St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

VITAMIN C 500 MG PO TABS

Facility

$0.05

Service Code	NDC 0904052360
Hospital Charge Code	0904052360
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

VITAMIN C 500 MG PO TABS

Facility

$0.07

Service Code	NDC 0904052361
Hospital Charge Code	0904052361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

VITAMIN C 500 MG PO TABS

Facility

$0.05

Service Code	NDC 0904052360
Hospital Charge Code	0904052360
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

VITAMIN D3 10 MCG (400 UNIT) PO TABS

Facility

$0.02

Service Code	NDC 0904582360
Hospital Charge Code	0904582360
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

VITAMIN D3 10 MCG (400 UNIT) PO TABS

Facility

$0.19

Service Code	NDC 4843310901
Hospital Charge Code	4843310901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.07
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

VITAMIN D3 10 MCG (400 UNIT) PO TABS

Facility

$0.23

Service Code	NDC 7733394825
Hospital Charge Code	7733394825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: EmblemHealth Commercial	$0.11
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

VITAMIN D3 10 MCG (400 UNIT) PO TABS

Facility

$0.23

Service Code	NDC 7733394825
Hospital Charge Code	7733394825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

VITAMIN D3 10 MCG (400 UNIT) PO TABS

Facility

$0.19

Service Code	NDC 4843310901
Hospital Charge Code	4843310901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

VITAMIN D3 10 MCG (400 UNIT) PO TABS

Facility

$0.02

Service Code	NDC 0904582360
Hospital Charge Code	0904582360
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

VITAMIN D3 10 MCG (400 UNIT) PO TABS

Facility

$0.23

Service Code	NDC 7733394810
Hospital Charge Code	7733394810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: EmblemHealth Commercial	$0.11
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

VITAMIN D3 10 MCG (400 UNIT) PO TABS

Facility

$0.23

Service Code	NDC 7733394810
Hospital Charge Code	7733394810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

VITAMIN D3 25 MCG (1000 UT) PO TABS

Facility

$0.21

Service Code	NDC 4843310401
Hospital Charge Code	4843310401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

VITAMIN D3 25 MCG (1000 UT) PO TABS

Facility

$0.21

Service Code	NDC 4843310401
Hospital Charge Code	4843310401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

VITAMIN E 180 MG (400 UNIT) PO CAPS

Facility

$0.08

Service Code	NDC 5789675201
Hospital Charge Code	5789675201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

VITAMIN E 180 MG (400 UNIT) PO CAPS

Facility

$0.08

Service Code	NDC 5789675201
Hospital Charge Code	5789675201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

VITAMIN K1 1 MG/0.5ML IJ SOLN

Facility

$59.35

Service Code	HCPCS J3430
Hospital Charge Code	7632912401
Hospital Revenue Code	250
Min. Negotiated Rate	$29.68
Max. Negotiated Rate	$29.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.68

VITAMIN K1 1 MG/0.5ML IJ SOLN

Facility

$11.39

Service Code	HCPCS J3430
Hospital Charge Code	0409915701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$9.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.56
Rate for Payer: Aetna Government	$3.56
Rate for Payer: Brighton Health Commercial	$8.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.75
Rate for Payer: EmblemHealth Commercial	$5.70
Rate for Payer: Group Health Inc Commercial	$5.70
Rate for Payer: Group Health Inc Medicare	$3.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.70
Rate for Payer: Hamaspik Choice Inc Medicare	$5.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.40

VITAMIN K1 1 MG/0.5ML IJ SOLN

Facility

$11.40

Service Code	HCPCS J3430
Hospital Charge Code	0409915731
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.70

VITAMIN K1 1 MG/0.5ML IJ SOLN

Facility

$11.39

Service Code	HCPCS J3430
Hospital Charge Code	0409915701
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.70

VITAMIN K1 1 MG/0.5ML IJ SOLN

Facility

$59.35

Service Code	HCPCS J3430
Hospital Charge Code	7632912401
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$47.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.56
Rate for Payer: Aetna Government	$3.56
Rate for Payer: Brighton Health Commercial	$44.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.36
Rate for Payer: EmblemHealth Commercial	$29.68
Rate for Payer: Group Health Inc Commercial	$29.68
Rate for Payer: Group Health Inc Medicare	$20.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.68
Rate for Payer: Hamaspik Choice Inc Medicare	$29.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.58

VITAMIN K1 1 MG/0.5ML IJ SOLN

Facility

$11.40

Service Code	HCPCS J3430
Hospital Charge Code	0409915731
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$9.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.56
Rate for Payer: Aetna Government	$3.56
Rate for Payer: Brighton Health Commercial	$8.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.75
Rate for Payer: EmblemHealth Commercial	$5.70
Rate for Payer: Group Health Inc Commercial	$5.70
Rate for Payer: Group Health Inc Medicare	$3.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.70
Rate for Payer: Hamaspik Choice Inc Medicare	$5.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.41

VITAMIN K1 1 MG/0.5ML IJ SOLN

Facility

$14.40

Service Code	HCPCS J3430
Hospital Charge Code	6909770996
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$11.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.56
Rate for Payer: Aetna Government	$3.56
Rate for Payer: Brighton Health Commercial	$10.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.79
Rate for Payer: EmblemHealth Commercial	$7.20
Rate for Payer: Group Health Inc Commercial	$7.20
Rate for Payer: Group Health Inc Medicare	$5.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.20
Rate for Payer: Hamaspik Choice Inc Medicare	$7.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.36

VITAMIN K1 1 MG/0.5ML IJ SOLN

Facility

$14.40

Service Code	HCPCS J3430
Hospital Charge Code	6909770996
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.20

VORICONAZOLE 10 MG/ML OPHTHALMIC DROPS - COMPOUNDED

Facility

$5.00

Service Code	NDC 9999701534
Hospital Charge Code	9999701534
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: EmblemHealth Commercial	$2.50
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

VORICONAZOLE 10 MG/ML OPHTHALMIC DROPS - COMPOUNDED

Facility

$5.00

Service Code	NDC 9999701534
Hospital Charge Code	9999701534
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50

Know your out-of-pocket cost for care.

All Charges