St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LABETALOL HCL 5 MG/ML IV SOLN

Facility

$0.42

Service Code	HCPCS J1920
Hospital Charge Code	0143962201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: EmblemHealth Commercial	$0.21
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

LABETALOL HCL 5 MG/ML IV SOLN

Facility

$0.42

Service Code	HCPCS J1920
Hospital Charge Code	0143962201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21

LABETALOL HCL 5 MG/ML IV SOLN

Facility

$0.18

Service Code	HCPCS J1920
Hospital Charge Code	0143932001
Hospital Revenue Code	258
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

LABETALOL HCL 5 MG/ML IV SOLN

Facility

$1.27

Service Code	HCPCS J1920
Hospital Charge Code	3600032001
Hospital Revenue Code	258
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$1.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: EmblemHealth Commercial	$0.63
Rate for Payer: Group Health Inc Commercial	$0.63
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.82

LABETALOL HCL 5 MG/ML IV SOLN

Facility

$0.48

Service Code	HCPCS J1920
Hospital Charge Code	7226610201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: EmblemHealth Commercial	$0.24
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

LABETALOL HCL 5 MG/ML IV SOLN

Facility

$0.42

Service Code	HCPCS J1920
Hospital Charge Code	0143962301
Hospital Revenue Code	258
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: EmblemHealth Commercial	$0.21
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

LABETALOL HCL 5 MG/ML IV SOLN

Facility

$0.42

Service Code	HCPCS J1920
Hospital Charge Code	0143962301
Hospital Revenue Code	258
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21

LABETALOL HCL 5 MG/ML IV SOLN

Facility

$0.22

Service Code	HCPCS J1920
Hospital Charge Code	2502131720
Hospital Revenue Code	258
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: EmblemHealth Commercial	$0.11
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

LABOR AND DELIVERY RELATED DIAGNOSES

Facility

$201.75

Service Code	EAPG 00760
Min. Negotiated Rate	$145.80
Max. Negotiated Rate	$201.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$145.80
Rate for Payer: Healthfirst Commercial	$201.75

LACOSAMIDE 100 MG PO TABS

Facility

$3.69

Service Code	NDC 6068768711
Hospital Charge Code	6068768711
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$1.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.84

LACOSAMIDE 100 MG PO TABS

Facility

$3.69

Service Code	NDC 6068768711
Hospital Charge Code	6068768711
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$2.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.84
Rate for Payer: Aetna Government	$1.84
Rate for Payer: Brighton Health Commercial	$2.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.51
Rate for Payer: EmblemHealth Commercial	$1.84
Rate for Payer: Group Health Inc Commercial	$1.84
Rate for Payer: Group Health Inc Medicare	$1.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.84
Rate for Payer: Hamaspik Choice Inc Medicare	$1.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.40

LACOSAMIDE 100 MG PO TABS

Facility

$2.46

Service Code	NDC 0904724568
Hospital Charge Code	0904724568
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.35
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	$1.67
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

LACOSAMIDE 100 MG PO TABS

Facility

$24.31

Service Code	NDC 0131247860
Hospital Charge Code	0131247860
Hospital Revenue Code	250
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$19.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.15
Rate for Payer: Aetna Government	$12.15
Rate for Payer: Brighton Health Commercial	$18.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.53
Rate for Payer: EmblemHealth Commercial	$12.15
Rate for Payer: Group Health Inc Commercial	$12.15
Rate for Payer: Group Health Inc Medicare	$8.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.15
Rate for Payer: Hamaspik Choice Inc Medicare	$12.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.80

LACOSAMIDE 100 MG PO TABS

Facility

$16.81

Service Code	NDC 6233217260
Hospital Charge Code	6233217260
Hospital Revenue Code	250
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$13.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.40
Rate for Payer: Aetna Government	$8.40
Rate for Payer: Brighton Health Commercial	$12.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.43
Rate for Payer: EmblemHealth Commercial	$8.40
Rate for Payer: Group Health Inc Commercial	$8.40
Rate for Payer: Group Health Inc Medicare	$5.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.40
Rate for Payer: Hamaspik Choice Inc Medicare	$8.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.93

