St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GLIMEPIRIDE 2 MG PO TABS

Facility

$0.65

Service Code	NDC 1672900201
Hospital Charge Code	1672900201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

GLIMEPIRIDE 2 MG PO TABS

Facility

$0.88

Service Code	NDC 5026835915
Hospital Charge Code	5026835915
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44

GLIMEPIRIDE 2 MG PO TABS

Facility

$0.65

Service Code	NDC 1672900201
Hospital Charge Code	1672900201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

GLIMEPIRIDE 2 MG PO TABS

Facility

$0.88

Service Code	NDC 5026835915
Hospital Charge Code	5026835915
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.44
Rate for Payer: Aetna Government	$0.44
Rate for Payer: Brighton Health Commercial	$0.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.60
Rate for Payer: EmblemHealth Commercial	$0.44
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.57

GLIMEPIRIDE 4 MG PO TABS

Facility

$1.23

Service Code	NDC 1672900301
Hospital Charge Code	1672900301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61

GLIMEPIRIDE 4 MG PO TABS

Facility

$1.23

Service Code	NDC 1672900301
Hospital Charge Code	1672900301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.61
Rate for Payer: Aetna Government	$0.61
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.84
Rate for Payer: EmblemHealth Commercial	$0.61
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.80

GLIMEPIRIDE 4 MG PO TABS

Facility

$4.88

Service Code	NDC 0039022310
Hospital Charge Code	0039022310
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.44

GLIMEPIRIDE 4 MG PO TABS

Facility

$1.22

Service Code	NDC 5026836011
Hospital Charge Code	5026836011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.61
Rate for Payer: Aetna Government	$0.61
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.83
Rate for Payer: EmblemHealth Commercial	$0.61
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.79

GLIMEPIRIDE 4 MG PO TABS

Facility

$1.22

Service Code	NDC 5026836011
Hospital Charge Code	5026836011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61

GLIMEPIRIDE 4 MG PO TABS

Facility

$1.22

Service Code	NDC 5026836015
Hospital Charge Code	5026836015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61

GLIMEPIRIDE 4 MG PO TABS

Facility

$1.22

Service Code	NDC 5026836015
Hospital Charge Code	5026836015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.61
Rate for Payer: Aetna Government	$0.61
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.83
Rate for Payer: EmblemHealth Commercial	$0.61
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.79

GLIMEPIRIDE 4 MG PO TABS

Facility

$4.88

Service Code	NDC 0039022310
Hospital Charge Code	0039022310
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$3.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.44
Rate for Payer: Aetna Government	$2.44
Rate for Payer: Brighton Health Commercial	$3.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.31
Rate for Payer: EmblemHealth Commercial	$2.44
Rate for Payer: Group Health Inc Commercial	$2.44
Rate for Payer: Group Health Inc Medicare	$1.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.44
Rate for Payer: Hamaspik Choice Inc Medicare	$2.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.17

GLIPIZIDE 10 MG PO TABS

Facility

$0.67

Service Code	NDC 6050501420
Hospital Charge Code	6050501420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

GLIPIZIDE 10 MG PO TABS

Facility

$0.76

Service Code	NDC 5026836215
Hospital Charge Code	5026836215
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: EmblemHealth Commercial	$0.38
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

GLIPIZIDE 10 MG PO TABS

Facility

$0.76

Service Code	NDC 5026836215
Hospital Charge Code	5026836215
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38

GLIPIZIDE 10 MG PO TABS

Facility

$0.76

Service Code	NDC 5026836211
Hospital Charge Code	5026836211
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: EmblemHealth Commercial	$0.38
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

GLIPIZIDE 10 MG PO TABS

Facility

$0.76

Service Code	NDC 5026836211
Hospital Charge Code	5026836211
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38

GLIPIZIDE 10 MG PO TABS

Facility

$0.67

Service Code	NDC 6050501420
Hospital Charge Code	6050501420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

GLIPIZIDE 5 MG PO TABS

Facility

$0.40

Service Code	NDC 0904663761
Hospital Charge Code	0904663761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

GLIPIZIDE 5 MG PO TABS

Facility

$0.40

Service Code	NDC 0904663761
Hospital Charge Code	0904663761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

GLUCAGON EMERGENCY 1 MG IJ KIT

Facility

$336.00

Service Code	HCPCS J1610
Hospital Charge Code	0548585000
Hospital Revenue Code	250
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00

