St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ACETAMINOPHEN 120 MG RE SUPP

Facility

$0.80

Service Code	NDC 5167221152
Hospital Charge Code	5167221152
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.40
Rate for Payer: Aetna Government	$0.40
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.55
Rate for Payer: EmblemHealth Commercial	$0.40
Rate for Payer: Group Health Inc Commercial	$0.40
Rate for Payer: Group Health Inc Medicare	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.40
Rate for Payer: Hamaspik Choice Inc Medicare	$0.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.52

ACETAMINOPHEN 120 MG RE SUPP

Facility

$0.58

Service Code	NDC 4580273200
Hospital Charge Code	4580273200
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.29

ACETAMINOPHEN 120 MG RE SUPP

Facility

$0.58

Service Code	NDC 4580273230
Hospital Charge Code	4580273230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.29

ACETAMINOPHEN 120 MG RE SUPP

Facility

$0.58

Service Code	NDC 4580273230
Hospital Charge Code	4580273230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.47
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	$0.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
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

ACETAMINOPHEN 160 MG/5ML PO LIQD

Facility

$0.04

Service Code	NDC 5865752516
Hospital Charge Code	5865752516
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

ACETAMINOPHEN 160 MG/5ML PO LIQD

Facility

$0.04

Service Code	NDC 5865752516
Hospital Charge Code	5865752516
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

ACETAMINOPHEN 160 MG/5ML PO LIQD

Facility

$0.04

Service Code	NDC 6936732316
Hospital Charge Code	6936732316
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

ACETAMINOPHEN 160 MG/5ML PO LIQD

Facility

$0.07

Service Code	NDC 5865752504
Hospital Charge Code	5865752504
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
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	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

ACETAMINOPHEN 160 MG/5ML PO LIQD

Facility

$0.04

Service Code	NDC 6936732316
Hospital Charge Code	6936732316
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

ACETAMINOPHEN 160 MG/5ML PO LIQD

Facility

$0.07

Service Code	NDC 5865752504
Hospital Charge Code	5865752504
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.55

Service Code	NDC 6809423101
Hospital Charge Code	6809423101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
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	$0.36

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.11

Service Code	NDC 0121282394
Hospital Charge Code	0121282394
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
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	$0.04
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	$0.07

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.03

Service Code	NDC 0904676620
Hospital Charge Code	0904676620
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.06

Service Code	NDC 0045012304
Hospital Charge Code	0045012304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.11

Service Code	NDC 0121282394
Hospital Charge Code	0121282394
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.07

Service Code	NDC 0536121277
Hospital Charge Code	0536121277
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
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	$0.05
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	$0.02
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

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.28

Service Code	NDC 0121178100
Hospital Charge Code	0121178100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.19
Rate for Payer: EmblemHealth Commercial	$0.14
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.18

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.11

Service Code	NDC 0121282321
Hospital Charge Code	0121282321
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
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	$0.04
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	$0.07

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.12

Service Code	NDC 6809433061
Hospital Charge Code	6809433061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: EmblemHealth Commercial	$0.06
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.05

Service Code	NDC 5058057902
Hospital Charge Code	5058057902
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.11

Service Code	NDC 0121282321
Hospital Charge Code	0121282321
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.03

Service Code	NDC 4580220326
Hospital Charge Code	4580220326
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.12

Service Code	NDC 6809433059
Hospital Charge Code	6809433059
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.12

Service Code	NDC 6809433061
Hospital Charge Code	6809433061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

ACETAMINOPHEN 160 MG/5ML PO SUSP

Facility

$0.14

Service Code	NDC 0121188294
Hospital Charge Code	0121188294
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

Know your out-of-pocket cost for care.

All Charges