St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LITHIUM CARBONATE 150 MG PO CAPS

Facility

$0.17

Service Code	NDC 0054252625
Hospital Charge Code	0054252625
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

LITHIUM CARBONATE 300 MG PO CAPS

Facility

$0.18

Service Code	NDC 6846222110
Hospital Charge Code	6846222110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

LITHIUM CARBONATE 300 MG PO CAPS

Facility

$0.37

Service Code	NDC 0054852725
Hospital Charge Code	0054852725
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	$0.28
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.24

LITHIUM CARBONATE 300 MG PO CAPS

Facility

$2.13

Service Code	NDC 6068780611
Hospital Charge Code	6068780611
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.06

LITHIUM CARBONATE 300 MG PO CAPS

Facility

$0.16

Service Code	NDC 3172254510
Hospital Charge Code	3172254510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

LITHIUM CARBONATE 300 MG PO CAPS

Facility

$0.16

Service Code	NDC 3172254510
Hospital Charge Code	3172254510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

LITHIUM CARBONATE 300 MG PO CAPS

Facility

$0.28

Service Code	NDC 0054252725
Hospital Charge Code	0054252725
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

LITHIUM CARBONATE 300 MG PO CAPS

Facility

$2.13

Service Code	NDC 6068780611
Hospital Charge Code	6068780611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$1.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.45
Rate for Payer: EmblemHealth Commercial	$1.06
Rate for Payer: Group Health Inc Commercial	$1.06
Rate for Payer: Group Health Inc Medicare	$0.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.38

LITHIUM CARBONATE 300 MG PO CAPS

Facility

$0.28

Service Code	NDC 0054252725
Hospital Charge Code	0054252725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14

LITHIUM CARBONATE 300 MG PO CAPS

Facility

$0.18

Service Code	NDC 6846222110
Hospital Charge Code	6846222110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
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	$0.13
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

LITHIUM CARBONATE 300 MG PO CAPS

Facility

$0.37

Service Code	NDC 0054852725
Hospital Charge Code	0054852725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18

LITHIUM CARBONATE 300 MG PO TABS

Facility

$0.21

Service Code	NDC 6275643088
Hospital Charge Code	6275643088
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
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	$0.14
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

LITHIUM CARBONATE 300 MG PO TABS

Facility

$0.21

Service Code	NDC 6275643018
Hospital Charge Code	6275643018
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
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	$0.14
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

LITHIUM CARBONATE 300 MG PO TABS

Facility

$0.21

Service Code	NDC 6275643088
Hospital Charge Code	6275643088
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

LITHIUM CARBONATE 300 MG PO TABS

Facility

$0.34

Service Code	NDC 0054852825
Hospital Charge Code	0054852825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.23
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

LITHIUM CARBONATE 300 MG PO TABS

Facility

$0.27

Service Code	NDC 0054452725
Hospital Charge Code	0054452725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

LITHIUM CARBONATE 300 MG PO TABS

Facility

$0.27

Service Code	NDC 0054452725
Hospital Charge Code	0054452725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

LITHIUM CARBONATE 300 MG PO TABS

Facility

$0.34

Service Code	NDC 0054852825
Hospital Charge Code	0054852825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

LITHIUM CARBONATE 300 MG PO TABS

Facility

$0.21

Service Code	NDC 6275643018
Hospital Charge Code	6275643018
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

Liver transplant &/or intestinal transplant

Facility

$274,887.00

Service Code	APR-DRG 0013
Min. Negotiated Rate	$79,627.63
Max. Negotiated Rate	$274,887.00
Rate for Payer: Affinity Essential Plan 1&2	$179,162.17
Rate for Payer: Affinity Essential Plan 3&4	$179,162.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$79,627.63
Rate for Payer: Amida Care Medicaid	$79,627.63
Rate for Payer: EmblemHealth Essential Plan 1&2	$179,162.17
Rate for Payer: EmblemHealth Essential Plan 3&4	$79,627.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$79,627.63
Rate for Payer: Fidelis Qualified Health Plan	$95,553.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$79,627.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$79,627.63
Rate for Payer: Healthfirst Commercial	$274,887.00
Rate for Payer: Healthfirst Essential Plan	$179,162.17
Rate for Payer: Healthfirst QHP	$140,641.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$79,627.63
Rate for Payer: SOMOS Essential	$179,162.17
Rate for Payer: United Healthcare Essential Plan 1&2	$179,162.17
Rate for Payer: United Healthcare Essential Plan 3&4	$179,162.17
Rate for Payer: United Healthcare Medicaid	$79,627.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$79,627.63

