St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

VORICONAZOLE 200 MG IV SOLR

Facility

$152.58

Service Code	HCPCS J3465
Hospital Charge Code	7043602980
Hospital Revenue Code	258
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$122.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.75
Rate for Payer: Aetna Government	$1.75
Rate for Payer: Brighton Health Commercial	$114.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$122.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$103.75
Rate for Payer: EmblemHealth Commercial	$76.29
Rate for Payer: Group Health Inc Commercial	$76.29
Rate for Payer: Group Health Inc Medicare	$53.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.29
Rate for Payer: Hamaspik Choice Inc Medicare	$76.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$99.18

VORICONAZOLE 200 MG IV SOLR

Facility

$72.36

Service Code	HCPCS J3465
Hospital Charge Code	0049319028
Hospital Revenue Code	258
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$57.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.75
Rate for Payer: Aetna Government	$1.75
Rate for Payer: Brighton Health Commercial	$54.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.20
Rate for Payer: EmblemHealth Commercial	$36.18
Rate for Payer: Group Health Inc Commercial	$36.18
Rate for Payer: Group Health Inc Medicare	$25.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.18
Rate for Payer: Hamaspik Choice Inc Medicare	$36.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.03

VORICONAZOLE 200 MG IV SOLR

Facility

$72.36

Service Code	HCPCS J3465
Hospital Charge Code	0049319028
Hospital Revenue Code	258
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.18

VORICONAZOLE 200 MG IV SOLR

Facility

$152.58

Service Code	HCPCS J3465
Hospital Charge Code	7043602980
Hospital Revenue Code	258
Min. Negotiated Rate	$76.29
Max. Negotiated Rate	$76.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.29

VORICONAZOLE 200 MG PO TABS

Facility

$79.52

Service Code	NDC 2724106303
Hospital Charge Code	2724106303
Hospital Revenue Code	250
Min. Negotiated Rate	$27.83
Max. Negotiated Rate	$63.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$43.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.76
Rate for Payer: Aetna Government	$39.76
Rate for Payer: Brighton Health Commercial	$59.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.07
Rate for Payer: EmblemHealth Commercial	$39.76
Rate for Payer: Group Health Inc Commercial	$39.76
Rate for Payer: Group Health Inc Medicare	$27.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.76
Rate for Payer: Hamaspik Choice Inc Medicare	$39.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$51.69

VORICONAZOLE 200 MG PO TABS

Facility

$26.42

Service Code	NDC 0904702404
Hospital Charge Code	0904702404
Hospital Revenue Code	250
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$13.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.21

VORICONAZOLE 200 MG PO TABS

Facility

$26.42

Service Code	NDC 0904702404
Hospital Charge Code	0904702404
Hospital Revenue Code	250
Min. Negotiated Rate	$9.25
Max. Negotiated Rate	$21.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.21
Rate for Payer: Aetna Government	$13.21
Rate for Payer: Brighton Health Commercial	$19.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.97
Rate for Payer: EmblemHealth Commercial	$13.21
Rate for Payer: Group Health Inc Commercial	$13.21
Rate for Payer: Group Health Inc Medicare	$9.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.21
Rate for Payer: Hamaspik Choice Inc Medicare	$13.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.17

VORICONAZOLE 200 MG PO TABS

Facility

$79.52

Service Code	NDC 2724106303
Hospital Charge Code	2724106303
Hospital Revenue Code	250
Min. Negotiated Rate	$39.76
Max. Negotiated Rate	$39.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.76

VORICONAZOLE 50 MG PO TABS

Facility

$12.56

Service Code	NDC 4338608803
Hospital Charge Code	4338608803
Hospital Revenue Code	250
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$10.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.28
Rate for Payer: Aetna Government	$6.28
Rate for Payer: Brighton Health Commercial	$9.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.54
Rate for Payer: EmblemHealth Commercial	$6.28
Rate for Payer: Group Health Inc Commercial	$6.28
Rate for Payer: Group Health Inc Medicare	$4.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.28
Rate for Payer: Hamaspik Choice Inc Medicare	$6.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.16

