St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Penis procedures

Facility

$66,393.11

Service Code	APR-DRG 4813
Min. Negotiated Rate	$23,493.00
Max. Negotiated Rate	$66,393.11
Rate for Payer: Affinity Essential Plan 1&2	$66,393.11
Rate for Payer: Affinity Essential Plan 3&4	$66,393.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,508.05
Rate for Payer: Amida Care Medicaid	$29,508.05
Rate for Payer: EmblemHealth Essential Plan 1&2	$66,393.11
Rate for Payer: EmblemHealth Essential Plan 3&4	$29,508.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,508.05
Rate for Payer: Fidelis Qualified Health Plan	$35,409.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,508.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,508.05
Rate for Payer: Healthfirst Commercial	$46,489.00
Rate for Payer: Healthfirst Essential Plan	$66,393.11
Rate for Payer: Healthfirst QHP	$23,493.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,508.05
Rate for Payer: SOMOS Essential	$66,393.11
Rate for Payer: United Healthcare Essential Plan 1&2	$66,393.11
Rate for Payer: United Healthcare Essential Plan 3&4	$66,393.11
Rate for Payer: United Healthcare Medicaid	$29,508.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,508.05

Penis procedures

Facility

$68,359.41

Service Code	APR-DRG 4814
Min. Negotiated Rate	$30,381.96
Max. Negotiated Rate	$68,359.41
Rate for Payer: Affinity Essential Plan 1&2	$68,359.41
Rate for Payer: Affinity Essential Plan 3&4	$68,359.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,381.96
Rate for Payer: Amida Care Medicaid	$30,381.96
Rate for Payer: EmblemHealth Essential Plan 1&2	$68,359.41
Rate for Payer: EmblemHealth Essential Plan 3&4	$30,381.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,381.96
Rate for Payer: Fidelis Qualified Health Plan	$36,458.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,381.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,381.96
Rate for Payer: Healthfirst Commercial	$64,204.00
Rate for Payer: Healthfirst Essential Plan	$68,359.41
Rate for Payer: Healthfirst QHP	$30,778.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,381.96
Rate for Payer: SOMOS Essential	$68,359.41
Rate for Payer: United Healthcare Essential Plan 1&2	$68,359.41
Rate for Payer: United Healthcare Essential Plan 3&4	$68,359.41
Rate for Payer: United Healthcare Medicaid	$30,381.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,381.96

Penis procedures

Facility

$53,464.57

Service Code	APR-DRG 4812
Min. Negotiated Rate	$14,220.00
Max. Negotiated Rate	$53,464.57
Rate for Payer: Affinity Essential Plan 1&2	$53,464.57
Rate for Payer: Affinity Essential Plan 3&4	$53,464.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,762.03
Rate for Payer: Amida Care Medicaid	$23,762.03
Rate for Payer: EmblemHealth Essential Plan 1&2	$53,464.57
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,762.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,762.03
Rate for Payer: Fidelis Qualified Health Plan	$28,514.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,762.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,762.03
Rate for Payer: Healthfirst Commercial	$22,568.00
Rate for Payer: Healthfirst Essential Plan	$53,464.57
Rate for Payer: Healthfirst QHP	$14,220.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,762.03
Rate for Payer: SOMOS Essential	$53,464.57
Rate for Payer: United Healthcare Essential Plan 1&2	$53,464.57
Rate for Payer: United Healthcare Essential Plan 3&4	$53,464.57
Rate for Payer: United Healthcare Medicaid	$23,762.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,762.03

Penis procedures

Facility

$45,068.33

Service Code	APR-DRG 4811
Min. Negotiated Rate	$8,285.00
Max. Negotiated Rate	$45,068.33
Rate for Payer: Affinity Essential Plan 1&2	$45,068.33
Rate for Payer: Affinity Essential Plan 3&4	$45,068.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,030.37
Rate for Payer: Amida Care Medicaid	$20,030.37
Rate for Payer: EmblemHealth Essential Plan 1&2	$45,068.33
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,030.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,030.37
Rate for Payer: Fidelis Qualified Health Plan	$24,036.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,030.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,030.37
Rate for Payer: Healthfirst Commercial	$14,916.00
Rate for Payer: Healthfirst Essential Plan	$45,068.33
Rate for Payer: Healthfirst QHP	$8,285.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,030.37
Rate for Payer: SOMOS Essential	$45,068.33
Rate for Payer: United Healthcare Essential Plan 1&2	$45,068.33
Rate for Payer: United Healthcare Essential Plan 3&4	$45,068.33
Rate for Payer: United Healthcare Medicaid	$20,030.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,030.37

