St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BROMOCRIPTINE MESYLATE 2.5 MG PO TABS

Facility

$3.76

Service Code	NDC 0574010601
Hospital Charge Code	0574010601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88

BROMOCRIPTINE MESYLATE 2.5 MG PO TABS

Facility

$6.27

Service Code	NDC 0781532531
Hospital Charge Code	0781532531
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$5.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.13
Rate for Payer: Aetna Government	$3.13
Rate for Payer: Brighton Health Commercial	$4.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.26
Rate for Payer: EmblemHealth Commercial	$3.13
Rate for Payer: Group Health Inc Commercial	$3.13
Rate for Payer: Group Health Inc Medicare	$2.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.13
Rate for Payer: Hamaspik Choice Inc Medicare	$3.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.07

BROMOCRIPTINE MESYLATE 2.5 MG PO TABS

Facility

$3.76

Service Code	NDC 0574010601
Hospital Charge Code	0574010601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$3.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.88
Rate for Payer: Aetna Government	$1.88
Rate for Payer: Brighton Health Commercial	$2.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.55
Rate for Payer: EmblemHealth Commercial	$1.88
Rate for Payer: Group Health Inc Commercial	$1.88
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.44

BROMOCRIPTINE MESYLATE 2.5 MG PO TABS

Facility

$4.14

Service Code	NDC 0574010603
Hospital Charge Code	0574010603
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$3.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.07
Rate for Payer: Aetna Government	$2.07
Rate for Payer: Brighton Health Commercial	$3.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.81
Rate for Payer: EmblemHealth Commercial	$2.07
Rate for Payer: Group Health Inc Commercial	$2.07
Rate for Payer: Group Health Inc Medicare	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.07
Rate for Payer: Hamaspik Choice Inc Medicare	$2.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.69

BROMOCRIPTINE MESYLATE 2.5 MG PO TABS

Facility

$4.14

Service Code	NDC 0574010603
Hospital Charge Code	0574010603
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.07

BROMOCRIPTINE MESYLATE 2.5 MG PO TABS

Facility

$6.27

Service Code	NDC 0781532531
Hospital Charge Code	0781532531
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.13

BRONCHIOLITIS AND RSV PNEUMONIA

Facility

$197.64

Service Code	EAPG 00572
Min. Negotiated Rate	$143.49
Max. Negotiated Rate	$197.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$143.49
Rate for Payer: Healthfirst Commercial	$197.64

Bronchiolitis & RSV pneumonia

Facility

$43,102.04

Service Code	APR-DRG 1382
Min. Negotiated Rate	$7,071.00
Max. Negotiated Rate	$43,102.04
Rate for Payer: Affinity Essential Plan 1&2	$43,102.04
Rate for Payer: Affinity Essential Plan 3&4	$43,102.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,156.46
Rate for Payer: Amida Care Medicaid	$19,156.46
Rate for Payer: EmblemHealth Essential Plan 1&2	$43,102.04
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,156.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,156.46
Rate for Payer: Fidelis Qualified Health Plan	$22,987.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,156.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,156.46
Rate for Payer: Healthfirst Commercial	$12,208.00
Rate for Payer: Healthfirst Essential Plan	$43,102.04
Rate for Payer: Healthfirst QHP	$7,071.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,156.46
Rate for Payer: SOMOS Essential	$43,102.04
Rate for Payer: United Healthcare Essential Plan 1&2	$43,102.04
Rate for Payer: United Healthcare Essential Plan 3&4	$43,102.04
Rate for Payer: United Healthcare Medicaid	$19,156.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,156.46

Bronchiolitis & RSV pneumonia

Facility

$85,195.87

Service Code	APR-DRG 1384
Min. Negotiated Rate	$20,388.00
Max. Negotiated Rate	$85,195.87
Rate for Payer: Affinity Essential Plan 1&2	$85,195.87
Rate for Payer: Affinity Essential Plan 3&4	$85,195.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$37,864.83
Rate for Payer: Amida Care Medicaid	$37,864.83
Rate for Payer: EmblemHealth Essential Plan 1&2	$85,195.87
Rate for Payer: EmblemHealth Essential Plan 3&4	$37,864.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,864.83
Rate for Payer: Fidelis Qualified Health Plan	$45,437.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,864.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,864.83
Rate for Payer: Healthfirst Commercial	$40,970.00
Rate for Payer: Healthfirst Essential Plan	$85,195.87
Rate for Payer: Healthfirst QHP	$20,388.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,864.83
Rate for Payer: SOMOS Essential	$85,195.87
Rate for Payer: United Healthcare Essential Plan 1&2	$85,195.87
Rate for Payer: United Healthcare Essential Plan 3&4	$85,195.87
Rate for Payer: United Healthcare Medicaid	$37,864.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,864.83

