100 MG TAB

Facility

$1.93

Hospital Charge Code	41644439
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$1.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.31
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.25

CARBIDOPA + LEVODOPA 25 MG-250 MG TAB

Facility

$2.45

Hospital Charge Code	41644438
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.22
Rate for Payer: Aetna Government	$1.22
Rate for Payer: Brighton Health Commercial	$1.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.67
Rate for Payer: Group Health Inc Commercial	$1.22
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.59

CARBIDOPA + LEVODOPA 25 MG-250 MG TAB

Facility

$2.45

Hospital Charge Code	41654438
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.22
Rate for Payer: Aetna Government	$1.22
Rate for Payer: Brighton Health Commercial	$1.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.67
Rate for Payer: Group Health Inc Commercial	$1.22
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.59

CARBIDOPA + LEVODOPA 50 MG-200 MG CR

Facility

$4.15

Hospital Charge Code	41641229
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$3.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.08
Rate for Payer: Aetna Government	$2.08
Rate for Payer: Brighton Health Commercial	$3.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.82
Rate for Payer: Group Health Inc Commercial	$2.08
Rate for Payer: Group Health Inc Medicare	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.08
Rate for Payer: Hamaspik Choice Inc Medicare	$2.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.70

CARBIDOPA + LEVODOPA 50 MG-200 MG CR

Facility

$4.15

Hospital Charge Code	41651229
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$3.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.08
Rate for Payer: Aetna Government	$2.08
Rate for Payer: Brighton Health Commercial	$3.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.82
Rate for Payer: Group Health Inc Commercial	$2.08
Rate for Payer: Group Health Inc Medicare	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.08
Rate for Payer: Hamaspik Choice Inc Medicare	$2.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.70

Know your out-of-pocket cost for care.

All Charges