St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ROFLUMILAST 500 MCG PO TABS

Facility

$12.38

Service Code	NDC 7220520090
Hospital Charge Code	7220520090
Hospital Revenue Code	250
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$6.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.19

ROFLUMILAST 500 MCG PO TABS

Facility

$12.38

Service Code	NDC 7220520090
Hospital Charge Code	7220520090
Hospital Revenue Code	250
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$9.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.19
Rate for Payer: Aetna Government	$6.19
Rate for Payer: Brighton Health Commercial	$9.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.42
Rate for Payer: EmblemHealth Commercial	$6.19
Rate for Payer: Group Health Inc Commercial	$6.19
Rate for Payer: Group Health Inc Medicare	$4.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.19
Rate for Payer: Hamaspik Choice Inc Medicare	$6.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.05

ROMIPLOSTIM 250 MCG SC SOLR

Facility

$3.00

Service Code	HCPCS J2796
Hospital Charge Code	5551322101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$83.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$83.47
Rate for Payer: Aetna Government	$83.47
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: EmblemHealth Commercial	$1.50
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

ROMIPLOSTIM 250 MCG SC SOLR

Facility

$3.00

Service Code	HCPCS J2796
Hospital Charge Code	5551322101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50

ROMIPLOSTIM 500 MCG SC SOLR

Facility

$6.00

Service Code	HCPCS J2796
Hospital Charge Code	5551322201
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$83.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$83.47
Rate for Payer: Aetna Government	$83.47
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: EmblemHealth Commercial	$3.00
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

ROMIPLOSTIM 500 MCG SC SOLR

Facility

$6.00

Service Code	HCPCS J2796
Hospital Charge Code	5551322201
Hospital Revenue Code	250
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00

ROMOSOZUMAB-AQQG 105 MG/1.17ML SC SOSY

Facility

$1.00

Service Code	HCPCS J3111
Hospital Charge Code	5551399802
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

ROMOSOZUMAB-AQQG 105 MG/1.17ML SC SOSY

Facility

$1.00

Service Code	HCPCS J3111
Hospital Charge Code	5551399802
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$12.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.07
Rate for Payer: Aetna Government	$12.07
Rate for Payer: Affinity Essential Plan 1&2	$8.45
Rate for Payer: Affinity Essential Plan 3&4	$8.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.45
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$12.07
Rate for Payer: EmblemHealth Commercial	$12.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.86
Rate for Payer: Fidelis Essential Plan Aliesa	$10.26
Rate for Payer: Fidelis Essential Plan QHP	$10.74
Rate for Payer: Fidelis Medicare Advantage	$12.07
Rate for Payer: Fidelis Qualified Health Plan	$10.74
Rate for Payer: Group Health Inc Commercial	$12.07
Rate for Payer: Group Health Inc Medicare	$12.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.07
Rate for Payer: Hamaspik Choice Inc Medicare	$12.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.07
Rate for Payer: Healthfirst Medicare Advantage	$10.26
Rate for Payer: Healthfirst QHP	$12.07
Rate for Payer: Humana Medicare	$12.31
Rate for Payer: Senior Whole Health Medicare Advantage	$12.07
Rate for Payer: United Healthcare Medicare Advantage	$12.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.47
Rate for Payer: Wellcare Medicare	$11.47

ROMOSOZUMAB-AQQG 105 MG/1.17ML SC SOSY

Facility

$1.00

Service Code	HCPCS J3111
Hospital Charge Code	5551388002
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

ROMOSOZUMAB-AQQG 105 MG/1.17ML SC SOSY

Facility

$1.00

Service Code	HCPCS J3111
Hospital Charge Code	5551388002
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$12.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.07
Rate for Payer: Aetna Government	$12.07
Rate for Payer: Affinity Essential Plan 1&2	$8.45
Rate for Payer: Affinity Essential Plan 3&4	$8.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.45
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$12.07
Rate for Payer: EmblemHealth Commercial	$12.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.86
Rate for Payer: Fidelis Essential Plan Aliesa	$10.26
Rate for Payer: Fidelis Essential Plan QHP	$10.74
Rate for Payer: Fidelis Medicare Advantage	$12.07
Rate for Payer: Fidelis Qualified Health Plan	$10.74
Rate for Payer: Group Health Inc Commercial	$12.07
Rate for Payer: Group Health Inc Medicare	$12.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.07
Rate for Payer: Hamaspik Choice Inc Medicare	$12.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.07
Rate for Payer: Healthfirst Medicare Advantage	$10.26
Rate for Payer: Healthfirst QHP	$12.07
Rate for Payer: Humana Medicare	$12.31
Rate for Payer: Senior Whole Health Medicare Advantage	$12.07
Rate for Payer: United Healthcare Medicare Advantage	$12.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.47
Rate for Payer: Wellcare Medicare	$11.47

