St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DACARBAZINE 200 MG IV SOLR

Facility

$14.40

Service Code	HCPCS J9130
Hospital Charge Code	6332312820
Hospital Revenue Code	258
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.20

DACARBAZINE 200 MG IV SOLR

Facility

$14.40

Service Code	HCPCS J9130
Hospital Charge Code	0143924510
Hospital Revenue Code	258
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$11.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.71
Rate for Payer: Aetna Government	$3.71
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	$3.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.36

DACARBAZINE 200 MG IV SOLR

Facility

$14.40

Service Code	HCPCS J9130
Hospital Charge Code	0143924510
Hospital Revenue Code	258
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.20

DACARBAZINE 200 MG IV SOLR

Facility

$14.40

Service Code	HCPCS J9130
Hospital Charge Code	6332312820
Hospital Revenue Code	258
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$11.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.71
Rate for Payer: Aetna Government	$3.71
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	$3.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.36

DAKINS (1/2 STRENGTH) 0.25 % EX SOLN

Facility

$0.04

Service Code	NDC 3932806325
Hospital Charge Code	3932806325
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

DAKINS (1/2 STRENGTH) 0.25 % EX SOLN

Facility

$0.03

Service Code	NDC 0436093616
Hospital Charge Code	0436093616
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
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	$0.02

DAKINS (1/2 STRENGTH) 0.25 % EX SOLN

Facility

$0.04

Service Code	NDC 3932806325
Hospital Charge Code	3932806325
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
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	$0.01
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	$0.02

DAKINS (1/2 STRENGTH) 0.25 % EX SOLN

Facility

$0.03

Service Code	NDC 0436093616
Hospital Charge Code	0436093616
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

DAKINS (1/4 STRENGTH) 0.125 % EX SOLN

Facility

$0.03

Service Code	NDC 0436067216
Hospital Charge Code	0436067216
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

DAKINS (1/4 STRENGTH) 0.125 % EX SOLN

Facility

$0.04

Service Code	NDC 3932806412
Hospital Charge Code	3932806412
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

DAKINS (1/4 STRENGTH) 0.125 % EX SOLN

Facility

$0.03

Service Code	NDC 0436067216
Hospital Charge Code	0436067216
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
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	$0.02

DAKINS (1/4 STRENGTH) 0.125 % EX SOLN

Facility

$0.04

Service Code	NDC 3932806412
Hospital Charge Code	3932806412
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
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	$0.01
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	$0.02

DALBAVANCIN HCL 500 MG IV SOLR

Facility

$2.00

Service Code	HCPCS J0875
Hospital Charge Code	5797010001
Hospital Revenue Code	258
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

DALBAVANCIN HCL 500 MG IV SOLR

Facility

$2.00

Service Code	HCPCS J0875
Hospital Charge Code	5797010001
Hospital Revenue Code	258
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$15.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.61
Rate for Payer: Aetna Government	$15.61
Rate for Payer: Affinity Essential Plan 1&2	$10.93
Rate for Payer: Affinity Essential Plan 3&4	$10.93
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.93
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Elderplan Medicare Advantage	$15.61
Rate for Payer: EmblemHealth Commercial	$15.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14.05
Rate for Payer: Fidelis Essential Plan Aliesa	$13.27
Rate for Payer: Fidelis Essential Plan QHP	$13.89
Rate for Payer: Fidelis Medicare Advantage	$15.61
Rate for Payer: Fidelis Qualified Health Plan	$13.89
Rate for Payer: Group Health Inc Commercial	$15.61
Rate for Payer: Group Health Inc Medicare	$15.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.61
Rate for Payer: Hamaspik Choice Inc Medicare	$15.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15.61
Rate for Payer: Healthfirst Medicare Advantage	$13.27
Rate for Payer: Healthfirst QHP	$15.61
Rate for Payer: Humana Medicare	$15.92
Rate for Payer: Senior Whole Health Medicare Advantage	$15.61
Rate for Payer: United Healthcare Medicare Advantage	$15.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14.83
Rate for Payer: Wellcare Medicare	$14.83

