St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS

Facility

$1.69

Service Code	NDC 0527169501
Hospital Charge Code	0527169501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84

BUTAMBEN-TETRACAINE-BENZOCAINE 2-2-14 % EX AERO

Facility

$14.64

Service Code	NDC 1022302014
Hospital Charge Code	1022302014
Hospital Revenue Code	250
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$11.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.32
Rate for Payer: Aetna Government	$7.32
Rate for Payer: Brighton Health Commercial	$10.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.96
Rate for Payer: EmblemHealth Commercial	$7.32
Rate for Payer: Group Health Inc Commercial	$7.32
Rate for Payer: Group Health Inc Medicare	$5.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.32
Rate for Payer: Hamaspik Choice Inc Medicare	$7.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.52

BUTAMBEN-TETRACAINE-BENZOCAINE 2-2-14 % EX AERO

Facility

$14.64

Service Code	NDC 1022302014
Hospital Charge Code	1022302014
Hospital Revenue Code	250
Min. Negotiated Rate	$7.32
Max. Negotiated Rate	$7.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.32

BUTAMBEN-TETRACAINE-BENZOCAINE 2-2-14 % EX AERO

Facility

$7.14

Service Code	NDC 1022302013
Hospital Charge Code	1022302013
Hospital Revenue Code	250
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$3.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.57

BUTAMBEN-TETRACAINE-BENZOCAINE 2-2-14 % EX AERO

Facility

$7.14

Service Code	NDC 1022302013
Hospital Charge Code	1022302013
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$5.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.57
Rate for Payer: Aetna Government	$3.57
Rate for Payer: Brighton Health Commercial	$5.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.86
Rate for Payer: EmblemHealth Commercial	$3.57
Rate for Payer: Group Health Inc Commercial	$3.57
Rate for Payer: Group Health Inc Medicare	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.57
Rate for Payer: Hamaspik Choice Inc Medicare	$3.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.64

BUTORPHANOL TARTRATE 1 MG/ML IJ SOLN

Facility

$8.09

Service Code	HCPCS J0595
Hospital Charge Code	0409162301
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$6.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.94
Rate for Payer: Aetna Government	$2.94
Rate for Payer: Brighton Health Commercial	$6.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.50
Rate for Payer: EmblemHealth Commercial	$4.05
Rate for Payer: Group Health Inc Commercial	$4.05
Rate for Payer: Group Health Inc Medicare	$2.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.05
Rate for Payer: Hamaspik Choice Inc Medicare	$4.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.26

BUTORPHANOL TARTRATE 1 MG/ML IJ SOLN

Facility

$8.09

Service Code	HCPCS J0595
Hospital Charge Code	0409162301
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.05

BUTORPHANOL TARTRATE 2 MG/ML IJ SOLN

Facility

$9.90

Service Code	HCPCS J0595
Hospital Charge Code	0409162601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$7.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.94
Rate for Payer: Aetna Government	$2.94
Rate for Payer: Brighton Health Commercial	$7.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.73
Rate for Payer: EmblemHealth Commercial	$4.95
Rate for Payer: Group Health Inc Commercial	$4.95
Rate for Payer: Group Health Inc Medicare	$3.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.95
Rate for Payer: Hamaspik Choice Inc Medicare	$4.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.43

BUTORPHANOL TARTRATE 2 MG/ML IJ SOLN

Facility

$9.90

Service Code	HCPCS J0595
Hospital Charge Code	0409162601
Hospital Revenue Code	250
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.95

CABAZITAXEL 60 MG/1.5ML IV SOLN

Facility

$11.00

Service Code	HCPCS J9043
Hospital Charge Code	0024582411
Hospital Revenue Code	258
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50