LACOSAMIDE 100 MG PO TABS

Facility

$2.46

Service Code	NDC 0904724568
Hospital Charge Code	0904724568
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23

LACOSAMIDE 100 MG PO TABS

Facility

$24.31

Service Code	NDC 0131247860
Hospital Charge Code	0131247860
Hospital Revenue Code	250
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.15

LACOSAMIDE 100 MG PO TABS

Facility

$16.81

Service Code	NDC 6233217260
Hospital Charge Code	6233217260
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.40

LACOSAMIDE 150 MG PO TABS

Facility

$2.95

Service Code	NDC 0904724668
Hospital Charge Code	0904724668
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$1.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.48

LACOSAMIDE 150 MG PO TABS

Facility

$18.82

Service Code	NDC 6787773560
Hospital Charge Code	6787773560
Hospital Revenue Code	250
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$15.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.41
Rate for Payer: Aetna Government	$9.41
Rate for Payer: Brighton Health Commercial	$14.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.80
Rate for Payer: EmblemHealth Commercial	$9.41
Rate for Payer: Group Health Inc Commercial	$9.41
Rate for Payer: Group Health Inc Medicare	$6.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.41
Rate for Payer: Hamaspik Choice Inc Medicare	$9.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.23

LACOSAMIDE 150 MG PO TABS

Facility

$17.80

Service Code	NDC 6233217360
Hospital Charge Code	6233217360
Hospital Revenue Code	250
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$14.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.90
Rate for Payer: Aetna Government	$8.90
Rate for Payer: Brighton Health Commercial	$13.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.11
Rate for Payer: EmblemHealth Commercial	$8.90
Rate for Payer: Group Health Inc Commercial	$8.90
Rate for Payer: Group Health Inc Medicare	$6.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.90
Rate for Payer: Hamaspik Choice Inc Medicare	$8.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.57

LACOSAMIDE 150 MG PO TABS

Facility

$2.95

Service Code	NDC 0904724668
Hospital Charge Code	0904724668
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.48
Rate for Payer: Aetna Government	$1.48
Rate for Payer: Brighton Health Commercial	$2.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.01
Rate for Payer: EmblemHealth Commercial	$1.48
Rate for Payer: Group Health Inc Commercial	$1.48
Rate for Payer: Group Health Inc Medicare	$1.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.48
Rate for Payer: Hamaspik Choice Inc Medicare	$1.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.92

LACOSAMIDE 150 MG PO TABS

Facility

$17.80

Service Code	NDC 6233217360
Hospital Charge Code	6233217360
Hospital Revenue Code	250
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$8.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.90

LACOSAMIDE 150 MG PO TABS

Facility

$18.82

Service Code	NDC 6787773560
Hospital Charge Code	6787773560
Hospital Revenue Code	250
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$9.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.41

LACOSAMIDE 150 MG PO TABS

Facility

$25.74

Service Code	NDC 0131247960
Hospital Charge Code	0131247960
Hospital Revenue Code	250
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$20.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.87
Rate for Payer: Aetna Government	$12.87
Rate for Payer: Brighton Health Commercial	$19.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.51
Rate for Payer: EmblemHealth Commercial	$12.87
Rate for Payer: Group Health Inc Commercial	$12.87
Rate for Payer: Group Health Inc Medicare	$9.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.87
Rate for Payer: Hamaspik Choice Inc Medicare	$12.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.73

LACOSAMIDE 150 MG PO TABS

Facility

$25.74

Service Code	NDC 0131247960
Hospital Charge Code	0131247960
Hospital Revenue Code	250
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$12.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.87

Know your out-of-pocket cost for care.

All Charges