St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MISOPROSTOL 100 MCG PO TABS

Facility

$0.98

Service Code	NDC 7095444310
Hospital Charge Code	7095444310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49

MISOPROSTOL 100 MCG PO TABS

Facility

$0.82

Service Code	NDC 5976250071
Hospital Charge Code	5976250071
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.41
Rate for Payer: Aetna Government	$0.41
Rate for Payer: Brighton Health Commercial	$0.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.56
Rate for Payer: EmblemHealth Commercial	$0.41
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.54

MISOPROSTOL 100 MCG PO TABS

Facility

$2.48

Service Code	NDC 6808404011
Hospital Charge Code	6808404011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$1.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.24
Rate for Payer: Aetna Government	$1.24
Rate for Payer: Brighton Health Commercial	$1.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.69
Rate for Payer: EmblemHealth Commercial	$1.24
Rate for Payer: Group Health Inc Commercial	$1.24
Rate for Payer: Group Health Inc Medicare	$0.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24
Rate for Payer: Hamaspik Choice Inc Medicare	$1.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.61

MISOPROSTOL 100 MCG PO TABS

Facility

$0.98

Service Code	NDC 7095444310
Hospital Charge Code	7095444310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.67
Rate for Payer: EmblemHealth Commercial	$0.49
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.64

MISOPROSTOL 100 MCG PO TABS

Facility

$2.48

Service Code	NDC 6808404011
Hospital Charge Code	6808404011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24

MISOPROSTOL 200 MCG PO TABS

Facility

$1.43

Service Code	NDC 7095444420
Hospital Charge Code	7095444420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$1.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: EmblemHealth Commercial	$0.72
Rate for Payer: Group Health Inc Commercial	$0.72
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72
Rate for Payer: Hamaspik Choice Inc Medicare	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.93

MISOPROSTOL 200 MCG PO TABS

Facility

$2.73

Service Code	NDC 6068774611
Hospital Charge Code	6068774611
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36

MISOPROSTOL 200 MCG PO TABS

Facility

$1.43

Service Code	NDC 4338616106
Hospital Charge Code	4338616106
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72

MISOPROSTOL 200 MCG PO TABS

Facility

$2.73

Service Code	NDC 6068774611
Hospital Charge Code	6068774611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.50
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	$2.18
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	$1.77

MISOPROSTOL 200 MCG PO TABS

Facility

$1.43

Service Code	NDC 4338616101
Hospital Charge Code	4338616101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$1.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: EmblemHealth Commercial	$0.72
Rate for Payer: Group Health Inc Commercial	$0.72
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72
Rate for Payer: Hamaspik Choice Inc Medicare	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.93

MISOPROSTOL 200 MCG PO TABS

Facility

$1.43

Service Code	NDC 4338616101
Hospital Charge Code	4338616101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72

MISOPROSTOL 200 MCG PO TABS

Facility

$1.43

Service Code	NDC 4338616106
Hospital Charge Code	4338616106
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$1.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: EmblemHealth Commercial	$0.72
Rate for Payer: Group Health Inc Commercial	$0.72
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72
Rate for Payer: Hamaspik Choice Inc Medicare	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.93

MISOPROSTOL 200 MCG PO TABS

Facility

$2.73

Service Code	NDC 6808404111
Hospital Charge Code	6808404111
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36

MISOPROSTOL 200 MCG PO TABS

Facility

$2.73

Service Code	NDC 6808404111
Hospital Charge Code	6808404111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.36
Rate for Payer: Aetna Government	$1.36
Rate for Payer: Brighton Health Commercial	$2.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.86
Rate for Payer: EmblemHealth Commercial	$1.36
Rate for Payer: Group Health Inc Commercial	$1.36
Rate for Payer: Group Health Inc Medicare	$0.96
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	$1.77

MISOPROSTOL 200 MCG PO TABS

Facility

$1.20

Service Code	NDC 5976250081
Hospital Charge Code	5976250081
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60

MISOPROSTOL 200 MCG PO TABS

Facility

$1.20

Service Code	NDC 5976250081
Hospital Charge Code	5976250081
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.60
Rate for Payer: Aetna Government	$0.60
Rate for Payer: Brighton Health Commercial	$0.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.82
Rate for Payer: EmblemHealth Commercial	$0.60
Rate for Payer: Group Health Inc Commercial	$0.60
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60
Rate for Payer: Hamaspik Choice Inc Medicare	$0.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.78