PENTAMIDINE ISETHIONATE 300 MG IJ SOLR

Facility

$117.24

Service Code	HCPCS J2545
Hospital Charge Code	2315574831
Hospital Revenue Code	250
Min. Negotiated Rate	$41.03
Max. Negotiated Rate	$123.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$123.72
Rate for Payer: Aetna Government	$123.72
Rate for Payer: Brighton Health Commercial	$87.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$93.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$79.72
Rate for Payer: EmblemHealth Commercial	$58.62
Rate for Payer: Group Health Inc Commercial	$58.62
Rate for Payer: Group Health Inc Medicare	$41.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.62
Rate for Payer: Hamaspik Choice Inc Medicare	$58.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$69.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$76.21

PENTAMIDINE ISETHIONATE 300 MG IJ SOLR

Facility

$180.50

Service Code	HCPCS J2545
Hospital Charge Code	1392551510
Hospital Revenue Code	250
Min. Negotiated Rate	$90.25
Max. Negotiated Rate	$90.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.25

PENTAMIDINE ISETHIONATE 300 MG IJ SOLR

Facility

$180.50

Service Code	HCPCS J2545
Hospital Charge Code	1392551510
Hospital Revenue Code	250
Min. Negotiated Rate	$63.17
Max. Negotiated Rate	$144.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$123.72
Rate for Payer: Aetna Government	$123.72
Rate for Payer: Brighton Health Commercial	$135.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$144.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$122.74
Rate for Payer: EmblemHealth Commercial	$90.25
Rate for Payer: Group Health Inc Commercial	$90.25
Rate for Payer: Group Health Inc Medicare	$63.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.25
Rate for Payer: Hamaspik Choice Inc Medicare	$90.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$69.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.33

PENTAMIDINE ISETHIONATE 300 MG IJ SOLR

Facility

$200.27

Service Code	HCPCS J2545
Hospital Charge Code	6332311310
Hospital Revenue Code	250
Min. Negotiated Rate	$69.73
Max. Negotiated Rate	$160.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$123.72
Rate for Payer: Aetna Government	$123.72
Rate for Payer: Brighton Health Commercial	$150.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.18
Rate for Payer: EmblemHealth Commercial	$100.13
Rate for Payer: Group Health Inc Commercial	$100.13
Rate for Payer: Group Health Inc Medicare	$70.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.13
Rate for Payer: Hamaspik Choice Inc Medicare	$100.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$69.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$130.17

PENTAMIDINE ISETHIONATE 300 MG IJ SOLR

Facility

$200.27

Service Code	HCPCS J2545
Hospital Charge Code	6332311310
Hospital Revenue Code	250
Min. Negotiated Rate	$100.13
Max. Negotiated Rate	$100.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.13

PENTAMIDINE ISETHIONATE 300 MG IJ SOLR

Facility

$117.24

Service Code	HCPCS J2545
Hospital Charge Code	2315574831
Hospital Revenue Code	250
Min. Negotiated Rate	$58.62
Max. Negotiated Rate	$58.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.62

PENTAMIDINE ISETHIONATE 300 MG IN SOLR

Facility

$200.27

Service Code	HCPCS J2545
Hospital Charge Code	6332387715
Hospital Revenue Code	250
Min. Negotiated Rate	$69.73
Max. Negotiated Rate	$160.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$123.72
Rate for Payer: Aetna Government	$123.72
Rate for Payer: Brighton Health Commercial	$150.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.18
Rate for Payer: EmblemHealth Commercial	$100.14
Rate for Payer: Group Health Inc Commercial	$100.14
Rate for Payer: Group Health Inc Medicare	$70.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.14
Rate for Payer: Hamaspik Choice Inc Medicare	$100.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$69.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$130.18