CABAZITAXEL 60 MG/1.5ML IV SOLN

Facility

$11.00

Service Code	HCPCS J9043
Hospital Charge Code	0024582411
Hospital Revenue Code	258
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$231.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$227.28
Rate for Payer: Aetna Government	$227.28
Rate for Payer: Affinity Essential Plan 1&2	$159.10
Rate for Payer: Affinity Essential Plan 3&4	$159.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$159.10
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$227.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Elderplan Medicare Advantage	$227.28
Rate for Payer: EmblemHealth Commercial	$227.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$204.55
Rate for Payer: Fidelis Essential Plan Aliesa	$193.19
Rate for Payer: Fidelis Essential Plan QHP	$202.28
Rate for Payer: Fidelis Medicare Advantage	$227.28
Rate for Payer: Fidelis Qualified Health Plan	$202.28
Rate for Payer: Group Health Inc Commercial	$227.28
Rate for Payer: Group Health Inc Medicare	$227.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$227.28
Rate for Payer: Hamaspik Choice Inc Medicare	$227.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$227.28
Rate for Payer: Healthfirst Medicare Advantage	$193.19
Rate for Payer: Healthfirst QHP	$227.28
Rate for Payer: Humana Medicare	$231.83
Rate for Payer: Senior Whole Health Medicare Advantage	$227.28
Rate for Payer: United Healthcare Medicare Advantage	$227.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$215.92
Rate for Payer: Wellcare Medicare	$215.92

CABOTEGRAVIR ER 600 MG/3ML IM SUER

Facility

$1.00

Service Code	HCPCS J0739
Hospital Charge Code	4970226423
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

CABOTEGRAVIR ER 600 MG/3ML IM SUER

Facility

$1.00

Service Code	HCPCS J0739
Hospital Charge Code	4970226423
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$7.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.02
Rate for Payer: Aetna Government	$7.02
Rate for Payer: Affinity Essential Plan 1&2	$4.91
Rate for Payer: Affinity Essential Plan 3&4	$4.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.91
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$7.02
Rate for Payer: EmblemHealth Commercial	$7.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.32
Rate for Payer: Fidelis Essential Plan Aliesa	$5.97
Rate for Payer: Fidelis Essential Plan QHP	$6.25
Rate for Payer: Fidelis Medicare Advantage	$7.02
Rate for Payer: Fidelis Qualified Health Plan	$6.25
Rate for Payer: Group Health Inc Commercial	$7.02
Rate for Payer: Group Health Inc Medicare	$7.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.02
Rate for Payer: Hamaspik Choice Inc Medicare	$7.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.02
Rate for Payer: Healthfirst Medicare Advantage	$5.97
Rate for Payer: Healthfirst QHP	$7.02
Rate for Payer: Humana Medicare	$7.16
Rate for Payer: Senior Whole Health Medicare Advantage	$7.02
Rate for Payer: United Healthcare Medicare Advantage	$7.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.67
Rate for Payer: Wellcare Medicare	$6.67

CABOTEGRAVIR & RILPIVIRINE ER 400 & 600 MG/2ML IM SUER

Facility

$1.00

Service Code	HCPCS J0741
Hospital Charge Code	4970225315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$24.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.65
Rate for Payer: Aetna Government	$23.65
Rate for Payer: Affinity Essential Plan 1&2	$16.55
Rate for Payer: Affinity Essential Plan 3&4	$16.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$16.55
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$23.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$23.65
Rate for Payer: EmblemHealth Commercial	$23.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21.29
Rate for Payer: Fidelis Essential Plan Aliesa	$20.10
Rate for Payer: Fidelis Essential Plan QHP	$21.05
Rate for Payer: Fidelis Medicare Advantage	$23.65
Rate for Payer: Fidelis Qualified Health Plan	$21.05
Rate for Payer: Group Health Inc Commercial	$23.65
Rate for Payer: Group Health Inc Medicare	$23.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.65
Rate for Payer: Hamaspik Choice Inc Medicare	$23.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23.65
Rate for Payer: Healthfirst Medicare Advantage	$20.10
Rate for Payer: Healthfirst QHP	$23.65
Rate for Payer: Humana Medicare	$24.12
Rate for Payer: Senior Whole Health Medicare Advantage	$23.65
Rate for Payer: United Healthcare Medicare Advantage	$23.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22.47
Rate for Payer: Wellcare Medicare	$22.47

CABOTEGRAVIR & RILPIVIRINE ER 400 & 600 MG/2ML IM SUER

Facility

$1.00

Service Code	HCPCS J0741
Hospital Charge Code	4970225315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

