St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BETAMETHASONE DIPROPIONATE 0.05 % EX CREA

Facility

$2.94

Service Code	NDC 5167212741
Hospital Charge Code	5167212741
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.47
Rate for Payer: Aetna Government	$1.47
Rate for Payer: Brighton Health Commercial	$2.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.00
Rate for Payer: EmblemHealth Commercial	$1.47
Rate for Payer: Group Health Inc Commercial	$1.47
Rate for Payer: Group Health Inc Medicare	$1.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.47
Rate for Payer: Hamaspik Choice Inc Medicare	$1.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.91

BETAMETHASONE DIPROPIONATE 0.05 % EX CREA

Facility

$2.93

Service Code	NDC 7071012331
Hospital Charge Code	7071012331
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.47

BETAMETHASONE DIPROPIONATE 0.05 % EX CREA

Facility

$2.93

Service Code	NDC 7071012331
Hospital Charge Code	7071012331
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.47
Rate for Payer: Aetna Government	$1.47
Rate for Payer: Brighton Health Commercial	$2.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.99
Rate for Payer: EmblemHealth Commercial	$1.47
Rate for Payer: Group Health Inc Commercial	$1.47
Rate for Payer: Group Health Inc Medicare	$1.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.47
Rate for Payer: Hamaspik Choice Inc Medicare	$1.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.91

BETAMETHASONE DIPROPIONATE 0.05 % EX CREA

Facility

$2.94

Service Code	NDC 5167212741
Hospital Charge Code	5167212741
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.47

BETAMETHASONE DIPROPIONATE 0.05 % EX OINT

Facility

$4.10

Service Code	NDC 0168005615
Hospital Charge Code	0168005615
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.05

BETAMETHASONE DIPROPIONATE 0.05 % EX OINT

Facility

$4.10

Service Code	NDC 0168005615
Hospital Charge Code	0168005615
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.05
Rate for Payer: Aetna Government	$2.05
Rate for Payer: Brighton Health Commercial	$3.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.79
Rate for Payer: EmblemHealth Commercial	$2.05
Rate for Payer: Group Health Inc Commercial	$2.05
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.05
Rate for Payer: Hamaspik Choice Inc Medicare	$2.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.66

BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP

Facility

$9.98

Service Code	HCPCS J0702
Hospital Charge Code	7820611801
Hospital Revenue Code	250
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$4.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.99

BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP

Facility

$9.98

Service Code	HCPCS J0702
Hospital Charge Code	7820611801
Hospital Revenue Code	250
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$8.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.04
Rate for Payer: Aetna Government	$8.04
Rate for Payer: Brighton Health Commercial	$7.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.79
Rate for Payer: EmblemHealth Commercial	$4.99
Rate for Payer: Group Health Inc Commercial	$4.99
Rate for Payer: Group Health Inc Medicare	$3.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.99
Rate for Payer: Hamaspik Choice Inc Medicare	$4.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.49

BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP

Facility

$9.66

Service Code	HCPCS J0702
Hospital Charge Code	0517079901
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$8.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.04
Rate for Payer: Aetna Government	$8.04
Rate for Payer: Brighton Health Commercial	$7.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.57
Rate for Payer: EmblemHealth Commercial	$4.83
Rate for Payer: Group Health Inc Commercial	$4.83
Rate for Payer: Group Health Inc Medicare	$3.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.83
Rate for Payer: Hamaspik Choice Inc Medicare	$4.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.28

BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP

Facility

$13.21

Service Code	HCPCS J0702
Hospital Charge Code	0517072001
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$10.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.04
Rate for Payer: Aetna Government	$8.04
Rate for Payer: Brighton Health Commercial	$9.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.98
Rate for Payer: EmblemHealth Commercial	$6.60
Rate for Payer: Group Health Inc Commercial	$6.60
Rate for Payer: Group Health Inc Medicare	$4.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.60
Rate for Payer: Hamaspik Choice Inc Medicare	$6.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.59

BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP

Facility

$9.66

Service Code	HCPCS J0702
Hospital Charge Code	0517079901
Hospital Revenue Code	250
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$4.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.83

BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP

Facility

$13.21

Service Code	HCPCS J0702
Hospital Charge Code	0517072001
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.60

BETAXOLOL HCL 0.5 % OP SOLN

Facility

$13.25

Service Code	NDC 6131424501
Hospital Charge Code	6131424501
Hospital Revenue Code	250
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$6.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.63

BETAXOLOL HCL 0.5 % OP SOLN

Facility

$13.25

Service Code	NDC 6131424501
Hospital Charge Code	6131424501
Hospital Revenue Code	250
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$10.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.63
Rate for Payer: Aetna Government	$6.63
Rate for Payer: Brighton Health Commercial	$9.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.01
Rate for Payer: EmblemHealth Commercial	$6.63
Rate for Payer: Group Health Inc Commercial	$6.63
Rate for Payer: Group Health Inc Medicare	$4.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.63
Rate for Payer: Hamaspik Choice Inc Medicare	$6.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.62

BETHANECHOL CHLORIDE 25 MG PO TABS

Facility

$2.67

Service Code	NDC 0832051289
Hospital Charge Code	0832051289
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$2.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.33
Rate for Payer: Aetna Government	$1.33
Rate for Payer: Brighton Health Commercial	$2.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.82
Rate for Payer: EmblemHealth Commercial	$1.33
Rate for Payer: Group Health Inc Commercial	$1.33
Rate for Payer: Group Health Inc Medicare	$0.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.33
Rate for Payer: Hamaspik Choice Inc Medicare	$1.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.74

BETHANECHOL CHLORIDE 25 MG PO TABS

Facility

$2.67

Service Code	NDC 0832051289
Hospital Charge Code	0832051289
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$1.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.33

BETHANECHOL CHLORIDE 5 MG PO TABS

Facility

$0.90

Service Code	NDC 0832051000
Hospital Charge Code	0832051000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: EmblemHealth Commercial	$0.45
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

BETHANECHOL CHLORIDE 5 MG PO TABS

Facility

$0.90

Service Code	NDC 0832051000
Hospital Charge Code	0832051000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45

BEVACIZUMAB 100 MG/4ML IV SOLN

Facility

$239.08

Service Code	HCPCS J9035
Hospital Charge Code	5024206001
Hospital Revenue Code	258
Min. Negotiated Rate	$51.24
Max. Negotiated Rate	$191.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$131.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.20
Rate for Payer: Aetna Government	$73.20
Rate for Payer: Affinity Essential Plan 1&2	$51.24
Rate for Payer: Affinity Essential Plan 3&4	$51.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$51.24
Rate for Payer: Brighton Health Commercial	$179.31
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$73.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$191.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.58
Rate for Payer: Elderplan Medicare Advantage	$73.20
Rate for Payer: EmblemHealth Commercial	$73.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$65.88
Rate for Payer: Fidelis Essential Plan Aliesa	$62.22
Rate for Payer: Fidelis Essential Plan QHP	$65.15
Rate for Payer: Fidelis Medicare Advantage	$73.20
Rate for Payer: Fidelis Qualified Health Plan	$65.15
Rate for Payer: Group Health Inc Commercial	$73.20
Rate for Payer: Group Health Inc Medicare	$73.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.20
Rate for Payer: Hamaspik Choice Inc Medicare	$73.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$73.20
Rate for Payer: Healthfirst Medicare Advantage	$62.22
Rate for Payer: Healthfirst QHP	$73.20
Rate for Payer: Humana Medicare	$74.66
Rate for Payer: Senior Whole Health Medicare Advantage	$73.20
Rate for Payer: United Healthcare Medicare Advantage	$73.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$155.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69.54
Rate for Payer: Wellcare Medicare	$69.54

BEVACIZUMAB 100 MG/4ML IV SOLN

Facility

$239.08

Service Code	HCPCS J9035
Hospital Charge Code	5024206001
Hospital Revenue Code	258
Min. Negotiated Rate	$119.54
Max. Negotiated Rate	$119.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.54

