St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]

Facility

$6.13

Service Code	NDC 00781323295
Hospital Charge Code	00781323295
Hospital Revenue Code	278
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$6.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$3.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.52
Rate for Payer: EmblemHealth Commercial	$3.06
Rate for Payer: Fidelis Medicare Advantage	$6.43
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]

Facility

$6.09

Service Code	NDC 00008092355
Hospital Charge Code	00008092355
Hospital Revenue Code	278
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$6.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.04
Rate for Payer: Aetna Government	$3.04
Rate for Payer: Brighton Health Commercial	$3.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.50
Rate for Payer: EmblemHealth Commercial	$3.04
Rate for Payer: Fidelis Medicare Advantage	$6.39
Rate for Payer: Group Health Inc Commercial	$3.04
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.04
Rate for Payer: Hamaspik Choice Inc Medicare	$3.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]

Facility

$6.13

Service Code	NDC 00781323294
Hospital Charge Code	00781323294
Hospital Revenue Code	278
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$6.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$3.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.52
Rate for Payer: EmblemHealth Commercial	$3.06
Rate for Payer: Fidelis Medicare Advantage	$6.43
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]

Facility

$6.13

Service Code	NDC 00781323295
Hospital Charge Code	00781323295
Hospital Revenue Code	278
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06

PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]

Facility

$8.50

Service Code	NDC 55150020210
Hospital Charge Code	55150020210
Hospital Revenue Code	278
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4.25

PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]

Facility

$6.09

Service Code	NDC 00008092355
Hospital Charge Code	00008092355
Hospital Revenue Code	278
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.04
Rate for Payer: Hamaspik Choice Inc Medicare	$3.04

PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]

Facility

$6.13

Service Code	NDC 00781323294
Hospital Charge Code	00781323294
Hospital Revenue Code	278
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06

PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]

Facility

$8.50

Service Code	NDC 55150020200
Hospital Charge Code	55150020200
Hospital Revenue Code	278
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$8.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.25
Rate for Payer: Aetna Government	$4.25
Rate for Payer: Brighton Health Commercial	$5.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.89
Rate for Payer: EmblemHealth Commercial	$4.25
Rate for Payer: Fidelis Medicare Advantage	$8.93
Rate for Payer: Group Health Inc Commercial	$4.25
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.53

PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]

Facility

$8.50

Service Code	NDC 62756012944
Hospital Charge Code	62756012944
Hospital Revenue Code	278
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$8.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.25
Rate for Payer: Aetna Government	$4.25
Rate for Payer: Brighton Health Commercial	$5.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.89
Rate for Payer: EmblemHealth Commercial	$4.25
Rate for Payer: Fidelis Medicare Advantage	$8.93
Rate for Payer: Group Health Inc Commercial	$4.25
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.53

PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]

Facility

$8.50

Service Code	NDC 55150020210
Hospital Charge Code	55150020210
Hospital Revenue Code	278
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$8.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.25
Rate for Payer: Aetna Government	$4.25
Rate for Payer: Brighton Health Commercial	$5.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.89
Rate for Payer: EmblemHealth Commercial	$4.25
Rate for Payer: Fidelis Medicare Advantage	$8.93
Rate for Payer: Group Health Inc Commercial	$4.25
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.53

PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]

Facility

$8.50

Service Code	NDC 62756012944
Hospital Charge Code	62756012944
Hospital Revenue Code	278
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4.25

PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]

Facility

$5.27

Service Code	NDC 31722071390
Hospital Charge Code	31722071390
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$4.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.63
Rate for Payer: Aetna Government	$2.63
Rate for Payer: Brighton Health Commercial	$3.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.58
Rate for Payer: Group Health Inc Commercial	$2.63
Rate for Payer: Group Health Inc Medicare	$1.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.63
Rate for Payer: Hamaspik Choice Inc Medicare	$2.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.42

PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]

Facility

$0.34

Service Code	NDC 63739056410
Hospital Charge Code	63739056410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.23
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]

Facility

$5.27

Service Code	NDC 65862056090
Hospital Charge Code	65862056090
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$4.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.63
Rate for Payer: Aetna Government	$2.63
Rate for Payer: Brighton Health Commercial	$3.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.58
Rate for Payer: Group Health Inc Commercial	$2.63
Rate for Payer: Group Health Inc Medicare	$1.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.63
Rate for Payer: Hamaspik Choice Inc Medicare	$2.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.42

PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]

Facility

$4.06

Service Code	NDC 62175061743
Hospital Charge Code	62175061743
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$3.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.03
Rate for Payer: Aetna Government	$2.03
Rate for Payer: Brighton Health Commercial	$3.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.76
Rate for Payer: Group Health Inc Commercial	$2.03
Rate for Payer: Group Health Inc Medicare	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.03
Rate for Payer: Hamaspik Choice Inc Medicare	$2.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.64

PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]

Facility

$4.09

Service Code	NDC 00904647461
Hospital Charge Code	00904647461
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.04
Rate for Payer: Aetna Government	$2.04
Rate for Payer: Brighton Health Commercial	$3.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.78
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.66

PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]

Facility

$4.08

Service Code	NDC 13668042990
Hospital Charge Code	13668042990
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.04
Rate for Payer: Aetna Government	$2.04
Rate for Payer: Brighton Health Commercial	$3.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.77
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.65

PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]

Facility

$4.03

Service Code	NDC 50268063915
Hospital Charge Code	50268063915
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$3.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.01
Rate for Payer: Aetna Government	$2.01
Rate for Payer: Brighton Health Commercial	$3.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.74
Rate for Payer: Group Health Inc Commercial	$2.01
Rate for Payer: Group Health Inc Medicare	$1.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.01
Rate for Payer: Hamaspik Choice Inc Medicare	$2.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.62

PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]

Facility

$0.26

Service Code	NDC 60687073665
Hospital Charge Code	60687073665
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]

Facility

$4.03

Service Code	NDC 50268063911
Hospital Charge Code	50268063911
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$3.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.01
Rate for Payer: Aetna Government	$2.01
Rate for Payer: Brighton Health Commercial	$3.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.74
Rate for Payer: Group Health Inc Commercial	$2.01
Rate for Payer: Group Health Inc Medicare	$1.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.01
Rate for Payer: Hamaspik Choice Inc Medicare	$2.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.62

PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]

Facility

$5.27

Service Code	NDC 65862056099
Hospital Charge Code	65862056099
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$4.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.63
Rate for Payer: Aetna Government	$2.63
Rate for Payer: Brighton Health Commercial	$3.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.58
Rate for Payer: Group Health Inc Commercial	$2.63
Rate for Payer: Group Health Inc Medicare	$1.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.63
Rate for Payer: Hamaspik Choice Inc Medicare	$2.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.42

PAPAVERINE 30 MG/ML INJ

Facility

$9.95

Service Code	HCPCS J2440
Hospital Charge Code	41653538
Hospital Revenue Code	636
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$4.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.97
Rate for Payer: Hamaspik Choice Inc Medicare	$4.97

PAPAVERINE 30 MG/ML INJ

Facility

$9.95

Service Code	HCPCS J2440
Hospital Charge Code	41643538
Hospital Revenue Code	636
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$31.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.05
Rate for Payer: Aetna Government	$31.05
Rate for Payer: Brighton Health Commercial	$5.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.72
Rate for Payer: Group Health Inc Commercial	$4.97
Rate for Payer: Group Health Inc Medicare	$3.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.97
Rate for Payer: Hamaspik Choice Inc Medicare	$4.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.47

PAPAVERINE 30 MG/ML INJ

Facility

$9.95

Service Code	HCPCS J2440
Hospital Charge Code	41643538
Hospital Revenue Code	636
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$4.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.97
Rate for Payer: Hamaspik Choice Inc Medicare	$4.97

PAPAVERINE 30 MG/ML INJ

Facility

$9.95

Service Code	HCPCS J2440
Hospital Charge Code	41653538
Hospital Revenue Code	636
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$31.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.05
Rate for Payer: Aetna Government	$31.05
Rate for Payer: Brighton Health Commercial	$5.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.72
Rate for Payer: Group Health Inc Commercial	$4.97
Rate for Payer: Group Health Inc Medicare	$3.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.97
Rate for Payer: Hamaspik Choice Inc Medicare	$4.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.47

Know your out-of-pocket cost for care.

All Charges