ROPINIROLE HCL 0.25 MG PO TABS

Facility

$2.50

Service Code	NDC 4354726810
Hospital Charge Code	4354726810
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.25

ROPINIROLE HCL 0.25 MG PO TABS

Facility

$2.50

Service Code	NDC 4354726810
Hospital Charge Code	4354726810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$2.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.25
Rate for Payer: Aetna Government	$1.25
Rate for Payer: Brighton Health Commercial	$1.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.70
Rate for Payer: EmblemHealth Commercial	$1.25
Rate for Payer: Group Health Inc Commercial	$1.25
Rate for Payer: Group Health Inc Medicare	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.62

ROPINIROLE HCL 0.25 MG PO TABS

Facility

$0.59

Service Code	NDC 0904637361
Hospital Charge Code	0904637361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30

ROPINIROLE HCL 0.25 MG PO TABS

Facility

$0.59

Service Code	NDC 0904637361
Hospital Charge Code	0904637361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Brighton Health Commercial	$0.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: EmblemHealth Commercial	$0.30
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.38

ROPINIROLE HCL 1 MG PO TABS

Facility

$2.51

Service Code	NDC 6846225501
Hospital Charge Code	6846225501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.25

ROPINIROLE HCL 1 MG PO TABS

Facility

$2.51

Service Code	NDC 6846225501
Hospital Charge Code	6846225501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$2.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.25
Rate for Payer: Aetna Government	$1.25
Rate for Payer: Brighton Health Commercial	$1.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.70
Rate for Payer: EmblemHealth Commercial	$1.25
Rate for Payer: Group Health Inc Commercial	$1.25
Rate for Payer: Group Health Inc Medicare	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.63

ROPINIROLE HCL ER 6 MG PO TB24

Facility

$8.21

Service Code	NDC 5511172730
Hospital Charge Code	5511172730
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.10

ROPINIROLE HCL ER 6 MG PO TB24

Facility

$8.21

Service Code	NDC 5511172730
Hospital Charge Code	5511172730
Hospital Revenue Code	250
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$6.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.10
Rate for Payer: Aetna Government	$4.10
Rate for Payer: Brighton Health Commercial	$6.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.58
Rate for Payer: EmblemHealth Commercial	$4.10
Rate for Payer: Group Health Inc Commercial	$4.10
Rate for Payer: Group Health Inc Medicare	$2.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.10
Rate for Payer: Hamaspik Choice Inc Medicare	$4.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.33

ROPIVACAINE HCL 10 MG/ML IJ SOLN

Facility

$0.60

Service Code	HCPCS J2795
Hospital Charge Code	4306602710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30

ROPIVACAINE HCL 10 MG/ML IJ SOLN

Facility

$0.60

Service Code	HCPCS J2795
Hospital Charge Code	4306602701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: EmblemHealth Commercial	$0.30
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

ROPIVACAINE HCL 10 MG/ML IJ SOLN

Facility

$0.60

Service Code	HCPCS J2795
Hospital Charge Code	4306602710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: EmblemHealth Commercial	$0.30
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

ROPIVACAINE HCL 10 MG/ML IJ SOLN

Facility

$0.60

Service Code	HCPCS J2795
Hospital Charge Code	4306602701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30

ROPIVACAINE HCL 2 MG/ML IJ SOLN

Facility

$0.36

Service Code	HCPCS J2795
Hospital Charge Code	4306615401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: EmblemHealth Commercial	$0.18
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

ROPIVACAINE HCL 2 MG/ML IJ SOLN

Facility

$0.36

Service Code	HCPCS J2795
Hospital Charge Code	4306615401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18

ROPIVACAINE HCL 2 MG/ML IJ SOLN

Facility

$0.46

Service Code	HCPCS J2795
Hospital Charge Code	2502167187
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
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: EmblemHealth Commercial	$0.23
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: Healthfirst CHP/FHP/Medicaid	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.30

Know your out-of-pocket cost for care.

All Charges