St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ISOSORBIDE MONONITRATE ER 60 MG PO TB24

Facility

$2.03

Service Code	NDC 0904645061
Hospital Charge Code	0904645061
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.01

ISOSORBIDE MONONITRATE ER 60 MG PO TB24

Facility

$2.03

Service Code	NDC 0904645061
Hospital Charge Code	0904645061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.01
Rate for Payer: Aetna Government	$1.01
Rate for Payer: Brighton Health Commercial	$1.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.38
Rate for Payer: EmblemHealth Commercial	$1.01
Rate for Payer: Group Health Inc Commercial	$1.01
Rate for Payer: Group Health Inc Medicare	$0.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.01
Rate for Payer: Hamaspik Choice Inc Medicare	$1.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.32

ISOSORBIDE MONONITRATE ER 60 MG PO TB24

Facility

$1.43

Service Code	NDC 2315517801
Hospital Charge Code	2315517801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.71
Rate for Payer: Aetna Government	$0.71
Rate for Payer: Brighton Health Commercial	$1.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: EmblemHealth Commercial	$0.71
Rate for Payer: Group Health Inc Commercial	$0.71
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71
Rate for Payer: Hamaspik Choice Inc Medicare	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.93

ITRACONAZOLE 100 MG PO CAPS

Facility

$4.00

Service Code	NDC 6068729925
Hospital Charge Code	6068729925
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: EmblemHealth Commercial	$2.00
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

ITRACONAZOLE 100 MG PO CAPS

Facility

$5.66

Service Code	NDC 5026845012
Hospital Charge Code	5026845012
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83

ITRACONAZOLE 100 MG PO CAPS

Facility

$4.00

Service Code	NDC 6068729925
Hospital Charge Code	6068729925
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00

ITRACONAZOLE 100 MG PO CAPS

Facility

$5.66

Service Code	NDC 5026845012
Hospital Charge Code	5026845012
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$4.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.83
Rate for Payer: Aetna Government	$2.83
Rate for Payer: Brighton Health Commercial	$4.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.85
Rate for Payer: EmblemHealth Commercial	$2.83
Rate for Payer: Group Health Inc Commercial	$2.83
Rate for Payer: Group Health Inc Medicare	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83
Rate for Payer: Hamaspik Choice Inc Medicare	$2.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.68

ITRACONAZOLE 10 MG/ML PO SOLN

Facility

$2.47

Service Code	NDC 3172200631
Hospital Charge Code	3172200631
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.23
Rate for Payer: Aetna Government	$1.23
Rate for Payer: Brighton Health Commercial	$1.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.68
Rate for Payer: EmblemHealth Commercial	$1.23
Rate for Payer: Group Health Inc Commercial	$1.23
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23
Rate for Payer: Hamaspik Choice Inc Medicare	$1.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.60

ITRACONAZOLE 10 MG/ML PO SOLN

Facility

$2.47

Service Code	NDC 3172200631
Hospital Charge Code	3172200631
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23

IVERMECTIN 3 MG PO TABS

Facility

$4.97

Service Code	NDC 4279980601
Hospital Charge Code	4279980601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$3.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.48
Rate for Payer: Aetna Government	$2.48
Rate for Payer: Brighton Health Commercial	$3.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.38
Rate for Payer: EmblemHealth Commercial	$2.48
Rate for Payer: Group Health Inc Commercial	$2.48
Rate for Payer: Group Health Inc Medicare	$1.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.48
Rate for Payer: Hamaspik Choice Inc Medicare	$2.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.23

IVERMECTIN 3 MG PO TABS

Facility

$2.87

Service Code	NDC 7590716710
Hospital Charge Code	7590716710
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.44

IVERMECTIN 3 MG PO TABS

Facility

$5.58

Service Code	NDC 0006003220
Hospital Charge Code	0006003220
Hospital Revenue Code	250
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$2.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.79

IVERMECTIN 3 MG PO TABS

Facility

$4.97

Service Code	NDC 4279980601
Hospital Charge Code	4279980601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$2.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.48

IVERMECTIN 3 MG PO TABS

Facility

$2.87

Service Code	NDC 7590716710
Hospital Charge Code	7590716710
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.44
Rate for Payer: Aetna Government	$1.44
Rate for Payer: Brighton Health Commercial	$2.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.95
Rate for Payer: EmblemHealth Commercial	$1.44
Rate for Payer: Group Health Inc Commercial	$1.44
Rate for Payer: Group Health Inc Medicare	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.87

IVERMECTIN 3 MG PO TABS

Facility

$5.58

Service Code	NDC 0006003220
Hospital Charge Code	0006003220
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$4.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.79
Rate for Payer: Aetna Government	$2.79
Rate for Payer: Brighton Health Commercial	$4.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.80
Rate for Payer: EmblemHealth Commercial	$2.79
Rate for Payer: Group Health Inc Commercial	$2.79
Rate for Payer: Group Health Inc Medicare	$1.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.63

JESSNERS EX SOLN

Facility

$0.29

Service Code	NDC 5155286506
Hospital Charge Code	5155286506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14

JESSNERS EX SOLN

Facility

$0.29

Service Code	NDC 5155286506
Hospital Charge Code	5155286506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
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	$0.19

KCL (0.149%) IN NACL 20-0.45 MEQ/L-% IV SOLN

Facility

$0.01

Service Code	NDC 0990925739
Hospital Charge Code	0990925739
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

KCL (0.149%) IN NACL 20-0.45 MEQ/L-% IV SOLN

Facility

$0.01

Service Code	NDC 0990925739
Hospital Charge Code	0990925739
Hospital Revenue Code	258
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN

Facility

$0.01

Service Code	NDC 0338066904
Hospital Charge Code	0338066904
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN

Facility

$0.01

Service Code	NDC 0338066904
Hospital Charge Code	0338066904
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

KCL IN DEXTROSE-NACL 20-5-0.2 MEQ/L-%-% IV SOLN

Facility

$0.01

Service Code	NDC 0338066304
Hospital Charge Code	0338066304
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

KCL IN DEXTROSE-NACL 20-5-0.2 MEQ/L-%-% IV SOLN

Facility

$0.01

Service Code	NDC 0338066304
Hospital Charge Code	0338066304
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN

Facility

$0.01

Service Code	NDC 0264763500
Hospital Charge Code	0264763500
Hospital Revenue Code	258
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN

Facility

$0.01

Service Code	NDC 0264763500
Hospital Charge Code	0264763500
Hospital Revenue Code	258
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

Know your out-of-pocket cost for care.

All Charges