St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FOLIC ACID 1 MG PO TABS

Facility

$0.08

Service Code	NDC 5865715110
Hospital Charge Code	5865715110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

FOLIC ACID 1 MG PO TABS

Facility

$0.08

Service Code	NDC 6931512710
Hospital Charge Code	6931512710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

FOLIC ACID 1 MG PO TABS

Facility

$0.08

Service Code	NDC 5374636110
Hospital Charge Code	5374636110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

FOLIC ACID 1 MG PO TABS

Facility

$0.20

Service Code	NDC 0904722461
Hospital Charge Code	0904722461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

FOLIC ACID 1 MG PO TABS

Facility

$0.08

Service Code	NDC 6931512710
Hospital Charge Code	6931512710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

FOLIC ACID 1 MG PO TABS

Facility

$0.21

Service Code	NDC 6068768101
Hospital Charge Code	6068768101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

FOLIC ACID 1 MG PO TABS

Facility

$0.08

Service Code	NDC 5374636110
Hospital Charge Code	5374636110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

FOLIC ACID 1 MG PO TABS

Facility

$0.08

Service Code	NDC 1153416503
Hospital Charge Code	1153416503
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

FOLIC ACID 1 MG PO TABS

Facility

$0.08

Service Code	NDC 5865715110
Hospital Charge Code	5865715110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

FOLIC ACID 1 MG PO TABS

Facility

$0.08

Service Code	NDC 1153416503
Hospital Charge Code	1153416503
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

FOLIC ACID 1 MG PO TABS

Facility

$0.19

Service Code	NDC 6258489701
Hospital Charge Code	6258489701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

FOLIC ACID 1 MG PO TABS

Facility

$0.19

Service Code	NDC 6258489701
Hospital Charge Code	6258489701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

FOLIC ACID 5 MG/ML IJ SOLN

Facility

$5.90

Service Code	NDC 6332318410
Hospital Charge Code	6332318410
Hospital Revenue Code	250
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$2.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.95

FOLIC ACID 5 MG/ML IJ SOLN

Facility

$5.90

Service Code	NDC 6332318410
Hospital Charge Code	6332318410
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$4.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.95
Rate for Payer: Aetna Government	$2.95
Rate for Payer: Brighton Health Commercial	$4.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.01
Rate for Payer: EmblemHealth Commercial	$2.95
Rate for Payer: Group Health Inc Commercial	$2.95
Rate for Payer: Group Health Inc Medicare	$2.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.95
Rate for Payer: Hamaspik Choice Inc Medicare	$2.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.84

FOLIC ACID 5 MG/ML IJ SOLN

Facility

$4.38

Service Code	NDC 3982211001
Hospital Charge Code	3982211001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$3.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.19
Rate for Payer: Aetna Government	$2.19
Rate for Payer: Brighton Health Commercial	$3.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.98
Rate for Payer: EmblemHealth Commercial	$2.19
Rate for Payer: Group Health Inc Commercial	$2.19
Rate for Payer: Group Health Inc Medicare	$1.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.19
Rate for Payer: Hamaspik Choice Inc Medicare	$2.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.84

FOLIC ACID 5 MG/ML IJ SOLN

Facility

$4.38

Service Code	NDC 3982211001
Hospital Charge Code	3982211001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$2.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.19

FOMEPIZOLE 1.5 GM/1.5ML IV SOLN

Facility

$1.00

Service Code	HCPCS J1451
Hospital Charge Code	7071014781
Hospital Revenue Code	258
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$6.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.28
Rate for Payer: Aetna Government	$6.28
Rate for Payer: Affinity Essential Plan 1&2	$4.40
Rate for Payer: Affinity Essential Plan 3&4	$4.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.40
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$6.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5.65
Rate for Payer: Fidelis Essential Plan Aliesa	$5.34
Rate for Payer: Fidelis Essential Plan QHP	$5.59
Rate for Payer: Fidelis Medicare Advantage	$6.28
Rate for Payer: Fidelis Qualified Health Plan	$5.59
Rate for Payer: Group Health Inc Commercial	$6.28
Rate for Payer: Group Health Inc Medicare	$6.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.28
Rate for Payer: Hamaspik Choice Inc Medicare	$6.28
Rate for Payer: Healthfirst Medicare Advantage	$5.34
Rate for Payer: Healthfirst QHP	$6.28
Rate for Payer: Humana Medicare	$6.41
Rate for Payer: Senior Whole Health Medicare Advantage	$6.28
Rate for Payer: United Healthcare Medicare Advantage	$6.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.97
Rate for Payer: Wellcare Medicare	$5.97

