St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LACOSAMIDE 200 MG/20ML IV SOLN

Facility

$4.71

Service Code	NDC 6954345520
Hospital Charge Code	6954345520
Hospital Revenue Code	258
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$2.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.36

LACOSAMIDE 200 MG/20ML IV SOLN

Facility

$5.80

Service Code	NDC 0131181067
Hospital Charge Code	0131181067
Hospital Revenue Code	258
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$4.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.90
Rate for Payer: Aetna Government	$2.90
Rate for Payer: Brighton Health Commercial	$4.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.94
Rate for Payer: EmblemHealth Commercial	$2.90
Rate for Payer: Group Health Inc Commercial	$2.90
Rate for Payer: Group Health Inc Medicare	$2.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.90
Rate for Payer: Hamaspik Choice Inc Medicare	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.77

LACOSAMIDE 200 MG/20ML IV SOLN

Facility

$4.71

Service Code	NDC 6954345520
Hospital Charge Code	6954345520
Hospital Revenue Code	258
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.36
Rate for Payer: Aetna Government	$2.36
Rate for Payer: Brighton Health Commercial	$3.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.20
Rate for Payer: EmblemHealth Commercial	$2.36
Rate for Payer: Group Health Inc Commercial	$2.36
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.36
Rate for Payer: Hamaspik Choice Inc Medicare	$2.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.06

LACOSAMIDE 200 MG/20ML IV SOLN

Facility

$6.97

Service Code	NDC 7006947101
Hospital Charge Code	7006947101
Hospital Revenue Code	258
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$5.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.49
Rate for Payer: Aetna Government	$3.49
Rate for Payer: Brighton Health Commercial	$5.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.74
Rate for Payer: EmblemHealth Commercial	$3.49
Rate for Payer: Group Health Inc Commercial	$3.49
Rate for Payer: Group Health Inc Medicare	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.49
Rate for Payer: Hamaspik Choice Inc Medicare	$3.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.53

LACOSAMIDE 200 MG/20ML IV SOLN

Facility

$3.60

Service Code	NDC 7226624201
Hospital Charge Code	7226624201
Hospital Revenue Code	258
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80

LACOSAMIDE 200 MG/20ML IV SOLN

Facility

$3.93

Service Code	NDC 2502179120
Hospital Charge Code	2502179120
Hospital Revenue Code	258
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$1.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.96

LACOSAMIDE 200 MG/20ML IV SOLN

Facility

$3.60

Service Code	NDC 7226624201
Hospital Charge Code	7226624201
Hospital Revenue Code	258
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.80
Rate for Payer: Aetna Government	$1.80
Rate for Payer: Brighton Health Commercial	$2.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.45
Rate for Payer: EmblemHealth Commercial	$1.80
Rate for Payer: Group Health Inc Commercial	$1.80
Rate for Payer: Group Health Inc Medicare	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.34

LACOSAMIDE 200 MG/20ML IV SOLN

Facility

$5.80

Service Code	NDC 0131181067
Hospital Charge Code	0131181067
Hospital Revenue Code	258
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.90

LACOSAMIDE 200 MG/20ML IV SOLN

Facility

$3.93

Service Code	NDC 2502179120
Hospital Charge Code	2502179120
Hospital Revenue Code	258
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$3.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.96
Rate for Payer: Aetna Government	$1.96
Rate for Payer: Brighton Health Commercial	$2.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.67
Rate for Payer: EmblemHealth Commercial	$1.96
Rate for Payer: Group Health Inc Commercial	$1.96
Rate for Payer: Group Health Inc Medicare	$1.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.96
Rate for Payer: Hamaspik Choice Inc Medicare	$1.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.55

LACOSAMIDE 200 MG/20ML IV SOLN

Facility

$6.97

Service Code	NDC 7006947101
Hospital Charge Code	7006947101
Hospital Revenue Code	258
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$3.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.49

LACOSAMIDE 50 MG PO TABS

Facility

$10.75

Service Code	NDC 6233217160
Hospital Charge Code	6233217160
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$8.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.38
Rate for Payer: Aetna Government	$5.38
Rate for Payer: Brighton Health Commercial	$8.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.31
Rate for Payer: EmblemHealth Commercial	$5.38
Rate for Payer: Group Health Inc Commercial	$5.38
Rate for Payer: Group Health Inc Medicare	$3.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.38
Rate for Payer: Hamaspik Choice Inc Medicare	$5.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.99

LACOSAMIDE 50 MG PO TABS

Facility

$10.75

Service Code	NDC 6233217160
Hospital Charge Code	6233217160
Hospital Revenue Code	250
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$5.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.38