DANTROLENE SODIUM 100 MG PO CAPS

Facility

$1.95

Service Code	NDC 4988436401
Hospital Charge Code	4988436401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.98
Rate for Payer: Aetna Government	$0.98
Rate for Payer: Brighton Health Commercial	$1.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.33
Rate for Payer: EmblemHealth Commercial	$0.98
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.27

DANTROLENE SODIUM 100 MG PO CAPS

Facility

$1.95

Service Code	NDC 4988436401
Hospital Charge Code	4988436401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98

DANTROLENE SODIUM 20 MG IV SOLR

Facility

$85.09

Service Code	NDC 0143929701
Hospital Charge Code	0143929701
Hospital Revenue Code	258
Min. Negotiated Rate	$29.78
Max. Negotiated Rate	$68.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.55
Rate for Payer: Aetna Government	$42.55
Rate for Payer: Brighton Health Commercial	$63.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.86
Rate for Payer: EmblemHealth Commercial	$42.55
Rate for Payer: Group Health Inc Commercial	$42.55
Rate for Payer: Group Health Inc Medicare	$29.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.55
Rate for Payer: Hamaspik Choice Inc Medicare	$42.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$55.31

DANTROLENE SODIUM 20 MG IV SOLR

Facility

$85.09

Service Code	NDC 0143929701
Hospital Charge Code	0143929701
Hospital Revenue Code	258
Min. Negotiated Rate	$42.55
Max. Negotiated Rate	$42.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.55

DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS

Facility

$23.29

Service Code	NDC 0310621030
Hospital Charge Code	0310621030
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$18.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.64
Rate for Payer: Aetna Government	$11.64
Rate for Payer: Brighton Health Commercial	$17.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.84
Rate for Payer: EmblemHealth Commercial	$11.64
Rate for Payer: Group Health Inc Commercial	$11.64
Rate for Payer: Group Health Inc Medicare	$8.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.64
Rate for Payer: Hamaspik Choice Inc Medicare	$11.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.14

DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS

Facility

$23.29

Service Code	NDC 0310621030
Hospital Charge Code	0310621030
Hospital Revenue Code	250
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$11.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.64

DAPAGLIFLOZIN PROPANEDIOL 5 MG PO TABS

Facility

$23.29

Service Code	NDC 0310620530
Hospital Charge Code	0310620530
Hospital Revenue Code	250
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$11.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.64

DAPAGLIFLOZIN PROPANEDIOL 5 MG PO TABS

Facility

$23.29

Service Code	NDC 0310620530
Hospital Charge Code	0310620530
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$18.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.64
Rate for Payer: Aetna Government	$11.64
Rate for Payer: Brighton Health Commercial	$17.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.84
Rate for Payer: EmblemHealth Commercial	$11.64
Rate for Payer: Group Health Inc Commercial	$11.64
Rate for Payer: Group Health Inc Medicare	$8.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.64
Rate for Payer: Hamaspik Choice Inc Medicare	$11.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.14

DAPSONE 100 MG PO TABS

Facility

$3.36

Service Code	NDC 4993810130
Hospital Charge Code	4993810130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$2.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$2.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.28
Rate for Payer: EmblemHealth Commercial	$1.68
Rate for Payer: Group Health Inc Commercial	$1.68
Rate for Payer: Group Health Inc Medicare	$1.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.18

DAPSONE 100 MG PO TABS

Facility

$3.36

Service Code	NDC 4993810130
Hospital Charge Code	4993810130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68

DAPSONE 100 MG PO TABS

Facility

$3.02

Service Code	NDC 7095413610
Hospital Charge Code	7095413610
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.51
Rate for Payer: Aetna Government	$1.51
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: EmblemHealth Commercial	$1.51
Rate for Payer: Group Health Inc Commercial	$1.51
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51
Rate for Payer: Hamaspik Choice Inc Medicare	$1.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.96

Know your out-of-pocket cost for care.

All Charges