PENTAMIDINE ISETHIONATE 300 MG IN SOLR

Facility

$200.27

Service Code	HCPCS J2545
Hospital Charge Code	6332387715
Hospital Revenue Code	250
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.14

PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN

Facility

$84.00

Service Code	HCPCS J2515
Hospital Charge Code	2502167620
Hospital Revenue Code	250
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$67.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.41
Rate for Payer: Aetna Government	$26.41
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.12
Rate for Payer: EmblemHealth Commercial	$42.00
Rate for Payer: Group Health Inc Commercial	$42.00
Rate for Payer: Group Health Inc Medicare	$29.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.00
Rate for Payer: Hamaspik Choice Inc Medicare	$42.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$54.60

PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN

Facility

$84.00

Service Code	HCPCS J2515
Hospital Charge Code	2502167620
Hospital Revenue Code	250
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.00

PENTOXIFYLLINE ER 400 MG PO TBCR

Facility

$1.50

Service Code	NDC 0904544861
Hospital Charge Code	0904544861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75

PENTOXIFYLLINE ER 400 MG PO TBCR

Facility

$1.50

Service Code	NDC 0904544861
Hospital Charge Code	0904544861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$1.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.02
Rate for Payer: EmblemHealth Commercial	$0.75
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.97

PEPTIC ULCER AND GASTRITIS

Facility

$271.35

Service Code	EAPG 00621
Min. Negotiated Rate	$196.72
Max. Negotiated Rate	$271.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$196.72
Rate for Payer: Healthfirst Commercial	$271.35

Peptic ulcer & gastritis

Facility

$41,522.69

Service Code	APR-DRG 2411
Min. Negotiated Rate	$6,103.00
Max. Negotiated Rate	$41,522.69
Rate for Payer: Affinity Essential Plan 1&2	$41,522.69
Rate for Payer: Affinity Essential Plan 3&4	$41,522.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,454.53
Rate for Payer: Amida Care Medicaid	$18,454.53
Rate for Payer: EmblemHealth Essential Plan 1&2	$41,522.69
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,454.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,454.53
Rate for Payer: Fidelis Qualified Health Plan	$22,145.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,454.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,454.53
Rate for Payer: Healthfirst Commercial	$10,395.00
Rate for Payer: Healthfirst Essential Plan	$41,522.69
Rate for Payer: Healthfirst QHP	$6,103.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,454.53
Rate for Payer: SOMOS Essential	$41,522.69
Rate for Payer: United Healthcare Essential Plan 1&2	$41,522.69
Rate for Payer: United Healthcare Essential Plan 3&4	$41,522.69
Rate for Payer: United Healthcare Medicaid	$18,454.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,454.53

Peptic ulcer & gastritis

Facility

$87,060.15

Service Code	APR-DRG 2414
Min. Negotiated Rate	$29,840.00
Max. Negotiated Rate	$87,060.15
Rate for Payer: Affinity Essential Plan 1&2	$87,060.15
Rate for Payer: Affinity Essential Plan 3&4	$87,060.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,693.40
Rate for Payer: Amida Care Medicaid	$38,693.40
Rate for Payer: EmblemHealth Essential Plan 1&2	$87,060.15
Rate for Payer: EmblemHealth Essential Plan 3&4	$38,693.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,693.40
Rate for Payer: Fidelis Qualified Health Plan	$46,432.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,693.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,693.40
Rate for Payer: Healthfirst Commercial	$52,351.00
Rate for Payer: Healthfirst Essential Plan	$87,060.15
Rate for Payer: Healthfirst QHP	$29,840.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,693.40
Rate for Payer: SOMOS Essential	$87,060.15
Rate for Payer: United Healthcare Essential Plan 1&2	$87,060.15
Rate for Payer: United Healthcare Essential Plan 3&4	$87,060.15
Rate for Payer: United Healthcare Medicaid	$38,693.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,693.40

