St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CEMENT BONE SIMPLEX P RADIOPAQUE

Facility

$1,652.00

Service Code	HCPCS C1713
Hospital Charge Code	40209587
Hospital Revenue Code	278
Min. Negotiated Rate	$826.00
Max. Negotiated Rate	$826.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$826.00
Rate for Payer: Hamaspik Choice Inc Medicare	$826.00

CEMENT BONE SIMPLEX P RADIOPAQUE

Facility

$348.50

Hospital Charge Code	64903940
Hospital Revenue Code	270
Min. Negotiated Rate	$121.98
Max. Negotiated Rate	$278.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$191.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$174.25
Rate for Payer: Aetna Government	$174.25
Rate for Payer: Brighton Health Commercial	$261.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$278.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$236.98
Rate for Payer: Group Health Inc Commercial	$174.25
Rate for Payer: Group Health Inc Medicare	$121.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.25
Rate for Payer: Hamaspik Choice Inc Medicare	$174.25

CEMENT BONE SIMPLEX P RADIOPAQUE

Facility

$1,652.00

Service Code	HCPCS C1713
Hospital Charge Code	40209587
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,734.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$908.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$991.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$826.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$949.90
Rate for Payer: EmblemHealth Commercial	$826.00
Rate for Payer: Fidelis Medicare Advantage	$1,734.60
Rate for Payer: Group Health Inc Commercial	$826.00
Rate for Payer: Group Health Inc Medicare	$578.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$826.00
Rate for Payer: Hamaspik Choice Inc Medicare	$826.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,073.80

CEMENT BONE TOBRAMYCIN

Facility

$1,293.75

Hospital Charge Code	64904539
Hospital Revenue Code	270
Min. Negotiated Rate	$452.81
Max. Negotiated Rate	$1,035.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$711.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$646.88
Rate for Payer: Aetna Government	$646.88
Rate for Payer: Brighton Health Commercial	$970.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,035.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$879.75
Rate for Payer: Group Health Inc Commercial	$646.88
Rate for Payer: Group Health Inc Medicare	$452.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$646.88
Rate for Payer: Hamaspik Choice Inc Medicare	$646.88

CEMENTED HIP STEM

Facility

$2,750.00

Service Code	HCPCS C1776
Hospital Charge Code	40200353
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,887.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,512.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,650.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,375.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,581.25
Rate for Payer: EmblemHealth Commercial	$1,375.00
Rate for Payer: Fidelis Medicare Advantage	$2,887.50
Rate for Payer: Group Health Inc Commercial	$1,375.00
Rate for Payer: Group Health Inc Medicare	$962.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,375.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,787.50

CEMENTED HIP STEM

Facility

$2,750.00

Service Code	HCPCS C1776
Hospital Charge Code	40200353
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.00
Max. Negotiated Rate	$1,375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,375.00

CEMENT PALACOS BONE 1X40SING

Facility

$197.13

Hospital Charge Code	64904436
Hospital Revenue Code	270
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$157.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$108.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.56
Rate for Payer: Aetna Government	$98.56
Rate for Payer: Brighton Health Commercial	$147.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$157.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$134.05
Rate for Payer: Group Health Inc Commercial	$98.56
Rate for Payer: Group Health Inc Medicare	$69.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.56
Rate for Payer: Hamaspik Choice Inc Medicare	$98.56

CEMENT RESTRICTER

Facility

$450.00

Hospital Charge Code	64906010
Hospital Revenue Code	270
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$225.00
Rate for Payer: Aetna Government	$225.00
Rate for Payer: Brighton Health Commercial	$337.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$360.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$306.00
Rate for Payer: Group Health Inc Commercial	$225.00
Rate for Payer: Group Health Inc Medicare	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00

CENT DISTAL RELIANCE

Facility

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907267
Hospital Revenue Code	278
Min. Negotiated Rate	$142.71
Max. Negotiated Rate	$428.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$244.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$203.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.46
Rate for Payer: EmblemHealth Commercial	$203.88
Rate for Payer: Fidelis Medicare Advantage	$428.14
Rate for Payer: Group Health Inc Commercial	$203.88
Rate for Payer: Group Health Inc Medicare	$142.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$265.04

CENT DISTAL RELIANCE

Facility

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907267
Hospital Revenue Code	278
Min. Negotiated Rate	$203.88
Max. Negotiated Rate	$203.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88

CENTRAL AUDITORY FUNC.TEST

Facility

$419.03

Service Code	HCPCS 92620
Hospital Charge Code	42004519
Hospital Revenue Code	471
Rate for Payer: Cash Price	$180.64

