St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MIRTAZAPINE 15 MG PO TABS

Facility

$1.05

Service Code	NDC 6808411901
Hospital Charge Code	6808411901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.84
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	$0.84
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	$0.37
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

MIRTAZAPINE 15 MG PO TABS

Facility

$2.86

Service Code	NDC 0904651961
Hospital Charge Code	0904651961
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43

MIRTAZAPINE 15 MG PO TABS

Facility

$2.70

Service Code	NDC 5723700830
Hospital Charge Code	5723700830
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.35
Rate for Payer: Aetna Government	$1.35
Rate for Payer: Brighton Health Commercial	$2.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.84
Rate for Payer: EmblemHealth Commercial	$1.35
Rate for Payer: Group Health Inc Commercial	$1.35
Rate for Payer: Group Health Inc Medicare	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.35
Rate for Payer: Hamaspik Choice Inc Medicare	$1.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.75

MIRTAZAPINE 15 MG PO TABS

Facility

$2.72

Service Code	NDC 6050502471
Hospital Charge Code	6050502471
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.36
Rate for Payer: Aetna Government	$1.36
Rate for Payer: Brighton Health Commercial	$2.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.85
Rate for Payer: EmblemHealth Commercial	$1.36
Rate for Payer: Group Health Inc Commercial	$1.36
Rate for Payer: Group Health Inc Medicare	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.76

MIRTAZAPINE 15 MG PO TABS

Facility

$1.05

Service Code	NDC 6808411901
Hospital Charge Code	6808411901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52

MIRTAZAPINE 15 MG PO TABS

Facility

$2.70

Service Code	NDC 5723700830
Hospital Charge Code	5723700830
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.35

MIRTAZAPINE 30 MG PO TABS

Facility

$1.29

Service Code	NDC 6808412011
Hospital Charge Code	6808412011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.65

MIRTAZAPINE 30 MG PO TABS

Facility

$1.29

Service Code	NDC 6808412011
Hospital Charge Code	6808412011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.65
Rate for Payer: Aetna Government	$0.65
Rate for Payer: Brighton Health Commercial	$0.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.88
Rate for Payer: EmblemHealth Commercial	$0.65
Rate for Payer: Group Health Inc Commercial	$0.65
Rate for Payer: Group Health Inc Medicare	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.65
Rate for Payer: Hamaspik Choice Inc Medicare	$0.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.84

MIRTAZAPINE 30 MG PO TABS

Facility

$0.21

Service Code	NDC 6373909910
Hospital Charge Code	6373909910
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	$0.13

MIRTAZAPINE 30 MG PO TABS

Facility

$0.21

Service Code	NDC 6373909910
Hospital Charge Code	6373909910
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

MIRTAZAPINE 30 MG PO TABS

Facility

$2.77

Service Code	NDC 1310700334
Hospital Charge Code	1310700334
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38

MIRTAZAPINE 30 MG PO TABS

Facility

$2.77

Service Code	NDC 1310700334
Hospital Charge Code	1310700334
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.38
Rate for Payer: Aetna Government	$1.38
Rate for Payer: Brighton Health Commercial	$2.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.88
Rate for Payer: EmblemHealth Commercial	$1.38
Rate for Payer: Group Health Inc Commercial	$1.38
Rate for Payer: Group Health Inc Medicare	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.80

MIRTAZAPINE 45 MG PO TABS

Facility

$2.85

Service Code	NDC 6808412101
Hospital Charge Code	6808412101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$2.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.94
Rate for Payer: EmblemHealth Commercial	$1.43
Rate for Payer: Group Health Inc Commercial	$1.43
Rate for Payer: Group Health Inc Medicare	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43
Rate for Payer: Hamaspik Choice Inc Medicare	$1.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.85

MIRTAZAPINE 45 MG PO TABS

Facility

$2.83

Service Code	NDC 1310703234
Hospital Charge Code	1310703234
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42

MIRTAZAPINE 45 MG PO TABS

Facility

$2.85

Service Code	NDC 6050502491
Hospital Charge Code	6050502491
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43

MIRTAZAPINE 45 MG PO TABS

Facility

$2.85

Service Code	NDC 0378354593
Hospital Charge Code	0378354593
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43