Peptic ulcer & gastritis

Facility

$53,872.61

Service Code	APR-DRG 2413
Min. Negotiated Rate	$12,274.00
Max. Negotiated Rate	$53,872.61
Rate for Payer: Affinity Essential Plan 1&2	$53,872.61
Rate for Payer: Affinity Essential Plan 3&4	$53,872.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,943.38
Rate for Payer: Amida Care Medicaid	$23,943.38
Rate for Payer: EmblemHealth Essential Plan 1&2	$53,872.61
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,943.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,943.38
Rate for Payer: Fidelis Qualified Health Plan	$28,732.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,943.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,943.38
Rate for Payer: Healthfirst Commercial	$22,085.00
Rate for Payer: Healthfirst Essential Plan	$53,872.61
Rate for Payer: Healthfirst QHP	$12,274.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,943.38
Rate for Payer: SOMOS Essential	$53,872.61
Rate for Payer: United Healthcare Essential Plan 1&2	$53,872.61
Rate for Payer: United Healthcare Essential Plan 3&4	$53,872.61
Rate for Payer: United Healthcare Medicaid	$23,943.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,943.38

Peptic ulcer & gastritis

Facility

$45,659.27

Service Code	APR-DRG 2412
Min. Negotiated Rate	$8,326.00
Max. Negotiated Rate	$45,659.27
Rate for Payer: Affinity Essential Plan 1&2	$45,659.27
Rate for Payer: Affinity Essential Plan 3&4	$45,659.27
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,293.01
Rate for Payer: Amida Care Medicaid	$20,293.01
Rate for Payer: EmblemHealth Essential Plan 1&2	$45,659.27
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,293.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,293.01
Rate for Payer: Fidelis Qualified Health Plan	$24,351.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,293.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,293.01
Rate for Payer: Healthfirst Commercial	$13,919.00
Rate for Payer: Healthfirst Essential Plan	$45,659.27
Rate for Payer: Healthfirst QHP	$8,326.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,293.01
Rate for Payer: SOMOS Essential	$45,659.27
Rate for Payer: United Healthcare Essential Plan 1&2	$45,659.27
Rate for Payer: United Healthcare Essential Plan 3&4	$45,659.27
Rate for Payer: United Healthcare Medicaid	$20,293.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,293.01

PERAMPANEL 12 MG PO TABS

Facility

$49.08

Service Code	NDC 6285628230
Hospital Charge Code	6285628230
Hospital Revenue Code	250
Min. Negotiated Rate	$17.18
Max. Negotiated Rate	$39.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.54
Rate for Payer: Aetna Government	$24.54
Rate for Payer: Brighton Health Commercial	$36.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.37
Rate for Payer: EmblemHealth Commercial	$24.54
Rate for Payer: Group Health Inc Commercial	$24.54
Rate for Payer: Group Health Inc Medicare	$17.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.54
Rate for Payer: Hamaspik Choice Inc Medicare	$24.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.90

PERAMPANEL 12 MG PO TABS

Facility

$49.08

Service Code	NDC 6285628230
Hospital Charge Code	6285628230
Hospital Revenue Code	250
Min. Negotiated Rate	$24.54
Max. Negotiated Rate	$24.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.54

PERAMPANEL 2 MG PO TABS

Facility

$24.84

Service Code	NDC 6285627230
Hospital Charge Code	6285627230
Hospital Revenue Code	250
Min. Negotiated Rate	$8.69
Max. Negotiated Rate	$19.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.42
Rate for Payer: Aetna Government	$12.42
Rate for Payer: Brighton Health Commercial	$18.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.89
Rate for Payer: EmblemHealth Commercial	$12.42
Rate for Payer: Group Health Inc Commercial	$12.42
Rate for Payer: Group Health Inc Medicare	$8.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.42
Rate for Payer: Hamaspik Choice Inc Medicare	$12.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.15

PERAMPANEL 2 MG PO TABS

Facility

$24.84

Service Code	NDC 6285627230
Hospital Charge Code	6285627230
Hospital Revenue Code	250
Min. Negotiated Rate	$12.42
Max. Negotiated Rate	$12.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.42

Know your out-of-pocket cost for care.

All Charges