CENTRAL AUDITORY FUNC.TEST

Facility

$419.03

Service Code	HCPCS 92620
Hospital Charge Code	42004519
Hospital Revenue Code	471
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$335.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.64
Rate for Payer: Aetna Government	$180.64
Rate for Payer: Affinity Essential Plan 1&2	$126.45
Rate for Payer: Affinity Essential Plan 3&4	$126.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$126.45
Rate for Payer: Brighton Health Commercial	$314.27
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$180.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.94
Rate for Payer: Elderplan Medicare Advantage	$180.64
Rate for Payer: EmblemHealth Commercial	$180.64
Rate for Payer: Fidelis Essential Plan Aliesa	$153.54
Rate for Payer: Fidelis Essential Plan QHP	$160.77
Rate for Payer: Fidelis Medicare Advantage	$180.64
Rate for Payer: Fidelis Qualified Health Plan	$160.77
Rate for Payer: Group Health Inc Commercial	$180.64
Rate for Payer: Group Health Inc Medicare	$180.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$180.64
Rate for Payer: Healthfirst Medicare Advantage	$153.54
Rate for Payer: Healthfirst QHP	$180.64
Rate for Payer: Humana Medicare	$184.25
Rate for Payer: Senior Whole Health Medicare Advantage	$180.64
Rate for Payer: United Healthcare Commercial	$158.00
Rate for Payer: United Healthcare Medicare Advantage	$180.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$144.51
Rate for Payer: Wellcare Medicare	$171.61

CENTRAL VENOUS CATH > 5YRS

Facility

$4,940.28

Service Code	HCPCS 36556
Hospital Charge Code	30105875
Hospital Revenue Code	450
Rate for Payer: Cash Price	$3,686.08

CENTRAL VENOUS CATH > 5YRS

Facility

$4,940.28

Service Code	HCPCS 36556
Hospital Charge Code	30105875
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$3,759.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,686.08
Rate for Payer: Aetna Government	$3,686.08
Rate for Payer: Affinity Essential Plan 1&2	$2,580.26
Rate for Payer: Affinity Essential Plan 3&4	$2,580.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,580.26
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$3,686.08
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,686.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$3,686.08
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,133.17
Rate for Payer: Fidelis Essential Plan QHP	$3,280.61
Rate for Payer: Fidelis Medicare Advantage	$3,686.08
Rate for Payer: Fidelis Qualified Health Plan	$3,280.61
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$3,686.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$3,686.08
Rate for Payer: Humana Medicare	$3,759.80
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$3,686.08
Rate for Payer: Senior Whole Health Medicare Advantage	$3,686.08
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$3,686.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,686.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,948.86
Rate for Payer: Wellcare Medicare	$3,501.78

CENTRAL VENOUS KIT

Facility

$70.52

Hospital Charge Code	40200869
Hospital Revenue Code	270
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$56.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.26
Rate for Payer: Aetna Government	$35.26
Rate for Payer: Brighton Health Commercial	$52.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.95
Rate for Payer: Group Health Inc Commercial	$35.26
Rate for Payer: Group Health Inc Medicare	$24.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.26
Rate for Payer: Hamaspik Choice Inc Medicare	$35.26

CENTRUM PO LIQD [1481]

Facility

$0.03

Service Code	NDC 00005434362
Hospital Charge Code	00005434362
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

CEPACOL MOUTHWASH

Facility

$6.73

Hospital Charge Code	40200918
Hospital Revenue Code	270
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Brighton Health Commercial	$5.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.58
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36

CEPHALEXIN 125 MG/5ML PO SUSR [9501]

Facility

$0.24

Service Code	NDC 67877054488
Hospital Charge Code	67877054488
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

CEPHALEXIN 125 MG/5ML PO SUSR [9501]

Facility

$0.24

Service Code	NDC 00093417573
Hospital Charge Code	00093417573
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

CEPHALEXIN 125 MG/5 ML SUSP

Facility

$0.10

Hospital Charge Code	41643594
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

CEPHALEXIN 125 MG/5 ML SUSP

Facility

$0.10

Hospital Charge Code	41653594
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

CEPHALEXIN 250 MG/5ML PO SUSR [9502]

Facility

$0.29

Service Code	NDC 68180044101
Hospital Charge Code	68180044101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
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	$0.19

CEPHALEXIN 250 MG/5ML PO SUSR [9502]

Facility

$0.29

Service Code	NDC 00093417773
Hospital Charge Code	00093417773
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
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	$0.19

CEPHALEXIN 250 MG/5ML PO SUSR [9502]

Facility

$0.23

Service Code	NDC 67877054588
Hospital Charge Code	67877054588
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
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	$0.16
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

CEPHALEXIN 250 MG/5ML PO SUSR [9502]

Facility

$0.29

Service Code	NDC 09999123404
Hospital Charge Code	67877054568
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
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	$0.19

Know your out-of-pocket cost for care.

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