BEVACIZUMAB 3 MG/0.12ML IZ SOSY

Facility

$239.08

Service Code	HCPCS J9035
Hospital Charge Code	9999123405
Hospital Revenue Code	250
Min. Negotiated Rate	$51.24
Max. Negotiated Rate	$191.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$131.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.20
Rate for Payer: Aetna Government	$73.20
Rate for Payer: Affinity Essential Plan 1&2	$51.24
Rate for Payer: Affinity Essential Plan 3&4	$51.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$51.24
Rate for Payer: Brighton Health Commercial	$179.31
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$73.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$191.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.58
Rate for Payer: Elderplan Medicare Advantage	$73.20
Rate for Payer: EmblemHealth Commercial	$73.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$65.88
Rate for Payer: Fidelis Essential Plan Aliesa	$62.22
Rate for Payer: Fidelis Essential Plan QHP	$65.15
Rate for Payer: Fidelis Medicare Advantage	$73.20
Rate for Payer: Fidelis Qualified Health Plan	$65.15
Rate for Payer: Group Health Inc Commercial	$73.20
Rate for Payer: Group Health Inc Medicare	$73.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.20
Rate for Payer: Hamaspik Choice Inc Medicare	$73.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$73.20
Rate for Payer: Healthfirst Medicare Advantage	$62.22
Rate for Payer: Healthfirst QHP	$73.20
Rate for Payer: Humana Medicare	$74.66
Rate for Payer: Senior Whole Health Medicare Advantage	$73.20
Rate for Payer: United Healthcare Medicare Advantage	$73.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$155.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69.54
Rate for Payer: Wellcare Medicare	$69.54

BEVACIZUMAB 3 MG/0.12ML IZ SOSY

Facility

$239.08

Service Code	HCPCS J9035
Hospital Charge Code	9999123405
Hospital Revenue Code	250
Min. Negotiated Rate	$119.54
Max. Negotiated Rate	$119.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.54

BEVACIZUMAB 400 MG/16ML IV SOLN

Facility

$239.08

Service Code	HCPCS J9035
Hospital Charge Code	5024206101
Hospital Revenue Code	258
Min. Negotiated Rate	$119.54
Max. Negotiated Rate	$119.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.54

BEVACIZUMAB 400 MG/16ML IV SOLN

Facility

$239.08

Service Code	HCPCS J9035
Hospital Charge Code	5024206101
Hospital Revenue Code	258
Min. Negotiated Rate	$51.24
Max. Negotiated Rate	$191.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$131.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.20
Rate for Payer: Aetna Government	$73.20
Rate for Payer: Affinity Essential Plan 1&2	$51.24
Rate for Payer: Affinity Essential Plan 3&4	$51.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$51.24
Rate for Payer: Brighton Health Commercial	$179.31
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$73.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$191.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.58
Rate for Payer: Elderplan Medicare Advantage	$73.20
Rate for Payer: EmblemHealth Commercial	$73.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$65.88
Rate for Payer: Fidelis Essential Plan Aliesa	$62.22
Rate for Payer: Fidelis Essential Plan QHP	$65.15
Rate for Payer: Fidelis Medicare Advantage	$73.20
Rate for Payer: Fidelis Qualified Health Plan	$65.15
Rate for Payer: Group Health Inc Commercial	$73.20
Rate for Payer: Group Health Inc Medicare	$73.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.20
Rate for Payer: Hamaspik Choice Inc Medicare	$73.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$73.20
Rate for Payer: Healthfirst Medicare Advantage	$62.22
Rate for Payer: Healthfirst QHP	$73.20
Rate for Payer: Humana Medicare	$74.66
Rate for Payer: Senior Whole Health Medicare Advantage	$73.20
Rate for Payer: United Healthcare Medicare Advantage	$73.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$155.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69.54
Rate for Payer: Wellcare Medicare	$69.54

BEVACIZUMAB-AWWB 100 MG/4ML IV SOLN

Facility

$209.32

Service Code	HCPCS Q5107
Hospital Charge Code	5551320601
Hospital Revenue Code	258
Min. Negotiated Rate	$104.66
Max. Negotiated Rate	$104.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.66

Know your out-of-pocket cost for care.

All Charges