MIRTAZAPINE 45 MG PO TABS

Facility

$2.85

Service Code	NDC 6808412111
Hospital Charge Code	6808412111
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$2.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.94
Rate for Payer: EmblemHealth Commercial	$1.43
Rate for Payer: Group Health Inc Commercial	$1.43
Rate for Payer: Group Health Inc Medicare	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43
Rate for Payer: Hamaspik Choice Inc Medicare	$1.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.85

MIRTAZAPINE 45 MG PO TABS

Facility

$2.83

Service Code	NDC 1310703234
Hospital Charge Code	1310703234
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$2.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.42
Rate for Payer: Aetna Government	$1.42
Rate for Payer: Brighton Health Commercial	$2.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.93
Rate for Payer: EmblemHealth Commercial	$1.42
Rate for Payer: Group Health Inc Commercial	$1.42
Rate for Payer: Group Health Inc Medicare	$0.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.84

MIRTAZAPINE 45 MG PO TABS

Facility

$2.85

Service Code	NDC 6050502491
Hospital Charge Code	6050502491
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$2.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.94
Rate for Payer: EmblemHealth Commercial	$1.43
Rate for Payer: Group Health Inc Commercial	$1.43
Rate for Payer: Group Health Inc Medicare	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43
Rate for Payer: Hamaspik Choice Inc Medicare	$1.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.85

MIRTAZAPINE 45 MG PO TABS

Facility

$2.85

Service Code	NDC 6808412111
Hospital Charge Code	6808412111
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43

MIRTAZAPINE 45 MG PO TABS

Facility

$2.85

Service Code	NDC 6808412101
Hospital Charge Code	6808412101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43

MIRTAZAPINE 45 MG PO TABS

Facility

$2.85

Service Code	NDC 0378354593
Hospital Charge Code	0378354593
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$2.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.94
Rate for Payer: EmblemHealth Commercial	$1.43
Rate for Payer: Group Health Inc Commercial	$1.43
Rate for Payer: Group Health Inc Medicare	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43
Rate for Payer: Hamaspik Choice Inc Medicare	$1.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.85

MIRVETUXIMAB SORAVTANSINE-GYNX 100 MG/20ML IV SOLN

Facility

$380.66

Service Code	HCPCS J9063
Hospital Charge Code	7290385301
Hospital Revenue Code	258
Min. Negotiated Rate	$190.33
Max. Negotiated Rate	$190.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.33

MIRVETUXIMAB SORAVTANSINE-GYNX 100 MG/20ML IV SOLN

Facility

$380.66

Service Code	HCPCS J9063
Hospital Charge Code	7290385301
Hospital Revenue Code	258
Min. Negotiated Rate	$48.64
Max. Negotiated Rate	$304.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.49
Rate for Payer: Aetna Government	$69.49
Rate for Payer: Affinity Essential Plan 1&2	$48.64
Rate for Payer: Affinity Essential Plan 3&4	$48.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$48.64
Rate for Payer: Brighton Health Commercial	$285.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$69.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$304.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.85
Rate for Payer: Elderplan Medicare Advantage	$69.49
Rate for Payer: EmblemHealth Commercial	$69.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62.54
Rate for Payer: Fidelis Essential Plan Aliesa	$59.07
Rate for Payer: Fidelis Essential Plan QHP	$61.85
Rate for Payer: Fidelis Medicare Advantage	$69.49
Rate for Payer: Fidelis Qualified Health Plan	$61.85
Rate for Payer: Group Health Inc Commercial	$69.49
Rate for Payer: Group Health Inc Medicare	$69.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$69.49
Rate for Payer: Hamaspik Choice Inc Medicare	$69.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$69.49
Rate for Payer: Healthfirst Medicare Advantage	$59.07
Rate for Payer: Healthfirst QHP	$69.49
Rate for Payer: Humana Medicare	$70.88
Rate for Payer: Senior Whole Health Medicare Advantage	$69.49
Rate for Payer: United Healthcare Medicare Advantage	$69.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$247.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$66.02
Rate for Payer: Wellcare Medicare	$66.02

MISOPROSTOL 100 MCG PO TABS

Facility

$0.82

Service Code	NDC 5976250071
Hospital Charge Code	5976250071
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41

Know your out-of-pocket cost for care.

All Charges