St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

IBUPROFEN 600 MG PO TABS

Facility

$0.36

Service Code	NDC 6068745711
Hospital Charge Code	6068745711
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.18
Rate for Payer: Aetna Government	$0.18
Rate for Payer: Brighton Health Commercial	$0.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.25
Rate for Payer: EmblemHealth Commercial	$0.18
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.24

IBUPROFEN 600 MG PO TABS

Facility

$0.52

Service Code	NDC 6787732001
Hospital Charge Code	6787732001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: EmblemHealth Commercial	$0.26
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.33

IBUPROFEN 600 MG PO TABS

Facility

$0.54

Service Code	NDC 4948360350
Hospital Charge Code	4948360350
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.43
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	$0.43
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	$0.35

IBUPROFEN 600 MG PO TABS

Facility

$0.54

Service Code	NDC 4948360350
Hospital Charge Code	4948360350
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

IBUPROFEN 600 MG PO TABS

Facility

$0.52

Service Code	NDC 6787732005
Hospital Charge Code	6787732005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: EmblemHealth Commercial	$0.26
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.33

IBUPROFEN 600 MG PO TABS

Facility

$0.55

Service Code	NDC 6516246550
Hospital Charge Code	6516246550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

IBUPROFEN 600 MG PO TABS

Facility

$0.31

Service Code	NDC 0904585461
Hospital Charge Code	0904585461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15

IBUPROFEN 600 MG PO TABS

Facility

$0.53

Service Code	NDC 6438080807
Hospital Charge Code	6438080807
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26

IBUPROFEN 600 MG PO TABS

Facility

$0.53

Service Code	NDC 5965136105
Hospital Charge Code	5965136105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: EmblemHealth Commercial	$0.26
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

IBUPROFEN 600 MG PO TABS

Facility

$0.52

Service Code	NDC 6787732005
Hospital Charge Code	6787732005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26

IBUPROFEN 600 MG PO TABS

Facility

$0.55

Service Code	NDC 6516246550
Hospital Charge Code	6516246550
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

IBUPROFEN 600 MG PO TABS

Facility

$0.52

Service Code	NDC 6787732001
Hospital Charge Code	6787732001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26

IBUPROFEN 600 MG PO TABS

Facility

$0.53

Service Code	NDC 6438080807
Hospital Charge Code	6438080807
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: EmblemHealth Commercial	$0.26
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

IBUPROFEN 600 MG PO TABS

Facility

$0.27

Service Code	NDC 0904585460
Hospital Charge Code	0904585460
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

IBUPROFEN 600 MG PO TABS

Facility

$0.27

Service Code	NDC 0904585460
Hospital Charge Code	0904585460
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14

IBUPROFEN 600 MG PO TABS

Facility

$0.31

Service Code	NDC 0904585461
Hospital Charge Code	0904585461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: EmblemHealth Commercial	$0.15
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

IBUPROFEN 800 MG/8ML IV SOLN

Facility

$3.70

Service Code	NDC 6622028708
Hospital Charge Code	6622028708
Hospital Revenue Code	258
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$2.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.85
Rate for Payer: Aetna Government	$1.85
Rate for Payer: Brighton Health Commercial	$2.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.52
Rate for Payer: EmblemHealth Commercial	$1.85
Rate for Payer: Group Health Inc Commercial	$1.85
Rate for Payer: Group Health Inc Medicare	$1.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.85
Rate for Payer: Hamaspik Choice Inc Medicare	$1.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.41

IBUPROFEN 800 MG/8ML IV SOLN

Facility

$3.70

Service Code	NDC 6622028708
Hospital Charge Code	6622028708
Hospital Revenue Code	258
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$1.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.85

IBUPROFEN LYSINE 10 MG/ML IV SOLN

Facility

$206.25

Service Code	NDC 3982210302
Hospital Charge Code	3982210302
Hospital Revenue Code	258
Min. Negotiated Rate	$103.12
Max. Negotiated Rate	$103.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.12

IBUPROFEN LYSINE 10 MG/ML IV SOLN

Facility

$206.25

Service Code	NDC 3982210302
Hospital Charge Code	3982210302
Hospital Revenue Code	258
Min. Negotiated Rate	$72.19
Max. Negotiated Rate	$165.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$113.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$103.12
Rate for Payer: Aetna Government	$103.12
Rate for Payer: Brighton Health Commercial	$154.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$165.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.25
Rate for Payer: EmblemHealth Commercial	$103.12
Rate for Payer: Group Health Inc Commercial	$103.12
Rate for Payer: Group Health Inc Medicare	$72.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.12
Rate for Payer: Hamaspik Choice Inc Medicare	$103.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$134.06

IBUPROFEN LYSINE 10 MG/ML IV SOLN

Facility

$206.25

Service Code	NDC 3982210301
Hospital Charge Code	3982210301
Hospital Revenue Code	258
Min. Negotiated Rate	$72.19
Max. Negotiated Rate	$165.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$113.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$103.12
Rate for Payer: Aetna Government	$103.12
Rate for Payer: Brighton Health Commercial	$154.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$165.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.25
Rate for Payer: EmblemHealth Commercial	$103.12
Rate for Payer: Group Health Inc Commercial	$103.12
Rate for Payer: Group Health Inc Medicare	$72.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.12
Rate for Payer: Hamaspik Choice Inc Medicare	$103.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$134.06

IBUPROFEN LYSINE 10 MG/ML IV SOLN

Facility

$273.74

Service Code	NDC 6699349036
Hospital Charge Code	6699349036
Hospital Revenue Code	258
Min. Negotiated Rate	$136.87
Max. Negotiated Rate	$136.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.87

IBUPROFEN LYSINE 10 MG/ML IV SOLN

Facility

$273.74

Service Code	NDC 6699349036
Hospital Charge Code	6699349036
Hospital Revenue Code	258
Min. Negotiated Rate	$95.81
Max. Negotiated Rate	$218.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$136.87
Rate for Payer: Aetna Government	$136.87
Rate for Payer: Brighton Health Commercial	$205.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$218.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.15
Rate for Payer: EmblemHealth Commercial	$136.87
Rate for Payer: Group Health Inc Commercial	$136.87
Rate for Payer: Group Health Inc Medicare	$95.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.87
Rate for Payer: Hamaspik Choice Inc Medicare	$136.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$177.93

IBUPROFEN LYSINE 10 MG/ML IV SOLN

Facility

$206.25

Service Code	NDC 3982210301
Hospital Charge Code	3982210301
Hospital Revenue Code	258
Min. Negotiated Rate	$103.12
Max. Negotiated Rate	$103.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.12

ICE IT REUSABLE COLD/C-PACK MISC

Facility

$7.57

Service Code	NDC 3870310120
Hospital Charge Code	3870310120
Hospital Revenue Code	250
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.79

Know your out-of-pocket cost for care.

All Charges