St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS [33227]

Facility

$3.79

Service Code	NDC 00093227434
Hospital Charge Code	00093227434
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$3.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.89
Rate for Payer: Aetna Government	$1.89
Rate for Payer: Brighton Health Commercial	$2.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.57
Rate for Payer: Group Health Inc Commercial	$1.89
Rate for Payer: Group Health Inc Medicare	$1.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.89
Rate for Payer: Hamaspik Choice Inc Medicare	$1.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.46

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS [33228]

Facility

$5.05

Service Code	NDC 00143924920
Hospital Charge Code	00143924920
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$4.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Brighton Health Commercial	$3.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.44
Rate for Payer: Group Health Inc Commercial	$2.53
Rate for Payer: Group Health Inc Medicare	$1.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.53
Rate for Payer: Hamaspik Choice Inc Medicare	$2.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.28

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS [33228]

Facility

$4.95

Service Code	NDC 65862050301
Hospital Charge Code	65862050301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$3.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.48
Rate for Payer: Aetna Government	$2.48
Rate for Payer: Brighton Health Commercial	$3.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.37
Rate for Payer: Group Health Inc Commercial	$2.48
Rate for Payer: Group Health Inc Medicare	$1.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.48
Rate for Payer: Hamaspik Choice Inc Medicare	$2.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.22

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS [33228]

Facility

$5.05

Service Code	NDC 66685100100
Hospital Charge Code	66685100100
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$4.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Brighton Health Commercial	$3.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.44
Rate for Payer: Group Health Inc Commercial	$2.53
Rate for Payer: Group Health Inc Medicare	$1.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.53
Rate for Payer: Hamaspik Choice Inc Medicare	$2.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.28

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS [33228]

Facility

$5.05

Service Code	NDC 00781185220
Hospital Charge Code	00781185220
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$4.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Brighton Health Commercial	$3.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.44
Rate for Payer: Group Health Inc Commercial	$2.53
Rate for Payer: Group Health Inc Medicare	$1.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.53
Rate for Payer: Hamaspik Choice Inc Medicare	$2.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.28

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS [33228]

Facility

$5.05

Service Code	NDC 42571016242
Hospital Charge Code	42571016242
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$4.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Brighton Health Commercial	$3.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.44
Rate for Payer: Group Health Inc Commercial	$2.53
Rate for Payer: Group Health Inc Medicare	$1.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.53
Rate for Payer: Hamaspik Choice Inc Medicare	$2.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.28

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS [33228]

Facility

$5.05

Service Code	NDC 00093227534
Hospital Charge Code	00093227534
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$4.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Brighton Health Commercial	$3.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.44
Rate for Payer: Group Health Inc Commercial	$2.53
Rate for Payer: Group Health Inc Medicare	$1.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.53
Rate for Payer: Hamaspik Choice Inc Medicare	$2.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.28

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS [33228]

Facility

$5.07

Service Code	NDC 65862050320
Hospital Charge Code	65862050320
Hospital Revenue Code	250
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$4.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.54
Rate for Payer: Aetna Government	$2.54
Rate for Payer: Brighton Health Commercial	$3.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.45
Rate for Payer: Group Health Inc Commercial	$2.54
Rate for Payer: Group Health Inc Medicare	$1.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.54
Rate for Payer: Hamaspik Choice Inc Medicare	$2.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.30

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS [33228]

Facility

$5.05

Service Code	NDC 42571016201
Hospital Charge Code	42571016201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$4.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Brighton Health Commercial	$3.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.44
Rate for Payer: Group Health Inc Commercial	$2.53
Rate for Payer: Group Health Inc Medicare	$1.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.53
Rate for Payer: Hamaspik Choice Inc Medicare	$2.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.28

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS [33228]

Facility

$4.90

Service Code	NDC 66685100101
Hospital Charge Code	66685100101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$3.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.45
Rate for Payer: Aetna Government	$2.45
Rate for Payer: Brighton Health Commercial	$3.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.33
Rate for Payer: Group Health Inc Commercial	$2.45
Rate for Payer: Group Health Inc Medicare	$1.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.18

AMPHETAMINE CONFIRMATION, UR

Facility

$107.50

Service Code	HCPCS 80324
Hospital Charge Code	40609016
Hospital Revenue Code	300
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$86.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$80.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.10
Rate for Payer: Group Health Inc Commercial	$53.75
Rate for Payer: Group Health Inc Medicare	$37.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.75
Rate for Payer: Hamaspik Choice Inc Medicare	$53.75
Rate for Payer: United Healthcare Commercial	$19.04

