St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$1.63
Max. Negotiated Rate	$1.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.63

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$3.50

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

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	$1.75
Max. Negotiated Rate	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.75

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$3.26

Service Code	NDC 4354754401
Hospital Charge Code	4354754401
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

$3.00

Service Code	NDC 7128841401
Hospital Charge Code	7128841401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50

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

$3.26

Service Code	NDC 4354754401
Hospital Charge Code	4354754401
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

$0.75

Service Code	NDC 7128841494
Hospital Charge Code	7128841494
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$7.31

Service Code	NDC 1672947108
Hospital Charge Code	1672947108
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$5.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.66
Rate for Payer: Aetna Government	$3.66
Rate for Payer: Brighton Health Commercial	$5.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.97
Rate for Payer: EmblemHealth Commercial	$3.66
Rate for Payer: Group Health Inc Commercial	$3.66
Rate for Payer: Group Health Inc Medicare	$2.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.66
Rate for Payer: Hamaspik Choice Inc Medicare	$3.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.75

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$14.38

Service Code	NDC 0517460225
Hospital Charge Code	0517460225
Hospital Revenue Code	250
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$7.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.19

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	$3.11
Max. Negotiated Rate	$7.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.44
Rate for Payer: Aetna Government	$4.44
Rate for Payer: Brighton Health Commercial	$6.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.04
Rate for Payer: EmblemHealth Commercial	$4.44
Rate for Payer: Group Health Inc Commercial	$4.44
Rate for Payer: Group Health Inc Medicare	$3.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.44
Rate for Payer: Hamaspik Choice Inc Medicare	$4.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.78

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$3.00

Service Code	NDC 7128841403
Hospital Charge Code	7128841403
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: EmblemHealth Commercial	$1.50
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$0.53

Service Code	NDC 0517460201
Hospital Charge Code	0517460201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$14.38

Service Code	NDC 0517460225
Hospital Charge Code	0517460225
Hospital Revenue Code	250
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$11.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.19
Rate for Payer: Aetna Government	$7.19
Rate for Payer: Brighton Health Commercial	$10.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$7.19
Rate for Payer: Group Health Inc Commercial	$7.19
Rate for Payer: Group Health Inc Medicare	$5.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.19
Rate for Payer: Hamaspik Choice Inc Medicare	$7.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.34

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$3.00

Service Code	NDC 7128841403
Hospital Charge Code	7128841403
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$3.12

Service Code	NDC 0143968125
Hospital Charge Code	0143968125
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$3.12

Service Code	NDC 0143968201
Hospital Charge Code	0143968201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$0.75

Service Code	NDC 7128841494
Hospital Charge Code	7128841494
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.51
Rate for Payer: EmblemHealth Commercial	$0.38
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.26
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

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$3.12

Service Code	NDC 0143968201
Hospital Charge Code	0143968201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$2.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.12
Rate for Payer: EmblemHealth Commercial	$1.56
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.03

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$4.56

Service Code	NDC 5175460004
Hospital Charge Code	5175460004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.28
Rate for Payer: Aetna Government	$2.28
Rate for Payer: Brighton Health Commercial	$3.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.10
Rate for Payer: EmblemHealth Commercial	$2.28
Rate for Payer: Group Health Inc Commercial	$2.28
Rate for Payer: Group Health Inc Medicare	$1.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.28
Rate for Payer: Hamaspik Choice Inc Medicare	$2.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.96

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$0.53

Service Code	NDC 0517460201
Hospital Charge Code	0517460201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$4.56

Service Code	NDC 5175460004
Hospital Charge Code	5175460004
Hospital Revenue Code	250
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.28

GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (WRAPPED)

Facility

$3.00

Service Code	NDC 7128841401
Hospital Charge Code	7128841401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: EmblemHealth Commercial	$1.50
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

GLYCOPYRROLATE 1 MG/5ML PO SOLN

Facility

$1.14

Service Code	NDC 4988404233
Hospital Charge Code	4988404233
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Brighton Health Commercial	$0.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: EmblemHealth Commercial	$0.57
Rate for Payer: Group Health Inc Commercial	$0.57
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57
Rate for Payer: Hamaspik Choice Inc Medicare	$0.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.74

GLYCOPYRROLATE 1 MG/5ML PO SOLN

Facility

$1.14

Service Code	NDC 4988404233
Hospital Charge Code	4988404233
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57

Know your out-of-pocket cost for care.

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