VORICONAZOLE 50 MG PO TABS

Facility

$19.88

Service Code	NDC 2724106203
Hospital Charge Code	2724106203
Hospital Revenue Code	250
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$15.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.94
Rate for Payer: Aetna Government	$9.94
Rate for Payer: Brighton Health Commercial	$14.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.52
Rate for Payer: EmblemHealth Commercial	$9.94
Rate for Payer: Group Health Inc Commercial	$9.94
Rate for Payer: Group Health Inc Medicare	$6.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.94
Rate for Payer: Hamaspik Choice Inc Medicare	$9.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.92

VORICONAZOLE 50 MG PO TABS

Facility

$9.72

Service Code	NDC 0904659604
Hospital Charge Code	0904659604
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$7.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.86
Rate for Payer: Aetna Government	$4.86
Rate for Payer: Brighton Health Commercial	$7.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.61
Rate for Payer: EmblemHealth Commercial	$4.86
Rate for Payer: Group Health Inc Commercial	$4.86
Rate for Payer: Group Health Inc Medicare	$3.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.86
Rate for Payer: Hamaspik Choice Inc Medicare	$4.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.32

VORICONAZOLE 50 MG PO TABS

Facility

$9.72

Service Code	NDC 0904659604
Hospital Charge Code	0904659604
Hospital Revenue Code	250
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$4.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.86

VORICONAZOLE 50 MG PO TABS

Facility

$19.88

Service Code	NDC 2724106203
Hospital Charge Code	2724106203
Hospital Revenue Code	250
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$9.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.94

VORICONAZOLE 50 MG PO TABS

Facility

$12.56

Service Code	NDC 4338608803
Hospital Charge Code	4338608803
Hospital Revenue Code	250
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$6.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.28

WARFARIN SODIUM 10 MG PO TABS

Facility

$0.95

Service Code	NDC 0832121989
Hospital Charge Code	0832121989
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.65
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

WARFARIN SODIUM 10 MG PO TABS

Facility

$0.95

Service Code	NDC 0832121901
Hospital Charge Code	0832121901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.65
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

WARFARIN SODIUM 10 MG PO TABS

Facility

$0.95

Service Code	NDC 0832121989
Hospital Charge Code	0832121989
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48

WARFARIN SODIUM 10 MG PO TABS

Facility

$1.00

Service Code	NDC 5167240351
Hospital Charge Code	5167240351
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: EmblemHealth Commercial	$0.50
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

WARFARIN SODIUM 10 MG PO TABS

Facility

$1.00

Service Code	NDC 5167240351
Hospital Charge Code	5167240351
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

WARFARIN SODIUM 10 MG PO TABS

Facility

$0.95

Service Code	NDC 0832121901
Hospital Charge Code	0832121901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48

WARFARIN SODIUM 1 MG PO TABS

Facility

$0.61

Service Code	NDC 5167240271
Hospital Charge Code	5167240271
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30

WARFARIN SODIUM 1 MG PO TABS

Facility

$0.62

Service Code	NDC 0832121101
Hospital Charge Code	0832121101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.42
Rate for Payer: EmblemHealth Commercial	$0.31
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.40

WARFARIN SODIUM 1 MG PO TABS

Facility

$0.61

Service Code	NDC 5167240271
Hospital Charge Code	5167240271
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Brighton Health Commercial	$0.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.49
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.40

WARFARIN SODIUM 1 MG PO TABS

Facility

$0.62

Service Code	NDC 0832121101
Hospital Charge Code	0832121101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31

WARFARIN SODIUM 2.5 MG PO TABS

Facility

$0.66

Service Code	NDC 0832121301
Hospital Charge Code	0832121301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

Know your out-of-pocket cost for care.

All Charges