St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

METRONIDAZOLE 500 MG PO TABS

Facility

$0.73

Service Code	NDC 5011133401
Hospital Charge Code	5011133401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

METRONIDAZOLE 500 MG PO TABS

Facility

$0.84

Service Code	NDC 0904712661
Hospital Charge Code	0904712661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

METRONIDAZOLE 500 MG PO TABS

Facility

$0.73

Service Code	NDC 2315565201
Hospital Charge Code	2315565201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.50
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

METRONIDAZOLE 500 MG PO TABS

Facility

$0.92

Service Code	NDC 6068755001
Hospital Charge Code	6068755001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46

METRONIDAZOLE 500 MG PO TABS

Facility

$0.84

Service Code	NDC 0904712661
Hospital Charge Code	0904712661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

METRONIDAZOLE 500 MG PO TABS

Facility

$0.73

Service Code	NDC 5011133401
Hospital Charge Code	5011133401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.50
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

METRONIDAZOLE IV SYRINGE (NEO/PED)

Facility

$0.03

Service Code	NDC 9999123474
Hospital Charge Code	9999123474
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

METRONIDAZOLE IV SYRINGE (NEO/PED)

Facility

$0.03

Service Code	NDC 0338105548
Hospital Charge Code	0338105548
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

METRONIDAZOLE IV SYRINGE (NEO/PED)

Facility

$0.03

Service Code	NDC 0338105548
Hospital Charge Code	0338105548
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

METRONIDAZOLE IV SYRINGE (NEO/PED)

Facility

$0.03

Service Code	NDC 9999123474
Hospital Charge Code	9999123474
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

MEXILETINE HCL 150 MG PO CAPS

Facility

$2.54

Service Code	NDC 0093873901
Hospital Charge Code	0093873901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$2.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.27
Rate for Payer: Aetna Government	$1.27
Rate for Payer: Brighton Health Commercial	$1.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
Rate for Payer: EmblemHealth Commercial	$1.27
Rate for Payer: Group Health Inc Commercial	$1.27
Rate for Payer: Group Health Inc Medicare	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.27
Rate for Payer: Hamaspik Choice Inc Medicare	$1.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.65

MEXILETINE HCL 150 MG PO CAPS

Facility

$2.54

Service Code	NDC 0093873901
Hospital Charge Code	0093873901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.27

MEXILETINE HCL 150 MG PO CAPS

Facility

$2.57

Service Code	NDC 6068777811
Hospital Charge Code	6068777811
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.28

MEXILETINE HCL 150 MG PO CAPS

Facility

$2.57

Service Code	NDC 6068777811
Hospital Charge Code	6068777811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$2.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.28
Rate for Payer: Aetna Government	$1.28
Rate for Payer: Brighton Health Commercial	$1.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.75
Rate for Payer: EmblemHealth Commercial	$1.28
Rate for Payer: Group Health Inc Commercial	$1.28
Rate for Payer: Group Health Inc Medicare	$0.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.28
Rate for Payer: Hamaspik Choice Inc Medicare	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.67

MEXILETINE HCL 200 MG PO CAPS

Facility

$3.03

Service Code	NDC 0093874001
Hospital Charge Code	0093874001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51

MEXILETINE HCL 200 MG PO CAPS

Facility

$3.03

Service Code	NDC 0093874001
Hospital Charge Code	0093874001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.51
Rate for Payer: Aetna Government	$1.51
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: EmblemHealth Commercial	$1.51
Rate for Payer: Group Health Inc Commercial	$1.51
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51
Rate for Payer: Hamaspik Choice Inc Medicare	$1.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

MICAFUNGIN SODIUM 100 MG IV SOLR

Facility

$179.52

Service Code	HCPCS J2248
Hospital Charge Code	4202323010
Hospital Revenue Code	258
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$143.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$98.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$134.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$143.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$122.07
Rate for Payer: EmblemHealth Commercial	$89.76
Rate for Payer: Group Health Inc Commercial	$89.76
Rate for Payer: Group Health Inc Medicare	$62.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.76
Rate for Payer: Hamaspik Choice Inc Medicare	$89.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$116.69

MICAFUNGIN SODIUM 100 MG IV SOLR

Facility

$57.60

Service Code	HCPCS J2248
Hospital Charge Code	6332372902
Hospital Revenue Code	258
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$46.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$43.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.17
Rate for Payer: EmblemHealth Commercial	$28.80
Rate for Payer: Group Health Inc Commercial	$28.80
Rate for Payer: Group Health Inc Medicare	$20.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.80
Rate for Payer: Hamaspik Choice Inc Medicare	$28.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37.44

MICAFUNGIN SODIUM 100 MG IV SOLR

Facility

$179.52

Service Code	HCPCS J2248
Hospital Charge Code	4202323010
Hospital Revenue Code	258
Min. Negotiated Rate	$89.76
Max. Negotiated Rate	$89.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.76

MICAFUNGIN SODIUM 100 MG IV SOLR

Facility

$57.60

Service Code	HCPCS J2248
Hospital Charge Code	6332372910
Hospital Revenue Code	258
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$28.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.80

MICAFUNGIN SODIUM 100 MG IV SOLR

Facility

$57.60

Service Code	HCPCS J2248
Hospital Charge Code	6332372910
Hospital Revenue Code	258
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$46.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$43.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.17
Rate for Payer: EmblemHealth Commercial	$28.80
Rate for Payer: Group Health Inc Commercial	$28.80
Rate for Payer: Group Health Inc Medicare	$20.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.80
Rate for Payer: Hamaspik Choice Inc Medicare	$28.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37.44

MICAFUNGIN SODIUM 100 MG IV SOLR

Facility

$57.60

Service Code	HCPCS J2248
Hospital Charge Code	6332372901
Hospital Revenue Code	258
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$28.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.80

MICAFUNGIN SODIUM 100 MG IV SOLR

Facility

$57.60

Service Code	HCPCS J2248
Hospital Charge Code	6332372901
Hospital Revenue Code	258
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$46.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$43.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.17
Rate for Payer: EmblemHealth Commercial	$28.80
Rate for Payer: Group Health Inc Commercial	$28.80
Rate for Payer: Group Health Inc Medicare	$20.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.80
Rate for Payer: Hamaspik Choice Inc Medicare	$28.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37.44

MICAFUNGIN SODIUM 100 MG IV SOLR

Facility

$57.60

Service Code	HCPCS J2248
Hospital Charge Code	6332372902
Hospital Revenue Code	258
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$28.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.80

MICAFUNGIN SODIUM 50 MG IV SOLR

Facility

$89.76

Service Code	HCPCS J2248
Hospital Charge Code	4202322910
Hospital Revenue Code	258
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$71.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$67.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.04
Rate for Payer: EmblemHealth Commercial	$44.88
Rate for Payer: Group Health Inc Commercial	$44.88
Rate for Payer: Group Health Inc Medicare	$31.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.88
Rate for Payer: Hamaspik Choice Inc Medicare	$44.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$58.34

Know your out-of-pocket cost for care.

All Charges