GLUCAGON EMERGENCY 1 MG IJ KIT

Facility

$336.00

Service Code	HCPCS J1610
Hospital Charge Code	5009065500
Hospital Revenue Code	250
Min. Negotiated Rate	$127.72
Max. Negotiated Rate	$268.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$182.45
Rate for Payer: Aetna Government	$182.45
Rate for Payer: Affinity Essential Plan 1&2	$127.72
Rate for Payer: Affinity Essential Plan 3&4	$127.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$127.72
Rate for Payer: Brighton Health Commercial	$252.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$182.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$268.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$228.48
Rate for Payer: Elderplan Medicare Advantage	$182.45
Rate for Payer: EmblemHealth Commercial	$182.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$164.21
Rate for Payer: Fidelis Essential Plan Aliesa	$155.08
Rate for Payer: Fidelis Essential Plan QHP	$162.38
Rate for Payer: Fidelis Medicare Advantage	$182.45
Rate for Payer: Fidelis Qualified Health Plan	$162.38
Rate for Payer: Group Health Inc Commercial	$182.45
Rate for Payer: Group Health Inc Medicare	$182.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.45
Rate for Payer: Hamaspik Choice Inc Medicare	$182.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$182.45
Rate for Payer: Healthfirst Medicare Advantage	$155.08
Rate for Payer: Healthfirst QHP	$182.45
Rate for Payer: Humana Medicare	$186.10
Rate for Payer: Senior Whole Health Medicare Advantage	$182.45
Rate for Payer: United Healthcare Medicare Advantage	$182.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$218.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$173.33
Rate for Payer: Wellcare Medicare	$173.33

GLUCAGON EMERGENCY 1 MG IJ KIT

Facility

$336.00

Service Code	HCPCS J1610
Hospital Charge Code	5009065500
Hospital Revenue Code	250
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00

GLUCAGON EMERGENCY 1 MG IJ KIT

Facility

$336.00

Service Code	HCPCS J1610
Hospital Charge Code	0548585000
Hospital Revenue Code	250
Min. Negotiated Rate	$127.72
Max. Negotiated Rate	$268.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$182.45
Rate for Payer: Aetna Government	$182.45
Rate for Payer: Affinity Essential Plan 1&2	$127.72
Rate for Payer: Affinity Essential Plan 3&4	$127.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$127.72
Rate for Payer: Brighton Health Commercial	$252.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$182.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$268.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$228.48
Rate for Payer: Elderplan Medicare Advantage	$182.45
Rate for Payer: EmblemHealth Commercial	$182.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$164.21
Rate for Payer: Fidelis Essential Plan Aliesa	$155.08
Rate for Payer: Fidelis Essential Plan QHP	$162.38
Rate for Payer: Fidelis Medicare Advantage	$182.45
Rate for Payer: Fidelis Qualified Health Plan	$162.38
Rate for Payer: Group Health Inc Commercial	$182.45
Rate for Payer: Group Health Inc Medicare	$182.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.45
Rate for Payer: Hamaspik Choice Inc Medicare	$182.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$182.45
Rate for Payer: Healthfirst Medicare Advantage	$155.08
Rate for Payer: Healthfirst QHP	$182.45
Rate for Payer: Humana Medicare	$186.10
Rate for Payer: Senior Whole Health Medicare Advantage	$182.45
Rate for Payer: United Healthcare Medicare Advantage	$182.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$218.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$173.33
Rate for Payer: Wellcare Medicare	$173.33

GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR

Facility

$194.40

Service Code	HCPCS J1610
Hospital Charge Code	6332359606
Hospital Revenue Code	250
Min. Negotiated Rate	$106.92
Max. Negotiated Rate	$186.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$182.45
Rate for Payer: Aetna Government	$182.45
Rate for Payer: Affinity Essential Plan 1&2	$127.72
Rate for Payer: Affinity Essential Plan 3&4	$127.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$127.72
Rate for Payer: Brighton Health Commercial	$145.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$182.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.19
Rate for Payer: Elderplan Medicare Advantage	$182.45
Rate for Payer: EmblemHealth Commercial	$182.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$164.21
Rate for Payer: Fidelis Essential Plan Aliesa	$155.08
Rate for Payer: Fidelis Essential Plan QHP	$162.38
Rate for Payer: Fidelis Medicare Advantage	$182.45
Rate for Payer: Fidelis Qualified Health Plan	$162.38
Rate for Payer: Group Health Inc Commercial	$182.45
Rate for Payer: Group Health Inc Medicare	$182.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.45
Rate for Payer: Hamaspik Choice Inc Medicare	$182.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$182.45
Rate for Payer: Healthfirst Medicare Advantage	$155.08
Rate for Payer: Healthfirst QHP	$182.45
Rate for Payer: Humana Medicare	$186.10
Rate for Payer: Senior Whole Health Medicare Advantage	$182.45
Rate for Payer: United Healthcare Medicare Advantage	$182.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$126.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$173.33
Rate for Payer: Wellcare Medicare	$173.33

Know your out-of-pocket cost for care.

All Charges