St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHLORHEXIDINE 0.12% 15ML

Facility

$0.10

Hospital Charge Code	41648451
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

CHLORHEXIDINE 0.12% MOUTHWASH 15 ML

Facility

$1.00

Hospital Charge Code	41642453
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
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	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
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

CHLORHEXIDINE 0.12% MOUTHWASH 15 ML

Facility

$1.00

Hospital Charge Code	41652453
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
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	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
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

CHLORHEXIDINE 4% SCRUB SOLUTION

Facility

$2.04

Hospital Charge Code	41654710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.02
Rate for Payer: Aetna Government	$1.02
Rate for Payer: Brighton Health Commercial	$1.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.39
Rate for Payer: Group Health Inc Commercial	$1.02
Rate for Payer: Group Health Inc Medicare	$0.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.02
Rate for Payer: Hamaspik Choice Inc Medicare	$1.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.33

CHLORHEXIDINE 4% SCRUB SOLUTION

Facility

$2.04

Hospital Charge Code	41644710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.02
Rate for Payer: Aetna Government	$1.02
Rate for Payer: Brighton Health Commercial	$1.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.39
Rate for Payer: Group Health Inc Commercial	$1.02
Rate for Payer: Group Health Inc Medicare	$0.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.02
Rate for Payer: Hamaspik Choice Inc Medicare	$1.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.33

CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN [9516]

Facility

$0.15

Service Code	NDC 00121089340
Hospital Charge Code	00121089340
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

CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN [9516]

Facility

$0.02

Service Code	NDC 48878062001
Hospital Charge Code	48878062001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN [9516]

Facility

$0.14

Service Code	NDC 00121089300
Hospital Charge Code	00121089300
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: 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

CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN [9516]

Facility

$0.03

Service Code	NDC 00116200116
Hospital Charge Code	00116200116
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN [9516]

Facility

$0.13

Service Code	NDC 00904703580
Hospital Charge Code	00904703580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.10
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	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
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	$0.08

CHLORHEXIDINE GLUCONATE 4 % EX SOLN [109392]

Facility

$0.07

Service Code	NDC 00234057517
Hospital Charge Code	00234057517
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

CHLORHEXIDINE GLUCONATE 4 % EX SOLN [109392]

Facility

$0.03

Service Code	NDC 00234057504
Hospital Charge Code	00234057504
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	$0.02
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

CHLORIDES

Facility

$11.50

Service Code	HCPCS 82435
Hospital Charge Code	40602070
Hospital Revenue Code	301
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$8.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.60
Rate for Payer: Aetna Government	$4.60
Rate for Payer: Affinity Essential Plan 1&2	$3.22
Rate for Payer: Affinity Essential Plan 3&4	$3.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.22
Rate for Payer: Brighton Health Commercial	$8.62
Rate for Payer: Cash Price	$4.60
Rate for Payer: Cash Price	$4.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.19
Rate for Payer: Elderplan Medicare Advantage	$4.60
Rate for Payer: EmblemHealth Commercial	$4.60
Rate for Payer: Fidelis Essential Plan Aliesa	$3.91
Rate for Payer: Fidelis Essential Plan QHP	$4.09
Rate for Payer: Fidelis Medicare Advantage	$4.60
Rate for Payer: Fidelis Qualified Health Plan	$4.09
Rate for Payer: Group Health Inc Commercial	$4.60
Rate for Payer: Group Health Inc Medicare	$4.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4.60
Rate for Payer: Healthfirst Medicare Advantage	$4.60
Rate for Payer: Healthfirst QHP	$4.60
Rate for Payer: Humana Medicare	$4.69
Rate for Payer: Senior Whole Health Medicare Advantage	$4.60
Rate for Payer: United Healthcare Commercial	$5.82
Rate for Payer: United Healthcare Medicare Advantage	$4.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.68
Rate for Payer: Wellcare Medicare	$4.14

CHLORIDES

Facility

$11.50

Service Code	HCPCS 82435
Hospital Charge Code	40602070
Hospital Revenue Code	301
Rate for Payer: Cash Price	$4.60

CHLOROPROCAINE HCL (PF) 3 % IJ SOLN [134068]

Facility

$1.34

Service Code	HCPCS J2400
Hospital Charge Code	63323047827
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$29.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.03
Rate for Payer: Aetna Government	$29.03
Rate for Payer: Brighton Health Commercial	$1.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.91
Rate for Payer: Group Health Inc Commercial	$0.67
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67
Rate for Payer: Hamaspik Choice Inc Medicare	$0.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.87

CHLOROPROCAINE HCL (PF) 3 % IJ SOLN [134068]

Facility

$1.34

Service Code	HCPCS J2400
Hospital Charge Code	63323047801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$29.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.03
Rate for Payer: Aetna Government	$29.03
Rate for Payer: Brighton Health Commercial	$1.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.91
Rate for Payer: Group Health Inc Commercial	$0.67
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67
Rate for Payer: Hamaspik Choice Inc Medicare	$0.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.87

CHLOROPROCAINE PF 3 % INJ

Facility

$15.00

Service Code	HCPCS J2400
Hospital Charge Code	41654135
Hospital Revenue Code	636
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50

CHLOROPROCAINE PF 3 % INJ

Facility

$15.00

Service Code	HCPCS J2400
Hospital Charge Code	41644135
Hospital Revenue Code	636
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$29.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.03
Rate for Payer: Aetna Government	$29.03
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.62
Rate for Payer: Group Health Inc Commercial	$7.50
Rate for Payer: Group Health Inc Medicare	$5.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.75

CHLOROPROCAINE PF 3 % INJ

Facility

$15.00

Service Code	HCPCS J2400
Hospital Charge Code	41644135
Hospital Revenue Code	636
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50

CHLOROPROCAINE PF 3 % INJ

Facility

$15.00

Service Code	HCPCS J2400
Hospital Charge Code	41654135
Hospital Revenue Code	636
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$29.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.03
Rate for Payer: Aetna Government	$29.03
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.62
Rate for Payer: Group Health Inc Commercial	$7.50
Rate for Payer: Group Health Inc Medicare	$5.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.75

CHLOROTHIAZIDE 50 MG/ML SUSP NEONATAL

Facility

$1.00

Hospital Charge Code	41653051
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
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	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
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

CHLOROTHIAZIDE 50 MG/ML SUSP NEONATAL

Facility

$1.00

Hospital Charge Code	41643051
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
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	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
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

CHLORPHENIRAMINE 4 MG TAB

Facility

$1.00

Hospital Charge Code	41650772
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
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	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
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

CHLORPHENIRAMINE 4 MG TAB

Facility

$1.00

Hospital Charge Code	41640772
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
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	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
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

CHLORPHENIRAMINE MALEATE 4 MG PO TABS [1645]

Facility

$0.04

Service Code	NDC 00904001259
Hospital Charge Code	00904001259
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

Know your out-of-pocket cost for care.

All Charges