St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MIDFACE INFLAY MOD,STD HALF SIZE

Facility

$380.00

Service Code	HCPCS C1713
Hospital Charge Code	40201242
Hospital Revenue Code	278
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.00
Rate for Payer: Hamaspik Choice Inc Medicare	$190.00

MIDODRINE 5 MG TAB - NF

Facility

$2.95

Hospital Charge Code	41652833
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.48
Rate for Payer: Aetna Government	$1.48
Rate for Payer: Brighton Health Commercial	$2.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.01
Rate for Payer: Group Health Inc Commercial	$1.48
Rate for Payer: Group Health Inc Medicare	$1.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.48
Rate for Payer: Hamaspik Choice Inc Medicare	$1.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.92

MIDODRINE 5 MG TAB - NF

Facility

$2.95

Hospital Charge Code	41642833
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.48
Rate for Payer: Aetna Government	$1.48
Rate for Payer: Brighton Health Commercial	$2.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.01
Rate for Payer: Group Health Inc Commercial	$1.48
Rate for Payer: Group Health Inc Medicare	$1.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.48
Rate for Payer: Hamaspik Choice Inc Medicare	$1.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.92

MIDODRINE HCL 5 MG PO TABS [10610]

Facility

$4.16

Service Code	NDC 00245021211
Hospital Charge Code	00245021211
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$3.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.08
Rate for Payer: Aetna Government	$2.08
Rate for Payer: Brighton Health Commercial	$3.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.83
Rate for Payer: Group Health Inc Commercial	$2.08
Rate for Payer: Group Health Inc Medicare	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.08
Rate for Payer: Hamaspik Choice Inc Medicare	$2.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.70

MIDODRINE HCL 5 MG PO TABS [10610]

Facility

$0.72

Service Code	NDC 00904681806
Hospital Charge Code	00904681806
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

MIDODRINE HCL 5 MG PO TABS [10610]

Facility

$2.43

Service Code	NDC 60505132101
Hospital Charge Code	60505132101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.22
Rate for Payer: Aetna Government	$1.22
Rate for Payer: Brighton Health Commercial	$1.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.65
Rate for Payer: Group Health Inc Commercial	$1.22
Rate for Payer: Group Health Inc Medicare	$0.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.58

MIDODRINE HCL 5 MG PO TABS [10610]

Facility

$1.04

Service Code	NDC 50268056215
Hospital Charge Code	50268056215
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.52
Rate for Payer: Aetna Government	$0.52
Rate for Payer: Brighton Health Commercial	$0.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.71
Rate for Payer: Group Health Inc Commercial	$0.52
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52
Rate for Payer: Hamaspik Choice Inc Medicare	$0.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.68

MIDODRINE HCL 5 MG PO TABS [10610]

Facility

$1.04

Service Code	NDC 00904681861
Hospital Charge Code	00904681861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.52
Rate for Payer: Aetna Government	$0.52
Rate for Payer: Brighton Health Commercial	$0.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.71
Rate for Payer: Group Health Inc Commercial	$0.52
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52
Rate for Payer: Hamaspik Choice Inc Medicare	$0.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.68

MID-STREAM CATH. KIT

Facility

$6.03

Hospital Charge Code	40203913
Hospital Revenue Code	270
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$4.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.02
Rate for Payer: Aetna Government	$3.02
Rate for Payer: Brighton Health Commercial	$4.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.10
Rate for Payer: Group Health Inc Commercial	$3.02
Rate for Payer: Group Health Inc Medicare	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.02
Rate for Payer: Hamaspik Choice Inc Medicare	$3.02

MILK OF MAGNESIA 30ML SUSPENSE

Facility

$1.00

Hospital Charge Code	41657155
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

MILK OF MAGNESIA 30ML SUSPENSE

Facility

$1.00

Hospital Charge Code	41647155
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

MILRINONE 20 MG/D5W 100 ML PREMIX

Facility

$5.61

Service Code	HCPCS J2260
Hospital Charge Code	41644962
Hospital Revenue Code	636
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$3.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.89
Rate for Payer: Aetna Government	$1.89
Rate for Payer: Brighton Health Commercial	$3.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.23
Rate for Payer: Group Health Inc Commercial	$2.80
Rate for Payer: Group Health Inc Medicare	$1.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.80
Rate for Payer: Hamaspik Choice Inc Medicare	$2.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.64
Rate for Payer: SOMOS Essential	$1.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.65

