St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HYDROCORTISONE 5 MG PO TABS

Facility

$1.95

Service Code	NDC 5026840511
Hospital Charge Code	5026840511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.98
Rate for Payer: Aetna Government	$0.98
Rate for Payer: Brighton Health Commercial	$1.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.33
Rate for Payer: EmblemHealth Commercial	$0.98
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.27

HYDROCORTISONE 5 MG PO TABS

Facility

$0.34

Service Code	NDC 0115169606
Hospital Charge Code	0115169606
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.23
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

HYDROCORTISONE 5 MG PO TABS

Facility

$0.34

Service Code	NDC 5976200731
Hospital Charge Code	5976200731
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

HYDROCORTISONE 5 MG PO TABS

Facility

$0.34

Service Code	NDC 5976200731
Hospital Charge Code	5976200731
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.23
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

HYDROCORTISONE 5 MG PO TABS

Facility

$1.95

Service Code	NDC 5026840511
Hospital Charge Code	5026840511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98

HYDROCORTISONE ACETATE 25 MG RE SUPP

Facility

$2.13

Service Code	NDC 3932802924
Hospital Charge Code	3932802924
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$1.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.45
Rate for Payer: EmblemHealth Commercial	$1.06
Rate for Payer: Group Health Inc Commercial	$1.06
Rate for Payer: Group Health Inc Medicare	$0.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.38

HYDROCORTISONE ACETATE 25 MG RE SUPP

Facility

$2.13

Service Code	NDC 3932802924
Hospital Charge Code	3932802924
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.06

HYDROCORTISONE ACETATE 25 MG RE SUPP

Facility

$73.25

Service Code	NDC 6564941124
Hospital Charge Code	6564941124
Hospital Revenue Code	250
Min. Negotiated Rate	$36.63
Max. Negotiated Rate	$36.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.63

HYDROCORTISONE ACETATE 25 MG RE SUPP

Facility

$22.65

Service Code	NDC 0713050312
Hospital Charge Code	0713050312
Hospital Revenue Code	250
Min. Negotiated Rate	$11.32
Max. Negotiated Rate	$11.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.32

HYDROCORTISONE ACETATE 25 MG RE SUPP

Facility

$14.43

Service Code	NDC 6936724312
Hospital Charge Code	6936724312
Hospital Revenue Code	250
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$11.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.21
Rate for Payer: Aetna Government	$7.21
Rate for Payer: Brighton Health Commercial	$10.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.81
Rate for Payer: EmblemHealth Commercial	$7.21
Rate for Payer: Group Health Inc Commercial	$7.21
Rate for Payer: Group Health Inc Medicare	$5.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.21
Rate for Payer: Hamaspik Choice Inc Medicare	$7.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.38

HYDROCORTISONE ACETATE 25 MG RE SUPP

Facility

$22.65

Service Code	NDC 0713050312
Hospital Charge Code	0713050312
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$18.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.32
Rate for Payer: Aetna Government	$11.32
Rate for Payer: Brighton Health Commercial	$16.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.40
Rate for Payer: EmblemHealth Commercial	$11.32
Rate for Payer: Group Health Inc Commercial	$11.32
Rate for Payer: Group Health Inc Medicare	$7.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.32
Rate for Payer: Hamaspik Choice Inc Medicare	$11.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.72

HYDROCORTISONE ACETATE 25 MG RE SUPP

Facility

$73.25

Service Code	NDC 6564941124
Hospital Charge Code	6564941124
Hospital Revenue Code	250
Min. Negotiated Rate	$25.64
Max. Negotiated Rate	$58.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.63
Rate for Payer: Aetna Government	$36.63
Rate for Payer: Brighton Health Commercial	$54.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.81
Rate for Payer: EmblemHealth Commercial	$36.63
Rate for Payer: Group Health Inc Commercial	$36.63
Rate for Payer: Group Health Inc Medicare	$25.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.63
Rate for Payer: Hamaspik Choice Inc Medicare	$36.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.62

HYDROCORTISONE ACETATE 25 MG RE SUPP

Facility

$14.43

Service Code	NDC 6936724312
Hospital Charge Code	6936724312
Hospital Revenue Code	250
Min. Negotiated Rate	$7.21
Max. Negotiated Rate	$7.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.21

