St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]

Facility

$0.44

Service Code	HCPCS J7613
Hospital Charge Code	00378827093
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
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	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.04
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]

Facility

$0.27

Service Code	HCPCS J7613
Hospital Charge Code	00487950101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.04
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]

Facility

$0.44

Service Code	HCPCS J7613
Hospital Charge Code	47335070349
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
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	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.04
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]

Facility

$0.44

Service Code	HCPCS J7613
Hospital Charge Code	00378827052
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
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	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.04
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]

Facility

$0.52

Service Code	HCPCS J7613
Hospital Charge Code	00378827055
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.04
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]

Facility

$0.27

Service Code	HCPCS J7613
Hospital Charge Code	00487950125
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.04
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]

Facility

$0.44

Service Code	HCPCS J7613
Hospital Charge Code	76204020025
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
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	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.04
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]

Facility

$0.44

Service Code	HCPCS J7613
Hospital Charge Code	76204020030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
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	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.04
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]

Facility

$0.12

Service Code	HCPCS J7613
Hospital Charge Code	60687039583
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
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	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.04
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]

Facility

$0.12

Service Code	HCPCS J7613
Hospital Charge Code	60687039579
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
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	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.04
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]

Facility

$0.47

Service Code	HCPCS J7613
Hospital Charge Code	76204020001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.32
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.04
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.30

ALBUTEROL SULFATE 2 MG/5ML PO SYRP [252]

Facility

$0.13

Service Code	NDC 70752010212
Hospital Charge Code	70752010212
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
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	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

ALBUTEROL SULFATE 2 MG/5ML PO SYRP [252]

Facility

$0.07

Service Code	NDC 00472082516
Hospital Charge Code	00472082516
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

ALBUTEROL SULFATE 2 MG PO TABS [253]

Facility

$7.47

Service Code	NDC 68084094995
Hospital Charge Code	68084094995
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$5.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.74
Rate for Payer: Aetna Government	$3.74
Rate for Payer: Brighton Health Commercial	$5.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.08
Rate for Payer: Group Health Inc Commercial	$3.74
Rate for Payer: Group Health Inc Medicare	$2.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.74
Rate for Payer: Hamaspik Choice Inc Medicare	$3.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.86

ALBUTEROL SULFATE 2 MG PO TABS [253]

Facility

$7.47

Service Code	NDC 68084094925
Hospital Charge Code	68084094925
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$5.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.74
Rate for Payer: Aetna Government	$3.74
Rate for Payer: Brighton Health Commercial	$5.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.08
Rate for Payer: Group Health Inc Commercial	$3.74
Rate for Payer: Group Health Inc Medicare	$2.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.74
Rate for Payer: Hamaspik Choice Inc Medicare	$3.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.86

ALBUTEROL SULFATE 2 MG PO TABS [253]

Facility

$7.05

Service Code	NDC 51079065720
Hospital Charge Code	51079065720
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$5.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.52
Rate for Payer: Aetna Government	$3.52
Rate for Payer: Brighton Health Commercial	$5.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.79
Rate for Payer: Group Health Inc Commercial	$3.52
Rate for Payer: Group Health Inc Medicare	$2.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.58

ALBUTEROL SULFATE (5 MG/ML) 0.5% CONTINUOUS NEB [400644]

Facility

$2.90

Service Code	NDC 50383074120
Hospital Charge Code	50383074120
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.45
Rate for Payer: Aetna Government	$1.45
Rate for Payer: Brighton Health Commercial	$2.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.97
Rate for Payer: Group Health Inc Commercial	$1.45
Rate for Payer: Group Health Inc Medicare	$1.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.88

ALBUTEROL SULFATE (5 MG/ML) 0.5% CONTINUOUS NEB [400644]

Facility

$1.13

Service Code	NDC 52959074120
Hospital Charge Code	52959074120
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Brighton Health Commercial	$0.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.77
Rate for Payer: Group Health Inc Commercial	$0.57
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57
Rate for Payer: Hamaspik Choice Inc Medicare	$0.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.74

ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU [251]

Facility

$3.00

Service Code	HCPCS J7611
Hospital Charge Code	73177014633
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.16
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.17
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.17
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU [251]

Facility

$1.08

Service Code	HCPCS J7611
Hospital Charge Code	69374030920
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.73
Rate for Payer: Group Health Inc Commercial	$0.54
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54
Rate for Payer: Hamaspik Choice Inc Medicare	$0.54
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.16
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.17
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.17
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.70

ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS [17837]

Facility

$14.28

Service Code	NDC 66758095985
Hospital Charge Code	66758095985
Hospital Revenue Code	250
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$11.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.14
Rate for Payer: Aetna Government	$7.14
Rate for Payer: Brighton Health Commercial	$10.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.71
Rate for Payer: Group Health Inc Commercial	$7.14
Rate for Payer: Group Health Inc Medicare	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.14
Rate for Payer: Hamaspik Choice Inc Medicare	$7.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.28

ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS [17837]

Facility

$13.57

Service Code	NDC 00054074287
Hospital Charge Code	00054074287
Hospital Revenue Code	250
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$10.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.78
Rate for Payer: Aetna Government	$6.78
Rate for Payer: Brighton Health Commercial	$10.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.23
Rate for Payer: Group Health Inc Commercial	$6.78
Rate for Payer: Group Health Inc Medicare	$4.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.78
Rate for Payer: Hamaspik Choice Inc Medicare	$6.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.82

ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS [17837]

Facility

$8.71

Service Code	NDC 68180096301
Hospital Charge Code	68180096301
Hospital Revenue Code	250
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$6.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.35
Rate for Payer: Aetna Government	$4.35
Rate for Payer: Brighton Health Commercial	$6.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.92
Rate for Payer: Group Health Inc Commercial	$4.35
Rate for Payer: Group Health Inc Medicare	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.35
Rate for Payer: Hamaspik Choice Inc Medicare	$4.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.66

ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS [17837]

Facility

$3.41

Service Code	NDC 00173068224
Hospital Charge Code	00173068224
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$2.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$2.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.32
Rate for Payer: Group Health Inc Commercial	$1.70
Rate for Payer: Group Health Inc Medicare	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.22

ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS [17837]

Facility

$8.71

Service Code	NDC 00093317431
Hospital Charge Code	00093317431
Hospital Revenue Code	250
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$6.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.35
Rate for Payer: Aetna Government	$4.35
Rate for Payer: Brighton Health Commercial	$6.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.92
Rate for Payer: Group Health Inc Commercial	$4.35
Rate for Payer: Group Health Inc Medicare	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.35
Rate for Payer: Hamaspik Choice Inc Medicare	$4.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.66

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