FOMEPIZOLE 1.5 GM/1.5ML IV SOLN

Facility

$1.00

Service Code	HCPCS J1451
Hospital Charge Code	0517071001
Hospital Revenue Code	258
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$6.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.28
Rate for Payer: Aetna Government	$6.28
Rate for Payer: Affinity Essential Plan 1&2	$4.40
Rate for Payer: Affinity Essential Plan 3&4	$4.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.40
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$6.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5.65
Rate for Payer: Fidelis Essential Plan Aliesa	$5.34
Rate for Payer: Fidelis Essential Plan QHP	$5.59
Rate for Payer: Fidelis Medicare Advantage	$6.28
Rate for Payer: Fidelis Qualified Health Plan	$5.59
Rate for Payer: Group Health Inc Commercial	$6.28
Rate for Payer: Group Health Inc Medicare	$6.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.28
Rate for Payer: Hamaspik Choice Inc Medicare	$6.28
Rate for Payer: Healthfirst Medicare Advantage	$5.34
Rate for Payer: Healthfirst QHP	$6.28
Rate for Payer: Humana Medicare	$6.41
Rate for Payer: Senior Whole Health Medicare Advantage	$6.28
Rate for Payer: United Healthcare Medicare Advantage	$6.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.97
Rate for Payer: Wellcare Medicare	$5.97

FOMEPIZOLE 1.5 GM/1.5ML IV SOLN

Facility

$821.44

Service Code	HCPCS J1451
Hospital Charge Code	6745721102
Hospital Revenue Code	258
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$657.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$451.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.28
Rate for Payer: Aetna Government	$6.28
Rate for Payer: Affinity Essential Plan 1&2	$4.40
Rate for Payer: Affinity Essential Plan 3&4	$4.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.40
Rate for Payer: Brighton Health Commercial	$616.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$657.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$558.58
Rate for Payer: Elderplan Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$6.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5.65
Rate for Payer: Fidelis Essential Plan Aliesa	$5.34
Rate for Payer: Fidelis Essential Plan QHP	$5.59
Rate for Payer: Fidelis Medicare Advantage	$6.28
Rate for Payer: Fidelis Qualified Health Plan	$5.59
Rate for Payer: Group Health Inc Commercial	$6.28
Rate for Payer: Group Health Inc Medicare	$6.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.28
Rate for Payer: Hamaspik Choice Inc Medicare	$6.28
Rate for Payer: Healthfirst Medicare Advantage	$5.34
Rate for Payer: Healthfirst QHP	$6.28
Rate for Payer: Humana Medicare	$6.41
Rate for Payer: Senior Whole Health Medicare Advantage	$6.28
Rate for Payer: United Healthcare Medicare Advantage	$6.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$533.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.97
Rate for Payer: Wellcare Medicare	$5.97

FOMEPIZOLE 1.5 GM/1.5ML IV SOLN

Facility

$821.44

Service Code	HCPCS J1451
Hospital Charge Code	6745721102
Hospital Revenue Code	258
Min. Negotiated Rate	$410.72
Max. Negotiated Rate	$410.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$410.72

FOMEPIZOLE 1.5 GM/1.5ML IV SOLN

Facility

$1.00

Service Code	HCPCS J1451
Hospital Charge Code	7071014781
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

FOMEPIZOLE 1.5 GM/1.5ML IV SOLN

Facility

$1.00

Service Code	HCPCS J1451
Hospital Charge Code	0517071001
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

FOMEPIZOLE 1 GM/ML IV SOLN

Facility

$1.00

Service Code	HCPCS J1451
Hospital Charge Code	7071014781
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

FOMEPIZOLE 1 GM/ML IV SOLN

Facility

$1.00

Service Code	HCPCS J1451
Hospital Charge Code	7071014781
Hospital Revenue Code	258
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$6.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.28
Rate for Payer: Aetna Government	$6.28
Rate for Payer: Affinity Essential Plan 1&2	$4.40
Rate for Payer: Affinity Essential Plan 3&4	$4.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.40
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$6.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5.65
Rate for Payer: Fidelis Essential Plan Aliesa	$5.34
Rate for Payer: Fidelis Essential Plan QHP	$5.59
Rate for Payer: Fidelis Medicare Advantage	$6.28
Rate for Payer: Fidelis Qualified Health Plan	$5.59
Rate for Payer: Group Health Inc Commercial	$6.28
Rate for Payer: Group Health Inc Medicare	$6.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.28
Rate for Payer: Hamaspik Choice Inc Medicare	$6.28
Rate for Payer: Healthfirst Medicare Advantage	$5.34
Rate for Payer: Healthfirst QHP	$6.28
Rate for Payer: Humana Medicare	$6.41
Rate for Payer: Senior Whole Health Medicare Advantage	$6.28
Rate for Payer: United Healthcare Medicare Advantage	$6.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.97
Rate for Payer: Wellcare Medicare	$5.97

FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN

Facility

$108.94

Service Code	HCPCS J1652
Hospital Charge Code	5515023300
Hospital Revenue Code	250
Min. Negotiated Rate	$54.47
Max. Negotiated Rate	$54.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.47

Know your out-of-pocket cost for care.

All Charges