CABOTEGRAVIR & RILPIVIRINE ER 600 & 900 MG/3ML IM SUER

Facility

$1.00

Service Code	HCPCS J0741
Hospital Charge Code	4970224015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

CABOTEGRAVIR & RILPIVIRINE ER 600 & 900 MG/3ML IM SUER

Facility

$1.00

Service Code	HCPCS J0741
Hospital Charge Code	4970224015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$24.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.65
Rate for Payer: Aetna Government	$23.65
Rate for Payer: Affinity Essential Plan 1&2	$16.55
Rate for Payer: Affinity Essential Plan 3&4	$16.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$16.55
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$23.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$23.65
Rate for Payer: EmblemHealth Commercial	$23.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21.29
Rate for Payer: Fidelis Essential Plan Aliesa	$20.10
Rate for Payer: Fidelis Essential Plan QHP	$21.05
Rate for Payer: Fidelis Medicare Advantage	$23.65
Rate for Payer: Fidelis Qualified Health Plan	$21.05
Rate for Payer: Group Health Inc Commercial	$23.65
Rate for Payer: Group Health Inc Medicare	$23.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.65
Rate for Payer: Hamaspik Choice Inc Medicare	$23.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23.65
Rate for Payer: Healthfirst Medicare Advantage	$20.10
Rate for Payer: Healthfirst QHP	$23.65
Rate for Payer: Humana Medicare	$24.12
Rate for Payer: Senior Whole Health Medicare Advantage	$23.65
Rate for Payer: United Healthcare Medicare Advantage	$23.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22.47
Rate for Payer: Wellcare Medicare	$22.47

CAFFEINE CITRATE 20 MG/ML PO SOLN

Facility

$16.15

Service Code	NDC 6332340603
Hospital Charge Code	6332340603
Hospital Revenue Code	250
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$12.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.07
Rate for Payer: Aetna Government	$8.07
Rate for Payer: Brighton Health Commercial	$12.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.98
Rate for Payer: EmblemHealth Commercial	$8.07
Rate for Payer: Group Health Inc Commercial	$8.07
Rate for Payer: Group Health Inc Medicare	$5.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.07
Rate for Payer: Hamaspik Choice Inc Medicare	$8.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.50

CAFFEINE CITRATE 20 MG/ML PO SOLN

Facility

$7.96

Service Code	NDC 7248511010
Hospital Charge Code	7248511010
Hospital Revenue Code	250
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$3.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.98

CAFFEINE CITRATE 20 MG/ML PO SOLN

Facility

$7.96

Service Code	NDC 7248511010
Hospital Charge Code	7248511010
Hospital Revenue Code	250
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$6.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.98
Rate for Payer: Aetna Government	$3.98
Rate for Payer: Brighton Health Commercial	$5.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.41
Rate for Payer: EmblemHealth Commercial	$3.98
Rate for Payer: Group Health Inc Commercial	$3.98
Rate for Payer: Group Health Inc Medicare	$2.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.98
Rate for Payer: Hamaspik Choice Inc Medicare	$3.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.17

CAFFEINE CITRATE 20 MG/ML PO SOLN

Facility

$16.15

Service Code	NDC 6332340603
Hospital Charge Code	6332340603
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.07

CAFFEINE CITRATE 20 MG/ML PO SOLN

Facility

$8.00

Service Code	NDC 2502160203
Hospital Charge Code	2502160203
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.00
Rate for Payer: Aetna Government	$4.00
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.44
Rate for Payer: EmblemHealth Commercial	$4.00
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

CAFFEINE CITRATE 20 MG/ML PO SOLN

Facility

$8.00

Service Code	NDC 2502160203
Hospital Charge Code	2502160203
Hospital Revenue Code	250
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00

CAFFEINE CITRATE 60 MG/3ML IV SOLN

Facility

$4.80

Service Code	NDC 5175405001
Hospital Charge Code	5175405001
Hospital Revenue Code	258
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40

CAFFEINE CITRATE 60 MG/3ML IV SOLN

Facility

$3.26

Service Code	NDC 6332340704
Hospital Charge Code	6332340704
Hospital Revenue Code	258
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$1.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.63

Know your out-of-pocket cost for care.

All Charges