St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MIDAZOLAM HCL (PF) 5 MG/ML IJ SOLN

Facility

$1.39

Service Code	HCPCS J2250
Hospital Charge Code	0409230821
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$1.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$1.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.95
Rate for Payer: EmblemHealth Commercial	$0.70
Rate for Payer: Group Health Inc Commercial	$0.70
Rate for Payer: Group Health Inc Medicare	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.70
Rate for Payer: Hamaspik Choice Inc Medicare	$0.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.90

MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN

Facility

$0.36

Service Code	HCPCS J2251
Hospital Charge Code	4456761110
Hospital Revenue Code	258
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18

MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN

Facility

$0.36

Service Code	HCPCS J2251
Hospital Charge Code	4456761110
Hospital Revenue Code	258
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	$0.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
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	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN

Facility

$0.36

Service Code	HCPCS J2251
Hospital Charge Code	4456761101
Hospital Revenue Code	258
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	$0.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
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	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN

Facility

$0.36

Service Code	HCPCS J2251
Hospital Charge Code	4456761101
Hospital Revenue Code	258
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18

MIDAZOLAM-SODIUM CHLORIDE 50-0.9 MG/50ML-% IV SOLN

Facility

$0.53

Service Code	HCPCS J2250
Hospital Charge Code	4456761010
Hospital Revenue Code	258
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-SODIUM CHLORIDE 50-0.9 MG/50ML-% IV SOLN

Facility

$0.53

Service Code	HCPCS J2250
Hospital Charge Code	4456761010
Hospital Revenue Code	258
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26

MIDAZOLAM-SODIUM CHLORIDE 50-0.9 MG/50ML-% IV SOLN

Facility

$0.53

Service Code	HCPCS J2250
Hospital Charge Code	4456761001
Hospital Revenue Code	258
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-SODIUM CHLORIDE 50-0.9 MG/50ML-% IV SOLN

Facility

$0.53

Service Code	HCPCS J2250
Hospital Charge Code	4456761001
Hospital Revenue Code	258
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26

MIDODRINE HCL 5 MG PO TABS

Facility

$4.16

Service Code	NDC 0245021211
Hospital Charge Code	0245021211
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$3.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.08
Rate for Payer: Aetna Government	$2.08
Rate for Payer: Brighton Health Commercial	$3.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.83
Rate for Payer: EmblemHealth Commercial	$2.08
Rate for Payer: Group Health Inc Commercial	$2.08
Rate for Payer: Group Health Inc Medicare	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.08
Rate for Payer: Hamaspik Choice Inc Medicare	$2.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.70

MIDODRINE HCL 5 MG PO TABS

Facility

$0.72

Service Code	NDC 0904681806
Hospital Charge Code	0904681806
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

MIDODRINE HCL 5 MG PO TABS

Facility

$0.72

Service Code	NDC 0904681806
Hospital Charge Code	0904681806
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
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

MIDODRINE HCL 5 MG PO TABS

Facility

$3.74

Service Code	NDC 7075604911
Hospital Charge Code	7075604911
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$2.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.87
Rate for Payer: Aetna Government	$1.87
Rate for Payer: Brighton Health Commercial	$2.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.54
Rate for Payer: EmblemHealth Commercial	$1.87
Rate for Payer: Group Health Inc Commercial	$1.87
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.43

MIDODRINE HCL 5 MG PO TABS

Facility

$1.04

Service Code	NDC 0904681861
Hospital Charge Code	0904681861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.52
Rate for Payer: Aetna Government	$0.52
Rate for Payer: Brighton Health Commercial	$0.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.71
Rate for Payer: EmblemHealth Commercial	$0.52
Rate for Payer: Group Health Inc Commercial	$0.52
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52
Rate for Payer: Hamaspik Choice Inc Medicare	$0.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.68

MIDODRINE HCL 5 MG PO TABS

Facility

$4.16

Service Code	NDC 0245021211
Hospital Charge Code	0245021211
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$2.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.08

MIDODRINE HCL 5 MG PO TABS

Facility

$1.04

Service Code	NDC 5026856215
Hospital Charge Code	5026856215
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52

MIDODRINE HCL 5 MG PO TABS

Facility

$3.74

Service Code	NDC 7075604911
Hospital Charge Code	7075604911
Hospital Revenue Code	250
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87

MIDODRINE HCL 5 MG PO TABS

Facility

$2.43

Service Code	NDC 6050513211
Hospital Charge Code	6050513211
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.22
Rate for Payer: Aetna Government	$1.22
Rate for Payer: Brighton Health Commercial	$1.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.65
Rate for Payer: EmblemHealth Commercial	$1.22
Rate for Payer: Group Health Inc Commercial	$1.22
Rate for Payer: Group Health Inc Medicare	$0.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.58

