St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE VISCOUS HCL 2 % MT SOLN

Facility

$0.31

Service Code	NDC 0121090315
Hospital Charge Code	0121090315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: EmblemHealth Commercial	$0.16
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

LIDOCAINE VISCOUS HCL 2 % MT SOLN

Facility

$0.31

Service Code	NDC 0121090315
Hospital Charge Code	0121090315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16

LINDANE 1 % EX SHAM

Facility

$2.28

Service Code	NDC 6043283460
Hospital Charge Code	6043283460
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.14
Rate for Payer: Aetna Government	$1.14
Rate for Payer: Brighton Health Commercial	$1.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.55
Rate for Payer: EmblemHealth Commercial	$1.14
Rate for Payer: Group Health Inc Commercial	$1.14
Rate for Payer: Group Health Inc Medicare	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.48

LINDANE 1 % EX SHAM

Facility

$2.28

Service Code	NDC 6043283460
Hospital Charge Code	6043283460
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14

LINEZOLID 100 MG/5ML PO SUSR

Facility

$5.46

Service Code	NDC 0009513601
Hospital Charge Code	0009513601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$4.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.73
Rate for Payer: Aetna Government	$2.73
Rate for Payer: Brighton Health Commercial	$4.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.71
Rate for Payer: EmblemHealth Commercial	$2.73
Rate for Payer: Group Health Inc Commercial	$2.73
Rate for Payer: Group Health Inc Medicare	$1.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.73
Rate for Payer: Hamaspik Choice Inc Medicare	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.55

LINEZOLID 100 MG/5ML PO SUSR

Facility

$5.47

Service Code	NDC 5976213081
Hospital Charge Code	5976213081
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$4.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.73
Rate for Payer: Aetna Government	$2.73
Rate for Payer: Brighton Health Commercial	$4.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.72
Rate for Payer: EmblemHealth Commercial	$2.73
Rate for Payer: Group Health Inc Commercial	$2.73
Rate for Payer: Group Health Inc Medicare	$1.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.73
Rate for Payer: Hamaspik Choice Inc Medicare	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.55

LINEZOLID 100 MG/5ML PO SUSR

Facility

$5.47

Service Code	NDC 5976213081
Hospital Charge Code	5976213081
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$2.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.73

LINEZOLID 100 MG/5ML PO SUSR

Facility

$5.46

Service Code	NDC 0009513601
Hospital Charge Code	0009513601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$2.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.73

LINEZOLID 600 MG/300ML IV SOLN

Facility

$0.13

Service Code	HCPCS J2020
Hospital Charge Code	0009514004
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$6.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.62
Rate for Payer: Aetna Government	$6.62
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

LINEZOLID 600 MG/300ML IV SOLN

Facility

$0.26

Service Code	HCPCS J2020
Hospital Charge Code	0781343395
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

LINEZOLID 600 MG/300ML IV SOLN

Facility

$0.26

Service Code	HCPCS J2020
Hospital Charge Code	0781343346
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

LINEZOLID 600 MG/300ML IV SOLN

Facility

$0.26

Service Code	HCPCS J2020
Hospital Charge Code	0781343346
Hospital Revenue Code	258
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$6.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.62
Rate for Payer: Aetna Government	$6.62
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

LINEZOLID 600 MG/300ML IV SOLN

Facility

$0.37

Service Code	HCPCS J2020
Hospital Charge Code	5515024251
Hospital Revenue Code	258
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18

LINEZOLID 600 MG/300ML IV SOLN

Facility

$0.37

Service Code	HCPCS J2020
Hospital Charge Code	5515024251
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$6.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.62
Rate for Payer: Aetna Government	$6.62
Rate for Payer: Brighton Health Commercial	$0.28
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: Healthfirst CHP/FHP/Medicaid	$3.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.24

LINEZOLID 600 MG/300ML IV SOLN

Facility

$0.13

Service Code	HCPCS J2020
Hospital Charge Code	0009514001
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$6.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.62
Rate for Payer: Aetna Government	$6.62
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

LINEZOLID 600 MG/300ML IV SOLN

Facility

$0.13

Service Code	HCPCS J2020
Hospital Charge Code	0009514004
Hospital Revenue Code	258
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

LINEZOLID 600 MG/300ML IV SOLN

Facility

$0.13

Service Code	HCPCS J2020
Hospital Charge Code	0009514001
Hospital Revenue Code	258
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

LINEZOLID 600 MG/300ML IV SOLN

Facility

$0.26

Service Code	HCPCS J2020
Hospital Charge Code	0781343395
Hospital Revenue Code	258
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$6.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.62
Rate for Payer: Aetna Government	$6.62
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

LINEZOLID 600 MG/300ML IV SOLN

Facility

$0.26

Service Code	HCPCS J2020
Hospital Charge Code	5766468357
Hospital Revenue Code	258
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$6.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.62
Rate for Payer: Aetna Government	$6.62
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

LINEZOLID 600 MG/300ML IV SOLN

Facility

$0.26

Service Code	HCPCS J2020
Hospital Charge Code	5766468357
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

LINEZOLID 600 MG PO TABS

Facility

$183.66

Service Code	NDC 6787741920
Hospital Charge Code	6787741920
Hospital Revenue Code	250
Min. Negotiated Rate	$91.83
Max. Negotiated Rate	$91.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.83

LINEZOLID 600 MG PO TABS

Facility

$183.66

Service Code	NDC 6787741933
Hospital Charge Code	6787741933
Hospital Revenue Code	250
Min. Negotiated Rate	$91.83
Max. Negotiated Rate	$91.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.83

LINEZOLID 600 MG PO TABS

Facility

$183.67

Service Code	NDC 5976213072
Hospital Charge Code	5976213072
Hospital Revenue Code	250
Min. Negotiated Rate	$64.29
Max. Negotiated Rate	$146.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$91.84
Rate for Payer: Aetna Government	$91.84
Rate for Payer: Brighton Health Commercial	$137.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.90
Rate for Payer: EmblemHealth Commercial	$91.84
Rate for Payer: Group Health Inc Commercial	$91.84
Rate for Payer: Group Health Inc Medicare	$64.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.84
Rate for Payer: Hamaspik Choice Inc Medicare	$91.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$119.39

LINEZOLID 600 MG PO TABS

Facility

$183.66

Service Code	NDC 6787741920
Hospital Charge Code	6787741920
Hospital Revenue Code	250
Min. Negotiated Rate	$64.28
Max. Negotiated Rate	$146.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$91.83
Rate for Payer: Aetna Government	$91.83
Rate for Payer: Brighton Health Commercial	$137.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.89
Rate for Payer: EmblemHealth Commercial	$91.83
Rate for Payer: Group Health Inc Commercial	$91.83
Rate for Payer: Group Health Inc Medicare	$64.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.83
Rate for Payer: Hamaspik Choice Inc Medicare	$91.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$119.38

LINEZOLID 600 MG PO TABS

Facility

$183.67

Service Code	NDC 5976213072
Hospital Charge Code	5976213072
Hospital Revenue Code	250
Min. Negotiated Rate	$91.84
Max. Negotiated Rate	$91.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.84

Know your out-of-pocket cost for care.

All Charges