Bronchiolitis & RSV pneumonia

Facility

$56,020.03

Service Code	APR-DRG 1383
Min. Negotiated Rate	$12,771.00
Max. Negotiated Rate	$56,020.03
Rate for Payer: Affinity Essential Plan 1&2	$56,020.03
Rate for Payer: Affinity Essential Plan 3&4	$56,020.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,897.79
Rate for Payer: Amida Care Medicaid	$24,897.79
Rate for Payer: EmblemHealth Essential Plan 1&2	$56,020.03
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,897.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,897.79
Rate for Payer: Fidelis Qualified Health Plan	$29,877.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,897.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,897.79
Rate for Payer: Healthfirst Commercial	$21,746.00
Rate for Payer: Healthfirst Essential Plan	$56,020.03
Rate for Payer: Healthfirst QHP	$12,771.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,897.79
Rate for Payer: SOMOS Essential	$56,020.03
Rate for Payer: United Healthcare Essential Plan 1&2	$56,020.03
Rate for Payer: United Healthcare Essential Plan 3&4	$56,020.03
Rate for Payer: United Healthcare Medicaid	$24,897.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,897.79

Bronchiolitis & RSV pneumonia

Facility

$40,594.07

Service Code	APR-DRG 1381
Min. Negotiated Rate	$5,529.00
Max. Negotiated Rate	$40,594.07
Rate for Payer: Affinity Essential Plan 1&2	$40,594.07
Rate for Payer: Affinity Essential Plan 3&4	$40,594.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,041.81
Rate for Payer: Amida Care Medicaid	$18,041.81
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,594.07
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,041.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,041.81
Rate for Payer: Fidelis Qualified Health Plan	$21,650.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,041.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,041.81
Rate for Payer: Healthfirst Commercial	$9,884.00
Rate for Payer: Healthfirst Essential Plan	$40,594.07
Rate for Payer: Healthfirst QHP	$5,529.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,041.81
Rate for Payer: SOMOS Essential	$40,594.07
Rate for Payer: United Healthcare Essential Plan 1&2	$40,594.07
Rate for Payer: United Healthcare Essential Plan 3&4	$40,594.07
Rate for Payer: United Healthcare Medicaid	$18,041.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,041.81

BSS IO SOLN

Facility

$0.09

Service Code	NDC 0065079550
Hospital Charge Code	0065079550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

BSS IO SOLN

Facility

$0.09

Service Code	NDC 0065179504
Hospital Charge Code	0065179504
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
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	$0.06

BSS IO SOLN

Facility

$0.97

Service Code	NDC 0065079515
Hospital Charge Code	0065079515
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.66
Rate for Payer: EmblemHealth Commercial	$0.49
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.63

BSS IO SOLN

Facility

$0.09

Service Code	NDC 0065179504
Hospital Charge Code	0065179504
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

BSS IO SOLN

Facility

$0.09

Service Code	NDC 0065079550
Hospital Charge Code	0065079550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
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	$0.06

BSS IO SOLN

Facility

$0.97

Service Code	NDC 0065079515
Hospital Charge Code	0065079515
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49

BUDESONIDE 0.25 MG/2ML IN SUSP

Facility

$4.71

Service Code	HCPCS J7626
Hospital Charge Code	0093681573
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$3.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.20
Rate for Payer: EmblemHealth Commercial	$2.35
Rate for Payer: Group Health Inc Commercial	$2.35
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.35
Rate for Payer: Hamaspik Choice Inc Medicare	$2.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.06

BUDESONIDE 0.25 MG/2ML IN SUSP

Facility

$4.70

Service Code	HCPCS J7626
Hospital Charge Code	0093681555
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$3.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$3.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.20
Rate for Payer: EmblemHealth Commercial	$2.35
Rate for Payer: Group Health Inc Commercial	$2.35
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.35
Rate for Payer: Hamaspik Choice Inc Medicare	$2.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.06

BUDESONIDE 0.25 MG/2ML IN SUSP

Facility

$5.23

Service Code	HCPCS J7626
Hospital Charge Code	0186198804
Hospital Revenue Code	250
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$2.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.61

BUDESONIDE 0.25 MG/2ML IN SUSP

Facility

$4.71

Service Code	HCPCS J7626
Hospital Charge Code	0115168774
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$3.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.20
Rate for Payer: EmblemHealth Commercial	$2.35
Rate for Payer: Group Health Inc Commercial	$2.35
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.35
Rate for Payer: Hamaspik Choice Inc Medicare	$2.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.06

BUDESONIDE 0.25 MG/2ML IN SUSP

Facility

$4.71

Service Code	HCPCS J7626
Hospital Charge Code	0115168774
Hospital Revenue Code	250
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$2.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.35

BUDESONIDE 0.25 MG/2ML IN SUSP

Facility

$4.71

Service Code	HCPCS J7626
Hospital Charge Code	0093681573
Hospital Revenue Code	250
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$2.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.35

BUDESONIDE 0.25 MG/2ML IN SUSP

Facility

$5.23

Service Code	HCPCS J7626
Hospital Charge Code	0186198804
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$4.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$3.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.56
Rate for Payer: EmblemHealth Commercial	$2.61
Rate for Payer: Group Health Inc Commercial	$2.61
Rate for Payer: Group Health Inc Medicare	$1.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.61
Rate for Payer: Hamaspik Choice Inc Medicare	$2.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.40

BUDESONIDE 0.25 MG/2ML IN SUSP

Facility

$4.74

Service Code	HCPCS J7626
Hospital Charge Code	0487960101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$2.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.37

Know your out-of-pocket cost for care.

All Charges