St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MICAFUNGIN SODIUM 50 MG IV SOLR

Facility

$89.76

Service Code	HCPCS J2248
Hospital Charge Code	4202322901
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

MICAFUNGIN SODIUM 50 MG IV SOLR

Facility

$89.76

Service Code	HCPCS J2248
Hospital Charge Code	4202322901
Hospital Revenue Code	258
Min. Negotiated Rate	$44.88
Max. Negotiated Rate	$44.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.88

MICAFUNGIN SODIUM 50 MG IV SOLR

Facility

$89.76

Service Code	HCPCS J2248
Hospital Charge Code	4202322910
Hospital Revenue Code	258
Min. Negotiated Rate	$44.88
Max. Negotiated Rate	$44.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.88

MICONAZOLE NITRATE 2 % VA CREA

Facility

$0.16

Service Code	NDC 6126973041
Hospital Charge Code	6126973041
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

MICONAZOLE NITRATE 2 % VA CREA

Facility

$0.16

Service Code	NDC 6126973041
Hospital Charge Code	6126973041
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

MICONAZOLE NITRATE 2 % VA CREA

Facility

$0.26

Service Code	NDC 0904773445
Hospital Charge Code	0904773445
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

MICONAZOLE NITRATE 2 % VA CREA

Facility

$0.26

Service Code	NDC 0904773445
Hospital Charge Code	0904773445
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
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

MIDAZOLAM 100 MG/100ML IV SOLN

Facility

$0.26

Service Code	NDC 6937431410
Hospital Charge Code	6937431410
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

MIDAZOLAM 100 MG/100ML IV SOLN

Facility

$0.26

Service Code	NDC 6937431410
Hospital Charge Code	6937431410
Hospital Revenue Code	258
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

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.78

Service Code	HCPCS J2250
Hospital Charge Code	6332341112
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: EmblemHealth Commercial	$0.39
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.51

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.53

Service Code	HCPCS J2250
Hospital Charge Code	2315560041
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: EmblemHealth Commercial	$0.26
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.19

Service Code	HCPCS J2250
Hospital Charge Code	0641620925
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.78

Service Code	HCPCS J2250
Hospital Charge Code	6332341112
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.19

Service Code	HCPCS J2250
Hospital Charge Code	0641620901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.78

Service Code	HCPCS J2250
Hospital Charge Code	6332341115
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: EmblemHealth Commercial	$0.39
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.51

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.19

Service Code	HCPCS J2250
Hospital Charge Code	0641620925
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.50

Service Code	HCPCS J2250
Hospital Charge Code	2502165502
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.33

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.53

Service Code	HCPCS J2250
Hospital Charge Code	2315560031
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.39

Service Code	HCPCS J2250
Hospital Charge Code	0641605725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.53

Service Code	HCPCS J2250
Hospital Charge Code	2315560031
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: EmblemHealth Commercial	$0.26
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.50

Service Code	HCPCS J2250
Hospital Charge Code	2502165502
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.19

Service Code	HCPCS J2250
Hospital Charge Code	0641620901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.53

Service Code	HCPCS J2250
Hospital Charge Code	2315560041
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.39

Service Code	HCPCS J2250
Hospital Charge Code	0641605725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

MIDAZOLAM HCL 2 MG/2ML IJ SOLN

Facility

$0.78

Service Code	HCPCS J2250
Hospital Charge Code	6332341115
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39

Know your out-of-pocket cost for care.

All Charges