St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

AMIKACIN SULFATE 500 MG/2ML IJ SOLN

Facility

$4.80

Service Code	HCPCS J0278
Hospital Charge Code	0641616710
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40

AMIKACIN SULFATE 500 MG/2ML IJ SOLN

Facility

$7.35

Service Code	HCPCS J0278
Hospital Charge Code	2315529041
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$5.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$5.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.00
Rate for Payer: EmblemHealth Commercial	$3.68
Rate for Payer: Group Health Inc Commercial	$3.68
Rate for Payer: Group Health Inc Medicare	$2.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.68
Rate for Payer: Hamaspik Choice Inc Medicare	$3.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.78

AMIKACIN SULFATE 500 MG/2ML IJ SOLN

Facility

$4.80

Service Code	HCPCS J0278
Hospital Charge Code	0641616710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$3.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.26
Rate for Payer: EmblemHealth Commercial	$2.40
Rate for Payer: Group Health Inc Commercial	$2.40
Rate for Payer: Group Health Inc Medicare	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.12

AMIKACIN SULFATE 500 MG/2ML IJ SOLN

Facility

$7.35

Service Code	HCPCS J0278
Hospital Charge Code	2315529041
Hospital Revenue Code	250
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$3.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.68

AMIKACIN SULFATE 500 MG/2ML IJ SOLN

Facility

$4.80

Service Code	HCPCS J0278
Hospital Charge Code	0641616701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40

AMIKACIN SULFATE 500 MG/2ML IJ SOLN

Facility

$7.36

Service Code	HCPCS J0278
Hospital Charge Code	2315529031
Hospital Revenue Code	250
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$3.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.68

AMILORIDE HCL 5 MG PO TABS

Facility

$0.27

Service Code	NDC 0574029201
Hospital Charge Code	0574029201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

AMILORIDE HCL 5 MG PO TABS

Facility

$0.27

Service Code	NDC 0574029201
Hospital Charge Code	0574029201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
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: EmblemHealth Commercial	$0.13
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

AMINOCAPROIC ACID 250 MG/ML IV SOLN

Facility

$0.57

Service Code	NDC 0517912001
Hospital Charge Code	0517912001
Hospital Revenue Code	258
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28

AMINOCAPROIC ACID 250 MG/ML IV SOLN

Facility

$0.57

Service Code	NDC 0517912025
Hospital Charge Code	0517912025
Hospital Revenue Code	258
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28

AMINOCAPROIC ACID 250 MG/ML IV SOLN

Facility

$0.57

Service Code	NDC 0517912025
Hospital Charge Code	0517912025
Hospital Revenue Code	258
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: EmblemHealth Commercial	$0.28
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.37

AMINOCAPROIC ACID 250 MG/ML IV SOLN

Facility

$0.57

Service Code	NDC 0517912001
Hospital Charge Code	0517912001
Hospital Revenue Code	258
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: EmblemHealth Commercial	$0.28
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.37

AMINOCAPROIC ACID 500 MG PO TABS

Facility

$22.40

Service Code	NDC 7220504930
Hospital Charge Code	7220504930
Hospital Revenue Code	250
Min. Negotiated Rate	$7.84
Max. Negotiated Rate	$17.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.20
Rate for Payer: Aetna Government	$11.20
Rate for Payer: Brighton Health Commercial	$16.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.23
Rate for Payer: EmblemHealth Commercial	$11.20
Rate for Payer: Group Health Inc Commercial	$11.20
Rate for Payer: Group Health Inc Medicare	$7.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.20
Rate for Payer: Hamaspik Choice Inc Medicare	$11.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.56

AMINOCAPROIC ACID 500 MG PO TABS

Facility

$22.40

Service Code	NDC 7220504930
Hospital Charge Code	7220504930
Hospital Revenue Code	250
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$11.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.20

AMINOPHYLLINE 25 MG/ML IV SOLN

Facility

$0.61

Service Code	HCPCS J0280
Hospital Charge Code	0409592201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$10.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.57
Rate for Payer: Aetna Government	$8.57
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: Healthfirst CHP/FHP/Medicaid	$10.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.40

AMINOPHYLLINE 25 MG/ML IV SOLN

Facility

$0.61

Service Code	HCPCS J0280
Hospital Charge Code	0409592201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30

AMINOPHYLLINE 25 MG/ML IV SOLN

Facility

$1.89

Service Code	HCPCS J0280
Hospital Charge Code	0409592101
Hospital Revenue Code	258
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$10.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.57
Rate for Payer: Aetna Government	$8.57
Rate for Payer: Brighton Health Commercial	$1.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.28
Rate for Payer: EmblemHealth Commercial	$0.94
Rate for Payer: Group Health Inc Commercial	$0.94
Rate for Payer: Group Health Inc Medicare	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94
Rate for Payer: Hamaspik Choice Inc Medicare	$0.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.23

AMINOPHYLLINE 25 MG/ML IV SOLN

Facility

$1.89

Service Code	HCPCS J0280
Hospital Charge Code	0409592116
Hospital Revenue Code	258
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$10.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.57
Rate for Payer: Aetna Government	$8.57
Rate for Payer: Brighton Health Commercial	$1.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.28
Rate for Payer: EmblemHealth Commercial	$0.94
Rate for Payer: Group Health Inc Commercial	$0.94
Rate for Payer: Group Health Inc Medicare	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94
Rate for Payer: Hamaspik Choice Inc Medicare	$0.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.23

AMINOPHYLLINE 25 MG/ML IV SOLN

Facility

$1.89

Service Code	HCPCS J0280
Hospital Charge Code	0409592116
Hospital Revenue Code	258
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94

AMINOPHYLLINE 25 MG/ML IV SOLN

Facility

$1.89

Service Code	HCPCS J0280
Hospital Charge Code	0409592101
Hospital Revenue Code	258
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94

AMIODARONE HCL 100 MG PO TABS

Facility

$7.43

Service Code	NDC 0245014401
Hospital Charge Code	0245014401
Hospital Revenue Code	250
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$5.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.71
Rate for Payer: Aetna Government	$3.71
Rate for Payer: Brighton Health Commercial	$5.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.05
Rate for Payer: EmblemHealth Commercial	$3.71
Rate for Payer: Group Health Inc Commercial	$3.71
Rate for Payer: Group Health Inc Medicare	$2.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.71
Rate for Payer: Hamaspik Choice Inc Medicare	$3.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.83

AMIODARONE HCL 100 MG PO TABS

Facility

$0.58

Service Code	NDC 7590700530
Hospital Charge Code	7590700530
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.29

AMIODARONE HCL 100 MG PO TABS

Facility

$7.43

Service Code	NDC 0245014401
Hospital Charge Code	0245014401
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$3.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.71

AMIODARONE HCL 100 MG PO TABS

Facility

$0.58

Service Code	NDC 7590700530
Hospital Charge Code	7590700530
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.29
Rate for Payer: Aetna Government	$0.29
Rate for Payer: Brighton Health Commercial	$0.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.39
Rate for Payer: EmblemHealth Commercial	$0.29
Rate for Payer: Group Health Inc Commercial	$0.29
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.29
Rate for Payer: Hamaspik Choice Inc Medicare	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.38

AMIODARONE HCL 150 MG/3ML IV SOLN

Facility

$2.33

Service Code	NDC 7043623272
Hospital Charge Code	7043623272
Hospital Revenue Code	258
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.17

Know your out-of-pocket cost for care.

All Charges