MIDODRINE HCL 5 MG PO TABS

Facility

$1.04

Service Code	NDC 0904681861
Hospital Charge Code	0904681861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52

MIDODRINE HCL 5 MG PO TABS

Facility

$1.04

Service Code	NDC 5026856215
Hospital Charge Code	5026856215
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.52
Rate for Payer: Aetna Government	$0.52
Rate for Payer: Brighton Health Commercial	$0.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.71
Rate for Payer: EmblemHealth Commercial	$0.52
Rate for Payer: Group Health Inc Commercial	$0.52
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52
Rate for Payer: Hamaspik Choice Inc Medicare	$0.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.68

MIDODRINE HCL 5 MG PO TABS

Facility

$2.43

Service Code	NDC 6050513211
Hospital Charge Code	6050513211
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22

MIGRAINE

Facility

$255.39

Service Code	EAPG 00531
Min. Negotiated Rate	$185.14
Max. Negotiated Rate	$255.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$185.14
Rate for Payer: Healthfirst Commercial	$255.39

Migraine & other headaches

Facility

$40,671.45

Service Code	APR-DRG 0541
Min. Negotiated Rate	$5,685.00
Max. Negotiated Rate	$40,671.45
Rate for Payer: Affinity Essential Plan 1&2	$40,671.45
Rate for Payer: Affinity Essential Plan 3&4	$40,671.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,076.20
Rate for Payer: Amida Care Medicaid	$18,076.20
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,671.45
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,076.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,076.20
Rate for Payer: Fidelis Qualified Health Plan	$21,691.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,076.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,076.20
Rate for Payer: Healthfirst Commercial	$9,464.00
Rate for Payer: Healthfirst Essential Plan	$40,671.45
Rate for Payer: Healthfirst QHP	$5,685.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,076.20
Rate for Payer: SOMOS Essential	$40,671.45
Rate for Payer: United Healthcare Essential Plan 1&2	$40,671.45
Rate for Payer: United Healthcare Essential Plan 3&4	$40,671.45
Rate for Payer: United Healthcare Medicaid	$18,076.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,076.20

Migraine & other headaches

Facility

$46,164.01

Service Code	APR-DRG 0544
Min. Negotiated Rate	$14,363.00
Max. Negotiated Rate	$46,164.01
Rate for Payer: Affinity Essential Plan 1&2	$46,164.01
Rate for Payer: Affinity Essential Plan 3&4	$46,164.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,517.34
Rate for Payer: Amida Care Medicaid	$20,517.34
Rate for Payer: EmblemHealth Essential Plan 1&2	$46,164.01
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,517.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,517.34
Rate for Payer: Fidelis Qualified Health Plan	$24,620.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,517.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,517.34
Rate for Payer: Healthfirst Commercial	$14,363.00
Rate for Payer: Healthfirst Essential Plan	$46,164.01
Rate for Payer: Healthfirst QHP	$15,536.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,517.34
Rate for Payer: SOMOS Essential	$46,164.01
Rate for Payer: United Healthcare Essential Plan 1&2	$46,164.01
Rate for Payer: United Healthcare Essential Plan 3&4	$46,164.01
Rate for Payer: United Healthcare Medicaid	$20,517.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,517.34

Migraine & other headaches

Facility

$45,909.00

Service Code	APR-DRG 0543
Min. Negotiated Rate	$8,224.00
Max. Negotiated Rate	$45,909.00
Rate for Payer: Affinity Essential Plan 1&2	$45,909.00
Rate for Payer: Affinity Essential Plan 3&4	$45,909.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,404.00
Rate for Payer: Amida Care Medicaid	$20,404.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$45,909.00
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,404.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,404.00
Rate for Payer: Fidelis Qualified Health Plan	$24,484.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,404.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,404.00
Rate for Payer: Healthfirst Commercial	$14,219.00
Rate for Payer: Healthfirst Essential Plan	$45,909.00
Rate for Payer: Healthfirst QHP	$8,224.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,404.00
Rate for Payer: SOMOS Essential	$45,909.00
Rate for Payer: United Healthcare Essential Plan 1&2	$45,909.00
Rate for Payer: United Healthcare Essential Plan 3&4	$45,909.00
Rate for Payer: United Healthcare Medicaid	$20,404.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,404.00

Know your out-of-pocket cost for care.

All Charges