St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ALBUTEROL SULFATE 2 MG/5ML PO SYRP

Facility

$0.07

Service Code	NDC 0472082516
Hospital Charge Code	0472082516
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

ALBUTEROL SULFATE 2 MG/5ML PO SYRP

Facility

$0.13

Service Code	NDC 7075210212
Hospital Charge Code	7075210212
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.06
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

ALBUTEROL SULFATE 2 MG/5ML PO SYRP

Facility

$0.13

Service Code	NDC 7075210212
Hospital Charge Code	7075210212
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

ALBUTEROL SULFATE 2 MG/5ML PO SYRP

Facility

$0.07

Service Code	NDC 0472082516
Hospital Charge Code	0472082516
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	$0.04
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

ALBUTEROL SULFATE 2 MG PO TABS

Facility

$7.47

Service Code	NDC 6808494995
Hospital Charge Code	6808494995
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$5.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.74
Rate for Payer: Aetna Government	$3.74
Rate for Payer: Brighton Health Commercial	$5.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.08
Rate for Payer: EmblemHealth Commercial	$3.74
Rate for Payer: Group Health Inc Commercial	$3.74
Rate for Payer: Group Health Inc Medicare	$2.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.74
Rate for Payer: Hamaspik Choice Inc Medicare	$3.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.86

ALBUTEROL SULFATE 2 MG PO TABS

Facility

$7.05

Service Code	NDC 5107965720
Hospital Charge Code	5107965720
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$5.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.52
Rate for Payer: Aetna Government	$3.52
Rate for Payer: Brighton Health Commercial	$5.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.79
Rate for Payer: EmblemHealth Commercial	$3.52
Rate for Payer: Group Health Inc Commercial	$3.52
Rate for Payer: Group Health Inc Medicare	$2.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.58

ALBUTEROL SULFATE 2 MG PO TABS

Facility

$7.05

Service Code	NDC 5107965720
Hospital Charge Code	5107965720
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$3.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.52

ALBUTEROL SULFATE 2 MG PO TABS

Facility

$7.47

Service Code	NDC 6808494995
Hospital Charge Code	6808494995
Hospital Revenue Code	250
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$3.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.74

ALBUTEROL SULFATE 2 MG PO TABS

Facility

$7.47

Service Code	NDC 6808494925
Hospital Charge Code	6808494925
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$5.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.74
Rate for Payer: Aetna Government	$3.74
Rate for Payer: Brighton Health Commercial	$5.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.08
Rate for Payer: EmblemHealth Commercial	$3.74
Rate for Payer: Group Health Inc Commercial	$3.74
Rate for Payer: Group Health Inc Medicare	$2.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.74
Rate for Payer: Hamaspik Choice Inc Medicare	$3.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.86

ALBUTEROL SULFATE 2 MG PO TABS

Facility

$7.47

Service Code	NDC 6808494925
Hospital Charge Code	6808494925
Hospital Revenue Code	250
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$3.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.74

ALBUTEROL SULFATE (5 MG/ML) 0.5% CONTINUOUS NEB

Facility

$1.13

Service Code	NDC 5295974120
Hospital Charge Code	5295974120
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57

ALBUTEROL SULFATE (5 MG/ML) 0.5% CONTINUOUS NEB

Facility

$2.90

Service Code	NDC 5038374120
Hospital Charge Code	5038374120
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.45
Rate for Payer: Aetna Government	$1.45
Rate for Payer: Brighton Health Commercial	$2.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.97
Rate for Payer: EmblemHealth Commercial	$1.45
Rate for Payer: Group Health Inc Commercial	$1.45
Rate for Payer: Group Health Inc Medicare	$1.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.88

ALBUTEROL SULFATE (5 MG/ML) 0.5% CONTINUOUS NEB

Facility

$1.13

Service Code	NDC 5295974120
Hospital Charge Code	5295974120
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Brighton Health Commercial	$0.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.77
Rate for Payer: EmblemHealth Commercial	$0.57
Rate for Payer: Group Health Inc Commercial	$0.57
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57
Rate for Payer: Hamaspik Choice Inc Medicare	$0.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.74

ALBUTEROL SULFATE (5 MG/ML) 0.5% CONTINUOUS NEB

Facility

$2.90

Service Code	NDC 5038374120
Hospital Charge Code	5038374120
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45

ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU

Facility

$1.08

Service Code	HCPCS J7611
Hospital Charge Code	6937430920
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54

ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU

Facility

$3.00

Service Code	HCPCS J7611
Hospital Charge Code	7317714633
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50

ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU

Facility

$3.00

Service Code	HCPCS J7611
Hospital Charge Code	7317714633
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
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: Healthfirst CHP/FHP/Medicaid	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU

Facility

$1.08

Service Code	HCPCS J7611
Hospital Charge Code	6937430920
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.73
Rate for Payer: EmblemHealth Commercial	$0.54
Rate for Payer: Group Health Inc Commercial	$0.54
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54
Rate for Payer: Hamaspik Choice Inc Medicare	$0.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.70

ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS

Facility

$3.80

Service Code	NDC 0173068220
Hospital Charge Code	0173068220
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$3.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.90
Rate for Payer: Aetna Government	$1.90
Rate for Payer: Brighton Health Commercial	$2.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.58
Rate for Payer: EmblemHealth Commercial	$1.90
Rate for Payer: Group Health Inc Commercial	$1.90
Rate for Payer: Group Health Inc Medicare	$1.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.47

ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS

Facility

$8.71

Service Code	NDC 6818096301
Hospital Charge Code	6818096301
Hospital Revenue Code	250
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$4.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.35

ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS

Facility

$3.41

Service Code	NDC 0173068224
Hospital Charge Code	0173068224
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$2.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$2.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.32
Rate for Payer: EmblemHealth Commercial	$1.70
Rate for Payer: Group Health Inc Commercial	$1.70
Rate for Payer: Group Health Inc Medicare	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.22

ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS

Facility

$3.47

Service Code	NDC 6699301968
Hospital Charge Code	6699301968
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$2.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.73
Rate for Payer: Aetna Government	$1.73
Rate for Payer: Brighton Health Commercial	$2.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.36
Rate for Payer: EmblemHealth Commercial	$1.73
Rate for Payer: Group Health Inc Commercial	$1.73
Rate for Payer: Group Health Inc Medicare	$1.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.73
Rate for Payer: Hamaspik Choice Inc Medicare	$1.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.25

ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS

Facility

$14.28

Service Code	NDC 6675895985
Hospital Charge Code	6675895985
Hospital Revenue Code	250
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$11.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.14
Rate for Payer: Aetna Government	$7.14
Rate for Payer: Brighton Health Commercial	$10.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.71
Rate for Payer: EmblemHealth Commercial	$7.14
Rate for Payer: Group Health Inc Commercial	$7.14
Rate for Payer: Group Health Inc Medicare	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.14
Rate for Payer: Hamaspik Choice Inc Medicare	$7.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.28

ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS

Facility

$6.71

Service Code	NDC 0781729685
Hospital Charge Code	0781729685
Hospital Revenue Code	250
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$5.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Brighton Health Commercial	$5.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.56
Rate for Payer: EmblemHealth Commercial	$3.36
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.36

ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS

Facility

$14.28

Service Code	NDC 6675895985
Hospital Charge Code	6675895985
Hospital Revenue Code	250
Min. Negotiated Rate	$7.14
Max. Negotiated Rate	$7.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.14

Know your out-of-pocket cost for care.

All Charges