Liver transplant &/or intestinal transplant

Facility

$267,391.00

Service Code	APR-DRG 0011
Min. Negotiated Rate	$62,405.99
Max. Negotiated Rate	$267,391.00
Rate for Payer: Affinity Essential Plan 1&2	$140,413.48
Rate for Payer: Affinity Essential Plan 3&4	$140,413.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$62,405.99
Rate for Payer: Amida Care Medicaid	$62,405.99
Rate for Payer: EmblemHealth Essential Plan 1&2	$140,413.48
Rate for Payer: EmblemHealth Essential Plan 3&4	$62,405.99
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62,405.99
Rate for Payer: Fidelis Qualified Health Plan	$74,887.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$62,405.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62,405.99
Rate for Payer: Healthfirst Commercial	$267,391.00
Rate for Payer: Healthfirst Essential Plan	$140,413.48
Rate for Payer: Healthfirst QHP	$119,641.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62,405.99
Rate for Payer: SOMOS Essential	$140,413.48
Rate for Payer: United Healthcare Essential Plan 1&2	$140,413.48
Rate for Payer: United Healthcare Essential Plan 3&4	$140,413.48
Rate for Payer: United Healthcare Medicaid	$62,405.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$62,405.99

Liver transplant &/or intestinal transplant

Facility

$272,466.00

Service Code	APR-DRG 0012
Min. Negotiated Rate	$62,405.99
Max. Negotiated Rate	$272,466.00
Rate for Payer: Affinity Essential Plan 1&2	$140,413.48
Rate for Payer: Affinity Essential Plan 3&4	$140,413.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$62,405.99
Rate for Payer: Amida Care Medicaid	$62,405.99
Rate for Payer: EmblemHealth Essential Plan 1&2	$140,413.48
Rate for Payer: EmblemHealth Essential Plan 3&4	$62,405.99
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62,405.99
Rate for Payer: Fidelis Qualified Health Plan	$74,887.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$62,405.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62,405.99
Rate for Payer: Healthfirst Commercial	$272,466.00
Rate for Payer: Healthfirst Essential Plan	$140,413.48
Rate for Payer: Healthfirst QHP	$119,641.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62,405.99
Rate for Payer: SOMOS Essential	$140,413.48
Rate for Payer: United Healthcare Essential Plan 1&2	$140,413.48
Rate for Payer: United Healthcare Essential Plan 3&4	$140,413.48
Rate for Payer: United Healthcare Medicaid	$62,405.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$62,405.99

Liver transplant &/or intestinal transplant

Facility

$543,815.00

Service Code	APR-DRG 0014
Min. Negotiated Rate	$151,063.21
Max. Negotiated Rate	$543,815.00
Rate for Payer: Affinity Essential Plan 1&2	$339,892.22
Rate for Payer: Affinity Essential Plan 3&4	$339,892.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$151,063.21
Rate for Payer: Amida Care Medicaid	$151,063.21
Rate for Payer: EmblemHealth Essential Plan 1&2	$339,892.22
Rate for Payer: EmblemHealth Essential Plan 3&4	$151,063.21
Rate for Payer: Fidelis CHP/HARP/Medicaid	$151,063.21
Rate for Payer: Fidelis Qualified Health Plan	$181,275.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$151,063.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$151,063.21
Rate for Payer: Healthfirst Commercial	$543,815.00
Rate for Payer: Healthfirst Essential Plan	$339,892.22
Rate for Payer: Healthfirst QHP	$290,943.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$151,063.21
Rate for Payer: SOMOS Essential	$339,892.22
Rate for Payer: United Healthcare Essential Plan 1&2	$339,892.22
Rate for Payer: United Healthcare Essential Plan 3&4	$339,892.22
Rate for Payer: United Healthcare Medicaid	$151,063.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$151,063.21

LOPERAMIDE HCL 1 MG/5ML PO LIQD

Facility

$0.05

Service Code	NDC 0363037726
Hospital Charge Code	0363037726
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

LOPERAMIDE HCL 1 MG/5ML PO LIQD

Facility

$0.05

Service Code	NDC 0363037726
Hospital Charge Code	0363037726
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

Know your out-of-pocket cost for care.

All Charges