MISOPROSTOL 200 MCG PO TABS

Facility

$2.73

Service Code	NDC 6068774601
Hospital Charge Code	6068774601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36

MISOPROSTOL 200 MCG PO TABS

Facility

$1.43

Service Code	NDC 7095444420
Hospital Charge Code	7095444420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72

MISOPROSTOL 200 MCG PO TABS

Facility

$2.73

Service Code	NDC 6068774601
Hospital Charge Code	6068774601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.50
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	$2.18
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	$1.77

MISOPROSTOL 25 MCG SPLIT TABS

Facility

$0.62

Service Code	NDC 09999701554
Hospital Charge Code	09999701554
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31

MISOPROSTOL 25 MCG SPLIT TABS

Facility

$0.62

Service Code	NDC 09999701554
Hospital Charge Code	09999701554
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	$0.42
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	$0.40

MITOMYCIN 20 MG IV SOLR

Facility

$758.40

Service Code	HCPCS J9280
Hospital Charge Code	0143927901
Hospital Revenue Code	258
Min. Negotiated Rate	$14.24
Max. Negotiated Rate	$606.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$417.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.35
Rate for Payer: Aetna Government	$20.35
Rate for Payer: Affinity Essential Plan 1&2	$14.24
Rate for Payer: Affinity Essential Plan 3&4	$14.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.24
Rate for Payer: Brighton Health Commercial	$568.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$606.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$515.71
Rate for Payer: Elderplan Medicare Advantage	$20.35
Rate for Payer: EmblemHealth Commercial	$20.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.32
Rate for Payer: Fidelis Essential Plan Aliesa	$17.30
Rate for Payer: Fidelis Essential Plan QHP	$18.11
Rate for Payer: Fidelis Medicare Advantage	$20.35
Rate for Payer: Fidelis Qualified Health Plan	$18.11
Rate for Payer: Group Health Inc Commercial	$20.35
Rate for Payer: Group Health Inc Medicare	$20.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.35
Rate for Payer: Hamaspik Choice Inc Medicare	$20.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.35
Rate for Payer: Healthfirst Medicare Advantage	$17.30
Rate for Payer: Healthfirst QHP	$20.35
Rate for Payer: Humana Medicare	$20.76
Rate for Payer: Senior Whole Health Medicare Advantage	$20.35
Rate for Payer: United Healthcare Medicare Advantage	$20.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$492.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.33
Rate for Payer: Wellcare Medicare	$19.33

MITOMYCIN 20 MG IV SOLR

Facility

$758.40

Service Code	HCPCS J9280
Hospital Charge Code	0143927901
Hospital Revenue Code	258
Min. Negotiated Rate	$379.20
Max. Negotiated Rate	$379.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$379.20

MITOMYCIN 20 MG IV SOLR

Facility

$540.00

Service Code	HCPCS J9280
Hospital Charge Code	7128813850
Hospital Revenue Code	258
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$270.00

MITOMYCIN 20 MG IV SOLR

Facility

$540.00

Service Code	HCPCS J9280
Hospital Charge Code	7128813850
Hospital Revenue Code	258
Min. Negotiated Rate	$14.24
Max. Negotiated Rate	$432.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$297.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.35
Rate for Payer: Aetna Government	$20.35
Rate for Payer: Affinity Essential Plan 1&2	$14.24
Rate for Payer: Affinity Essential Plan 3&4	$14.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.24
Rate for Payer: Brighton Health Commercial	$405.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$432.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$367.20
Rate for Payer: Elderplan Medicare Advantage	$20.35
Rate for Payer: EmblemHealth Commercial	$20.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.32
Rate for Payer: Fidelis Essential Plan Aliesa	$17.30
Rate for Payer: Fidelis Essential Plan QHP	$18.11
Rate for Payer: Fidelis Medicare Advantage	$20.35
Rate for Payer: Fidelis Qualified Health Plan	$18.11
Rate for Payer: Group Health Inc Commercial	$20.35
Rate for Payer: Group Health Inc Medicare	$20.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.35
Rate for Payer: Hamaspik Choice Inc Medicare	$20.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.35
Rate for Payer: Healthfirst Medicare Advantage	$17.30
Rate for Payer: Healthfirst QHP	$20.35
Rate for Payer: Humana Medicare	$20.76
Rate for Payer: Senior Whole Health Medicare Advantage	$20.35
Rate for Payer: United Healthcare Medicare Advantage	$20.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$351.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.33
Rate for Payer: Wellcare Medicare	$19.33

Know your out-of-pocket cost for care.

All Charges