HYDROCORTISONE (PERIANAL) 2.5 % EX CREA

Facility

$2.91

Service Code	NDC 6498032430
Hospital Charge Code	6498032430
Hospital Revenue Code	250
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46

HYDROCORTISONE (PERIANAL) 2.5 % EX CREA

Facility

$2.91

Service Code	NDC 6498032430
Hospital Charge Code	6498032430
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$2.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.46
Rate for Payer: Aetna Government	$1.46
Rate for Payer: Brighton Health Commercial	$2.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.98
Rate for Payer: EmblemHealth Commercial	$1.46
Rate for Payer: Group Health Inc Commercial	$1.46
Rate for Payer: Group Health Inc Medicare	$1.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.89

HYDROCORTISONE (PERIANAL) 2.5 % EX CREA

Facility

$3.00

Service Code	NDC 6931531228
Hospital Charge Code	6931531228
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50

HYDROCORTISONE (PERIANAL) 2.5 % EX CREA

Facility

$3.00

Service Code	NDC 6931531228
Hospital Charge Code	6931531228
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

HYDROCORTISONE (PERIANAL) 2.5 % EX CREA

Facility

$3.08

Service Code	NDC 1063140701
Hospital Charge Code	1063140701
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$2.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.54
Rate for Payer: Aetna Government	$1.54
Rate for Payer: Brighton Health Commercial	$2.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.09
Rate for Payer: EmblemHealth Commercial	$1.54
Rate for Payer: Group Health Inc Commercial	$1.54
Rate for Payer: Group Health Inc Medicare	$1.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.00

HYDROCORTISONE (PERIANAL) 2.5 % EX CREA

Facility

$3.08

Service Code	NDC 1063140701
Hospital Charge Code	1063140701
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.54

HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR

Facility

$18.12

Service Code	HCPCS J1720
Hospital Charge Code	0009082501
Hospital Revenue Code	250
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$21.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.81
Rate for Payer: Aetna Government	$14.81
Rate for Payer: Brighton Health Commercial	$13.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.32
Rate for Payer: EmblemHealth Commercial	$9.06
Rate for Payer: Group Health Inc Commercial	$9.06
Rate for Payer: Group Health Inc Medicare	$6.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.06
Rate for Payer: Hamaspik Choice Inc Medicare	$9.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.78

HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR

Facility

$24.48

Service Code	HCPCS J1720
Hospital Charge Code	0009001103
Hospital Revenue Code	250
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$12.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.24

HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR

Facility

$18.12

Service Code	HCPCS J1720
Hospital Charge Code	0009082501
Hospital Revenue Code	250
Min. Negotiated Rate	$9.06
Max. Negotiated Rate	$9.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.06

HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR

Facility

$24.49

Service Code	HCPCS J1720
Hospital Charge Code	0009001104
Hospital Revenue Code	250
Min. Negotiated Rate	$8.57
Max. Negotiated Rate	$21.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.81
Rate for Payer: Aetna Government	$14.81
Rate for Payer: Brighton Health Commercial	$18.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.65
Rate for Payer: EmblemHealth Commercial	$12.24
Rate for Payer: Group Health Inc Commercial	$12.24
Rate for Payer: Group Health Inc Medicare	$8.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.24
Rate for Payer: Hamaspik Choice Inc Medicare	$12.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.92

HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR

Facility

$24.49

Service Code	HCPCS J1720
Hospital Charge Code	0009001104
Hospital Revenue Code	250
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$12.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.24

HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR

Facility

$24.48

Service Code	HCPCS J1720
Hospital Charge Code	0009001103
Hospital Revenue Code	250
Min. Negotiated Rate	$8.57
Max. Negotiated Rate	$21.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.81
Rate for Payer: Aetna Government	$14.81
Rate for Payer: Brighton Health Commercial	$18.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.65
Rate for Payer: EmblemHealth Commercial	$12.24
Rate for Payer: Group Health Inc Commercial	$12.24
Rate for Payer: Group Health Inc Medicare	$8.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.24
Rate for Payer: Hamaspik Choice Inc Medicare	$12.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.91

Know your out-of-pocket cost for care.

All Charges