St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GLYBURIDE 2.5 MG PO TABS

Facility

$0.46

Service Code	NDC 2315505701
Hospital Charge Code	2315505701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23

GLYBURIDE 2.5 MG PO TABS

Facility

$0.46

Service Code	NDC 2315505701
Hospital Charge Code	2315505701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: EmblemHealth Commercial	$0.23
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.30

GLYBURIDE 5 MG PO TABS

Facility

$0.78

Service Code	NDC 2315505801
Hospital Charge Code	2315505801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: EmblemHealth Commercial	$0.39
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.51

GLYBURIDE 5 MG PO TABS

Facility

$0.78

Service Code	NDC 2315505801
Hospital Charge Code	2315505801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39

GLYCERIN (ADULT) 2 G RE SUPP

Facility

$0.32

Service Code	NDC 5723732552
Hospital Charge Code	5723732552
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.22
Rate for Payer: EmblemHealth Commercial	$0.16
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.21

GLYCERIN (ADULT) 2 G RE SUPP

Facility

$0.17

Service Code	NDC 0132007912
Hospital Charge Code	0132007912
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

GLYCERIN (ADULT) 2 G RE SUPP

Facility

$0.32

Service Code	NDC 5723732552
Hospital Charge Code	5723732552
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16

GLYCERIN (ADULT) 2 G RE SUPP

Facility

$0.17

Service Code	NDC 0132007912
Hospital Charge Code	0132007912
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

GLYCERIN-HYPROMELLOSE-PEG 400 0.2-0.2-1 % OP SOLN

Facility

$0.14

Service Code	NDC 5789618105
Hospital Charge Code	5789618105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

GLYCERIN-HYPROMELLOSE-PEG 400 0.2-0.2-1 % OP SOLN

Facility

$0.14

Service Code	NDC 5789618105
Hospital Charge Code	5789618105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

GLYCERIN (INFANTS & CHILDREN) 1 G RE SUPP

Facility

$0.84

Service Code	NDC 5898040912
Hospital Charge Code	5898040912
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

GLYCERIN (INFANTS & CHILDREN) 1 G RE SUPP

Facility

$0.84

Service Code	NDC 5898040912
Hospital Charge Code	5898040912
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

GLYCERIN (LAXATIVE) 1 G RE SUPP

Facility

$0.10

Service Code	NDC 7000004291
Hospital Charge Code	7000004291
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

GLYCERIN (LAXATIVE) 1 G RE SUPP

Facility

$0.10

Service Code	NDC 7000004291
Hospital Charge Code	7000004291
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN

Facility

$3.26

Service Code	NDC 4354754301
Hospital Charge Code	4354754301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$1.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.63

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN

Facility

$3.26

Service Code	NDC 4354763925
Hospital Charge Code	4354763925
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.63
Rate for Payer: Aetna Government	$1.63
Rate for Payer: Brighton Health Commercial	$2.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.22
Rate for Payer: EmblemHealth Commercial	$1.63
Rate for Payer: Group Health Inc Commercial	$1.63
Rate for Payer: Group Health Inc Medicare	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.63
Rate for Payer: Hamaspik Choice Inc Medicare	$1.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.12

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN

Facility

$3.26

Service Code	NDC 4354754325
Hospital Charge Code	4354754325
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$1.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.63

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN

Facility

$3.26

Service Code	NDC 4354754325
Hospital Charge Code	4354754325
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.63
Rate for Payer: Aetna Government	$1.63
Rate for Payer: Brighton Health Commercial	$2.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.22
Rate for Payer: EmblemHealth Commercial	$1.63
Rate for Payer: Group Health Inc Commercial	$1.63
Rate for Payer: Group Health Inc Medicare	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.63
Rate for Payer: Hamaspik Choice Inc Medicare	$1.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.12

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN

Facility

$2.88

Service Code	NDC 6679420202
Hospital Charge Code	6679420202
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.44

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN

Facility

$3.26

Service Code	NDC 4354754301
Hospital Charge Code	4354754301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.63
Rate for Payer: Aetna Government	$1.63
Rate for Payer: Brighton Health Commercial	$2.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.22
Rate for Payer: EmblemHealth Commercial	$1.63
Rate for Payer: Group Health Inc Commercial	$1.63
Rate for Payer: Group Health Inc Medicare	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.63
Rate for Payer: Hamaspik Choice Inc Medicare	$1.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.12

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN

Facility

$2.88

Service Code	NDC 6679420202
Hospital Charge Code	6679420202
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.44
Rate for Payer: Aetna Government	$1.44
Rate for Payer: Brighton Health Commercial	$2.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.96
Rate for Payer: EmblemHealth Commercial	$1.44
Rate for Payer: Group Health Inc Commercial	$1.44
Rate for Payer: Group Health Inc Medicare	$1.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.87

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN

Facility

$3.26

Service Code	NDC 4354763925
Hospital Charge Code	4354763925
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$1.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.63

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$3.26

Service Code	NDC 4354754325
Hospital Charge Code	4354754325
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.63
Rate for Payer: Aetna Government	$1.63
Rate for Payer: Brighton Health Commercial	$2.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.22
Rate for Payer: EmblemHealth Commercial	$1.63
Rate for Payer: Group Health Inc Commercial	$1.63
Rate for Payer: Group Health Inc Medicare	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.63
Rate for Payer: Hamaspik Choice Inc Medicare	$1.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.12

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$8.89

Service Code	NDC 7183912525
Hospital Charge Code	7183912525
Hospital Revenue Code	250
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$4.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.44

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$3.50

Service Code	NDC 0781382596
Hospital Charge Code	0781382596
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$2.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.75
Rate for Payer: Aetna Government	$1.75
Rate for Payer: Brighton Health Commercial	$2.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.38
Rate for Payer: EmblemHealth Commercial	$1.75
Rate for Payer: Group Health Inc Commercial	$1.75
Rate for Payer: Group Health Inc Medicare	$1.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.27

Know your out-of-pocket cost for care.

All Charges