MILRINONE 20 MG/D5W 100 ML PREMIX

Facility

$5.61

Service Code	HCPCS J2260
Hospital Charge Code	41654962
Hospital Revenue Code	636
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.80
Rate for Payer: Hamaspik Choice Inc Medicare	$2.80

MILRINONE 20 MG/D5W 100 ML PREMIX

Facility

$5.61

Service Code	HCPCS J2260
Hospital Charge Code	41654962
Hospital Revenue Code	636
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$3.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.89
Rate for Payer: Aetna Government	$1.89
Rate for Payer: Brighton Health Commercial	$3.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.23
Rate for Payer: Group Health Inc Commercial	$2.80
Rate for Payer: Group Health Inc Medicare	$1.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.80
Rate for Payer: Hamaspik Choice Inc Medicare	$2.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.64
Rate for Payer: SOMOS Essential	$1.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.65

MILRINONE 20 MG/D5W 100 ML PREMIX

Facility

$5.61

Service Code	HCPCS J2260
Hospital Charge Code	41644962
Hospital Revenue Code	636
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.80
Rate for Payer: Hamaspik Choice Inc Medicare	$2.80

MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN [137869]

Facility

$0.18

Service Code	HCPCS J2260
Hospital Charge Code	25021031382
Hospital Revenue Code	278
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09

MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN [137869]

Facility

$0.18

Service Code	HCPCS J2260
Hospital Charge Code	25021031382
Hospital Revenue Code	278
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.89
Rate for Payer: Aetna Government	$1.89
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Fidelis Medicare Advantage	$0.19
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN [137869]

Facility

$0.18

Service Code	HCPCS J2260
Hospital Charge Code	00143971910
Hospital Revenue Code	278
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.89
Rate for Payer: Aetna Government	$1.89
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Fidelis Medicare Advantage	$0.19
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN [137869]

Facility

$0.18

Service Code	HCPCS J2260
Hospital Charge Code	00143971910
Hospital Revenue Code	278
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09

MINERAL OIL FOR RECTAL USE

Facility

$4.00

Hospital Charge Code	41640349
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

MINERAL OIL FOR RECTAL USE

Facility

$4.00

Hospital Charge Code	41650349
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

MINERAL OIL LIGHT OIL [27386]

Facility

$2.10

Service Code	NDC 63323025410
Hospital Charge Code	63323025410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$1.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.43
Rate for Payer: Group Health Inc Commercial	$1.05
Rate for Payer: Group Health Inc Medicare	$0.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.05
Rate for Payer: Hamaspik Choice Inc Medicare	$1.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.37

MINERAL OIL LIGHT TOPICAL 10 ML

Facility

$14.13

Hospital Charge Code	41653438
Hospital Revenue Code	250
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$11.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.06
Rate for Payer: Aetna Government	$7.06
Rate for Payer: Brighton Health Commercial	$10.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.61
Rate for Payer: Group Health Inc Commercial	$7.06
Rate for Payer: Group Health Inc Medicare	$4.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.06
Rate for Payer: Hamaspik Choice Inc Medicare	$7.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.18

MINERAL OIL LIGHT TOPICAL 10 ML

Facility

$14.13

Hospital Charge Code	41643438
Hospital Revenue Code	250
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$11.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.06
Rate for Payer: Aetna Government	$7.06
Rate for Payer: Brighton Health Commercial	$10.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.61
Rate for Payer: Group Health Inc Commercial	$7.06
Rate for Payer: Group Health Inc Medicare	$4.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.06
Rate for Payer: Hamaspik Choice Inc Medicare	$7.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.18

MINERAL OIL ORAL

Facility

$0.87

Hospital Charge Code	41653497
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.44
Rate for Payer: Aetna Government	$0.44
Rate for Payer: Brighton Health Commercial	$0.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.59
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.57

Know your out-of-pocket cost for care.

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