Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

MONTELUKAST SODIUM 10 MG PO TABS

Facility

OP

$5.03

Service Code	NDC 1366808190
Hospital Charge Code	1366808190
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Brighton Health Commercial	$3.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.42
Rate for Payer: EmblemHealth Commercial	$2.51
Rate for Payer: Group Health Inc Commercial	$2.51
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51
Rate for Payer: Hamaspik Choice Inc Medicare	$2.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.27

MONTELUKAST SODIUM 10 MG PO TABS

Facility

OP

$5.66

Service Code	NDC 1672911917
Hospital Charge Code	1672911917
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$4.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.83
Rate for Payer: Aetna Government	$2.83
Rate for Payer: Brighton Health Commercial	$4.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.85
Rate for Payer: EmblemHealth Commercial	$2.83
Rate for Payer: Group Health Inc Commercial	$2.83
Rate for Payer: Group Health Inc Medicare	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83
Rate for Payer: Hamaspik Choice Inc Medicare	$2.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.68

MONTELUKAST SODIUM 10 MG PO TABS

Facility

IP

$5.66

Service Code	NDC 1672911910
Hospital Charge Code	1672911910
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83

MONTELUKAST SODIUM 10 MG PO TABS

Facility

OP

$0.40

Service Code	NDC 0904680806
Hospital Charge Code	0904680806
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

MONTELUKAST SODIUM 10 MG PO TABS

Facility

IP

$5.66

Service Code	NDC 5511172510
Hospital Charge Code	5511172510
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83

MONTELUKAST SODIUM 10 MG PO TABS

Facility

IP

$5.66

Service Code	NDC 1672911917
Hospital Charge Code	1672911917
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83

MONTELUKAST SODIUM 10 MG PO TABS

Facility

IP

$0.40

Service Code	NDC 0904680806
Hospital Charge Code	0904680806
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

MONTELUKAST SODIUM 10 MG PO TABS

Facility

IP

$0.40

Service Code	NDC 0904680861
Hospital Charge Code	0904680861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

MONTELUKAST SODIUM 10 MG PO TABS

Facility

IP

$5.03

Service Code	NDC 1366808190
Hospital Charge Code	1366808190
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51

MONTELUKAST SODIUM 10 MG PO TABS

Facility

OP

$0.40

Service Code	NDC 0904680861
Hospital Charge Code	0904680861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

MONTELUKAST SODIUM 10 MG PO TABS

Facility

OP

$5.66

Service Code	NDC 3172272630
Hospital Charge Code	3172272630
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$4.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.83
Rate for Payer: Aetna Government	$2.83
Rate for Payer: Brighton Health Commercial	$4.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.85
Rate for Payer: EmblemHealth Commercial	$2.83
Rate for Payer: Group Health Inc Commercial	$2.83
Rate for Payer: Group Health Inc Medicare	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83
Rate for Payer: Hamaspik Choice Inc Medicare	$2.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.68

MONTELUKAST SODIUM 10 MG PO TABS

Facility

OP

$5.66

Service Code	NDC 5511172510
Hospital Charge Code	5511172510
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$4.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.83
Rate for Payer: Aetna Government	$2.83
Rate for Payer: Brighton Health Commercial	$4.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.85
Rate for Payer: EmblemHealth Commercial	$2.83
Rate for Payer: Group Health Inc Commercial	$2.83
Rate for Payer: Group Health Inc Medicare	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83
Rate for Payer: Hamaspik Choice Inc Medicare	$2.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.68

MONTELUKAST SODIUM 10 MG PO TABS

Facility

IP

$5.66

Service Code	NDC 3172272630
Hospital Charge Code	3172272630
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83

MONTELUKAST SODIUM 10 MG PO TABS

Facility

OP

$5.66

Service Code	NDC 1672911910
Hospital Charge Code	1672911910
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$4.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.83
Rate for Payer: Aetna Government	$2.83
Rate for Payer: Brighton Health Commercial	$4.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.85
Rate for Payer: EmblemHealth Commercial	$2.83
Rate for Payer: Group Health Inc Commercial	$2.83
Rate for Payer: Group Health Inc Medicare	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83
Rate for Payer: Hamaspik Choice Inc Medicare	$2.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.68

MONTELUKAST SODIUM 4 MG PO CHEW

Facility

IP

$5.03

Service Code	NDC 3334211007
Hospital Charge Code	3334211007
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51

MONTELUKAST SODIUM 4 MG PO CHEW

Facility

OP

$3.66

Service Code	NDC 5026857311
Hospital Charge Code	5026857311
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$2.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.83
Rate for Payer: Aetna Government	$1.83
Rate for Payer: Brighton Health Commercial	$2.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.49
Rate for Payer: EmblemHealth Commercial	$1.83
Rate for Payer: Group Health Inc Commercial	$1.83
Rate for Payer: Group Health Inc Medicare	$1.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.83
Rate for Payer: Hamaspik Choice Inc Medicare	$1.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.38

MONTELUKAST SODIUM 4 MG PO CHEW

Facility

IP

$5.66

Service Code	NDC 3172272730
Hospital Charge Code	3172272730
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83

MONTELUKAST SODIUM 4 MG PO CHEW

Facility

IP

$3.66

Service Code	NDC 5026857311
Hospital Charge Code	5026857311
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$1.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.83

MONTELUKAST SODIUM 4 MG PO CHEW

Facility

OP

$5.03

Service Code	NDC 1366807930
Hospital Charge Code	1366807930
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Brighton Health Commercial	$3.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.42
Rate for Payer: EmblemHealth Commercial	$2.51
Rate for Payer: Group Health Inc Commercial	$2.51
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51
Rate for Payer: Hamaspik Choice Inc Medicare	$2.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.27

MONTELUKAST SODIUM 4 MG PO CHEW

Facility

IP

$5.03

Service Code	NDC 1366807930
Hospital Charge Code	1366807930
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51

MONTELUKAST SODIUM 4 MG PO CHEW

Facility

OP

$5.66

Service Code	NDC 3172272730
Hospital Charge Code	3172272730
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$4.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.83
Rate for Payer: Aetna Government	$2.83
Rate for Payer: Brighton Health Commercial	$4.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.85
Rate for Payer: EmblemHealth Commercial	$2.83
Rate for Payer: Group Health Inc Commercial	$2.83
Rate for Payer: Group Health Inc Medicare	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83
Rate for Payer: Hamaspik Choice Inc Medicare	$2.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.68

MONTELUKAST SODIUM 4 MG PO CHEW

Facility

OP

$5.03

Service Code	NDC 3334211007
Hospital Charge Code	3334211007
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Brighton Health Commercial	$3.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.42
Rate for Payer: EmblemHealth Commercial	$2.51
Rate for Payer: Group Health Inc Commercial	$2.51
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51
Rate for Payer: Hamaspik Choice Inc Medicare	$2.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.27

MONTELUKAST SODIUM 5 MG PO CHEW

Facility

OP

$5.03

Service Code	NDC 3334211110
Hospital Charge Code	3334211110
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Brighton Health Commercial	$3.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.42
Rate for Payer: EmblemHealth Commercial	$2.51
Rate for Payer: Group Health Inc Commercial	$2.51
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51
Rate for Payer: Hamaspik Choice Inc Medicare	$2.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.27

MONTELUKAST SODIUM 5 MG PO CHEW

Facility

IP

$5.03

Service Code	NDC 3334211110
Hospital Charge Code	3334211110
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51

MONTELUKAST SODIUM 5 MG PO CHEW

Facility

IP

$4.11

Service Code	NDC 5026857415
Hospital Charge Code	5026857415
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.05

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