LACOSAMIDE 50 MG PO TABS

Facility

$1.48

Service Code	NDC 0904724468
Hospital Charge Code	0904724468
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.74
Rate for Payer: Aetna Government	$0.74
Rate for Payer: Brighton Health Commercial	$1.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.00
Rate for Payer: EmblemHealth Commercial	$0.74
Rate for Payer: Group Health Inc Commercial	$0.74
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.74
Rate for Payer: Hamaspik Choice Inc Medicare	$0.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.96

LACOSAMIDE 50 MG PO TABS

Facility

$15.55

Service Code	NDC 0131247760
Hospital Charge Code	0131247760
Hospital Revenue Code	250
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$12.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.77
Rate for Payer: Aetna Government	$7.77
Rate for Payer: Brighton Health Commercial	$11.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.57
Rate for Payer: EmblemHealth Commercial	$7.77
Rate for Payer: Group Health Inc Commercial	$7.77
Rate for Payer: Group Health Inc Medicare	$5.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.77
Rate for Payer: Hamaspik Choice Inc Medicare	$7.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.11

LACOSAMIDE 50 MG PO TABS

Facility

$1.48

Service Code	NDC 0904724468
Hospital Charge Code	0904724468
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$0.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.74

LACOSAMIDE 50 MG PO TABS

Facility

$11.37

Service Code	NDC 6787773360
Hospital Charge Code	6787773360
Hospital Revenue Code	250
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$5.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.68

LACOSAMIDE 50 MG PO TABS

Facility

$11.37

Service Code	NDC 6787773360
Hospital Charge Code	6787773360
Hospital Revenue Code	250
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$9.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.68
Rate for Payer: Aetna Government	$5.68
Rate for Payer: Brighton Health Commercial	$8.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.73
Rate for Payer: EmblemHealth Commercial	$5.68
Rate for Payer: Group Health Inc Commercial	$5.68
Rate for Payer: Group Health Inc Medicare	$3.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.68
Rate for Payer: Hamaspik Choice Inc Medicare	$5.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.39

LACOSAMIDE 50 MG PO TABS

Facility

$14.13

Service Code	NDC 0131247735
Hospital Charge Code	0131247735
Hospital Revenue Code	250
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$7.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.07

LACOSAMIDE 50 MG PO TABS

Facility

$14.13

Service Code	NDC 0131247735
Hospital Charge Code	0131247735
Hospital Revenue Code	250
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$11.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.07
Rate for Payer: Aetna Government	$7.07
Rate for Payer: Brighton Health Commercial	$10.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.61
Rate for Payer: EmblemHealth Commercial	$7.07
Rate for Payer: Group Health Inc Commercial	$7.07
Rate for Payer: Group Health Inc Medicare	$4.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.07
Rate for Payer: Hamaspik Choice Inc Medicare	$7.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.19

LACOSAMIDE 50 MG PO TABS

Facility

$15.55

Service Code	NDC 0131247760
Hospital Charge Code	0131247760
Hospital Revenue Code	250
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$7.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.77

LACOSAMIDE IN NACL 100MG/100 ML PREMIX

Facility

$5.80

Service Code	NDC 9999123498
Hospital Charge Code	9999123498
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.90

LACOSAMIDE IN NACL 100MG/100 ML PREMIX

Facility

$5.80

Service Code	NDC 9999123498
Hospital Charge Code	9999123498
Hospital Revenue Code	250
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$4.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.90
Rate for Payer: Aetna Government	$2.90
Rate for Payer: Brighton Health Commercial	$4.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.94
Rate for Payer: EmblemHealth Commercial	$2.90
Rate for Payer: Group Health Inc Commercial	$2.90
Rate for Payer: Group Health Inc Medicare	$2.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.90
Rate for Payer: Hamaspik Choice Inc Medicare	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.77

LACOSAMIDE IN NACL 200MG/100 ML PREMIX

Facility

$5.80

Service Code	NDC 9999123501
Hospital Charge Code	9999123501
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.90

LACOSAMIDE IN NACL 200MG/100 ML PREMIX

Facility

$5.80

Service Code	NDC 9999123501
Hospital Charge Code	9999123501
Hospital Revenue Code	250
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$4.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.90
Rate for Payer: Aetna Government	$2.90
Rate for Payer: Brighton Health Commercial	$4.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.94
Rate for Payer: EmblemHealth Commercial	$2.90
Rate for Payer: Group Health Inc Commercial	$2.90
Rate for Payer: Group Health Inc Medicare	$2.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.90
Rate for Payer: Hamaspik Choice Inc Medicare	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.77

LACTATED RINGERS IV BOLUS

Facility

$0.01

Service Code	HCPCS J7120
Hospital Charge Code	0338011704
Hospital Revenue Code	258
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

Know your out-of-pocket cost for care.

All Charges