St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LOPERAMIDE HCL 1 MG/7.5ML PO SOLN

Facility

$0.21

Service Code	NDC 6809412962
Hospital Charge Code	6809412962
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
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	$0.14
Rate for Payer: EmblemHealth Commercial	$0.11
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

LOPERAMIDE HCL 1 MG/7.5ML PO SOLN

Facility

$0.21

Service Code	NDC 6809412962
Hospital Charge Code	6809412962
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

LOPERAMIDE HCL 1 MG/7.5ML PO SOLN

Facility

$0.21

Service Code	NDC 6809412959
Hospital Charge Code	6809412959
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

LOPERAMIDE HCL 1 MG/7.5ML PO SOLN

Facility

$0.21

Service Code	NDC 6809412959
Hospital Charge Code	6809412959
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
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	$0.14
Rate for Payer: EmblemHealth Commercial	$0.11
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

LOPERAMIDE HCL 2 MG PO CAPS

Facility

$1.02

Service Code	NDC 6068722911
Hospital Charge Code	6068722911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51

LOPERAMIDE HCL 2 MG PO CAPS

Facility

$1.37

Service Code	NDC 0093031101
Hospital Charge Code	0093031101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.68
Rate for Payer: Aetna Government	$0.68
Rate for Payer: Brighton Health Commercial	$1.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.93
Rate for Payer: EmblemHealth Commercial	$0.68
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

LOPERAMIDE HCL 2 MG PO CAPS

Facility

$1.02

Service Code	NDC 6068722901
Hospital Charge Code	6068722901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51

LOPERAMIDE HCL 2 MG PO CAPS

Facility

$1.37

Service Code	NDC 6945227120
Hospital Charge Code	6945227120
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.68
Rate for Payer: Aetna Government	$0.68
Rate for Payer: Brighton Health Commercial	$1.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.93
Rate for Payer: EmblemHealth Commercial	$0.68
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

LOPERAMIDE HCL 2 MG PO CAPS

Facility

$1.02

Service Code	NDC 6068722911
Hospital Charge Code	6068722911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Brighton Health Commercial	$0.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.69
Rate for Payer: EmblemHealth Commercial	$0.51
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

LOPERAMIDE HCL 2 MG PO CAPS

Facility

$1.02

Service Code	NDC 6068722901
Hospital Charge Code	6068722901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Brighton Health Commercial	$0.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.69
Rate for Payer: EmblemHealth Commercial	$0.51
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

LOPERAMIDE HCL 2 MG PO CAPS

Facility

$1.37

Service Code	NDC 6945227120
Hospital Charge Code	6945227120
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68

LOPERAMIDE HCL 2 MG PO CAPS

Facility

$1.37

Service Code	NDC 0093031101
Hospital Charge Code	0093031101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68

LOPINAVIR-RITONAVIR 200-50 MG PO TABS

Facility

$10.24

Service Code	NDC 0074679922
Hospital Charge Code	0074679922
Hospital Revenue Code	250
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$8.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.12
Rate for Payer: Aetna Government	$5.12
Rate for Payer: Brighton Health Commercial	$7.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.96
Rate for Payer: EmblemHealth Commercial	$5.12
Rate for Payer: Group Health Inc Commercial	$5.12
Rate for Payer: Group Health Inc Medicare	$3.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.12
Rate for Payer: Hamaspik Choice Inc Medicare	$5.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.66

LOPINAVIR-RITONAVIR 200-50 MG PO TABS

Facility

$10.24

Service Code	NDC 0074679922
Hospital Charge Code	0074679922
Hospital Revenue Code	250
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$5.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.12

LOPINAVIR-RITONAVIR 400-100 MG/5ML PO SOLN

Facility

$3.84

Service Code	NDC 0074395646
Hospital Charge Code	0074395646
Hospital Revenue Code	250
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$3.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.92
Rate for Payer: Aetna Government	$1.92
Rate for Payer: Brighton Health Commercial	$2.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.61
Rate for Payer: EmblemHealth Commercial	$1.92
Rate for Payer: Group Health Inc Commercial	$1.92
Rate for Payer: Group Health Inc Medicare	$1.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.92
Rate for Payer: Hamaspik Choice Inc Medicare	$1.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.50

LOPINAVIR-RITONAVIR 400-100 MG/5ML PO SOLN

Facility

$3.84

Service Code	NDC 0074395646
Hospital Charge Code	0074395646
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.92

LORAZEPAM 0.5 MG PO TABS

Facility

$0.63

Service Code	NDC 6931590405
Hospital Charge Code	6931590405
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31

LORAZEPAM 0.5 MG PO TABS

Facility

$0.64

Service Code	NDC 6931590401
Hospital Charge Code	6931590401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: EmblemHealth Commercial	$0.32
Rate for Payer: Group Health Inc Commercial	$0.32
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32
Rate for Payer: Hamaspik Choice Inc Medicare	$0.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

LORAZEPAM 0.5 MG PO TABS

Facility

$0.10

Service Code	NDC 0904600761
Hospital Charge Code	0904600761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

LORAZEPAM 0.5 MG PO TABS

Facility

$0.10

Service Code	NDC 0904600761
Hospital Charge Code	0904600761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

LORAZEPAM 0.5 MG PO TABS

Facility

$0.17

Service Code	NDC 6068762711
Hospital Charge Code	6068762711
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	$0.13
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	$0.11

LORAZEPAM 0.5 MG PO TABS

Facility

$0.64

Service Code	NDC 6931590401
Hospital Charge Code	6931590401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32

LORAZEPAM 0.5 MG PO TABS

Facility

$0.17

Service Code	NDC 6068762711
Hospital Charge Code	6068762711
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

LORAZEPAM 0.5 MG PO TABS

Facility

$0.63

Service Code	NDC 6931590405
Hospital Charge Code	6931590405
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.43
Rate for Payer: EmblemHealth Commercial	$0.31
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.41

LORAZEPAM 1 MG PO TABS

Facility

$0.84

Service Code	NDC 6931590510
Hospital Charge Code	6931590510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

Know your out-of-pocket cost for care.

All Charges