AMPHETAMINE-DEXTROAMPHET ER 10 MG PO CP24 [31587]

Facility

$1.67

Service Code	NDC 49884084001
Hospital Charge Code	49884084001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$1.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.83
Rate for Payer: Aetna Government	$0.83
Rate for Payer: Brighton Health Commercial	$1.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.13
Rate for Payer: Group Health Inc Commercial	$0.83
Rate for Payer: Group Health Inc Medicare	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.83
Rate for Payer: Hamaspik Choice Inc Medicare	$0.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.08

AMPHETAMINE-DEXTROAMPHET ER 10 MG PO CP24 [31587]

Facility

$7.05

Service Code	NDC 00115148701
Hospital Charge Code	00115148701
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

AMPHETAMINE-DEXTROAMPHET ER 5 MG PO CP24 [33005]

Facility

$8.55

Service Code	NDC 54092038101
Hospital Charge Code	54092038101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$6.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.27
Rate for Payer: Aetna Government	$4.27
Rate for Payer: Brighton Health Commercial	$6.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.81
Rate for Payer: Group Health Inc Commercial	$4.27
Rate for Payer: Group Health Inc Medicare	$2.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.27
Rate for Payer: Hamaspik Choice Inc Medicare	$4.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.56

AMPHETAMINE SCREEN, URINE

Facility

$107.50

Service Code	HCPCS 80324
Hospital Charge Code	40609013
Hospital Revenue Code	300
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$86.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$80.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.10
Rate for Payer: Group Health Inc Commercial	$53.75
Rate for Payer: Group Health Inc Medicare	$37.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.75
Rate for Payer: Hamaspik Choice Inc Medicare	$53.75
Rate for Payer: United Healthcare Commercial	$19.04

AMPHETAMINE_SCREEN, URINE

Facility

$107.50

Service Code	HCPCS 80324
Hospital Charge Code	40609842
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$86.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$80.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.10
Rate for Payer: Group Health Inc Commercial	$53.75
Rate for Payer: Group Health Inc Medicare	$37.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.75
Rate for Payer: Hamaspik Choice Inc Medicare	$53.75
Rate for Payer: United Healthcare Commercial	$19.04

AMPHETAMINES, URINE

Facility

$107.50

Service Code	HCPCS 80324
Hospital Charge Code	40608161
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$86.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$80.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.10
Rate for Payer: Group Health Inc Commercial	$53.75
Rate for Payer: Group Health Inc Medicare	$37.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.75
Rate for Payer: Hamaspik Choice Inc Medicare	$53.75
Rate for Payer: United Healthcare Commercial	$19.04

AMPHOTERICIN B 50 MG IV SOLR [166800]

Facility

$60.00

Service Code	HCPCS J0285
Hospital Charge Code	39822105505
Hospital Revenue Code	278
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$63.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.65
Rate for Payer: Aetna Government	$42.65
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.50
Rate for Payer: EmblemHealth Commercial	$30.00
Rate for Payer: Fidelis Medicare Advantage	$63.00
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.00

AMPHOTERICIN B 50 MG IV SOLR [166800]

Facility

$60.00

Service Code	HCPCS J0285
Hospital Charge Code	39822105505
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00

AMPHOTERICIN B INJ

Facility

$3.00

Service Code	HCPCS J0285
Hospital Charge Code	41644263
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$42.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.65
Rate for Payer: Aetna Government	$42.65
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: SOMOS CHP/HARP/Medicaid	$40.89
Rate for Payer: SOMOS Essential	$40.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

AMPHOTERICIN B INJ

Facility

$3.00

Service Code	HCPCS J0285
Hospital Charge Code	41644263
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

AMPHOTERICIN B INJ

Facility

$3.00

Service Code	HCPCS J0285
Hospital Charge Code	41654263
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$42.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.65
Rate for Payer: Aetna Government	$42.65
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: SOMOS CHP/HARP/Medicaid	$40.89
Rate for Payer: SOMOS Essential	$40.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

AMPHOTERICIN B INJ

Facility

$3.00

Service Code	HCPCS J0285
Hospital Charge Code	41654263
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

AMPHOTERICIN B LIPOSOMAL 1 MG/ML INJ NEO

Facility

$1.00

Hospital Charge Code	41653813
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

AMPHOTERICIN B LIPOSOMAL 1 MG/ML INJ NEO

Facility

$1.00

Hospital Charge Code	41643813
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

Know your out-of-pocket cost for care.

All Charges