St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$4.08

Service Code	NDC 1366842990
Hospital Charge Code	1366842990
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.04
Rate for Payer: Aetna Government	$2.04
Rate for Payer: Brighton Health Commercial	$3.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.77
Rate for Payer: EmblemHealth Commercial	$2.04
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.65

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$4.03

Service Code	NDC 5026863911
Hospital Charge Code	5026863911
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$3.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.01
Rate for Payer: Aetna Government	$2.01
Rate for Payer: Brighton Health Commercial	$3.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.74
Rate for Payer: EmblemHealth Commercial	$2.01
Rate for Payer: Group Health Inc Commercial	$2.01
Rate for Payer: Group Health Inc Medicare	$1.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.01
Rate for Payer: Hamaspik Choice Inc Medicare	$2.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.62

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$4.03

Service Code	NDC 5026863915
Hospital Charge Code	5026863915
Hospital Revenue Code	250
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.01

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$4.09

Service Code	NDC 0904647461
Hospital Charge Code	0904647461
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.04
Rate for Payer: Aetna Government	$2.04
Rate for Payer: Brighton Health Commercial	$3.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.78
Rate for Payer: EmblemHealth Commercial	$2.04
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.66

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$5.27

Service Code	NDC 3172271390
Hospital Charge Code	3172271390
Hospital Revenue Code	250
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$2.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.63

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$5.27

Service Code	NDC 3172271390
Hospital Charge Code	3172271390
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$4.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.63
Rate for Payer: Aetna Government	$2.63
Rate for Payer: Brighton Health Commercial	$3.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.58
Rate for Payer: EmblemHealth Commercial	$2.63
Rate for Payer: Group Health Inc Commercial	$2.63
Rate for Payer: Group Health Inc Medicare	$1.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.63
Rate for Payer: Hamaspik Choice Inc Medicare	$2.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.42

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$5.27

Service Code	NDC 6586256090
Hospital Charge Code	6586256090
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$4.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.63
Rate for Payer: Aetna Government	$2.63
Rate for Payer: Brighton Health Commercial	$3.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.58
Rate for Payer: EmblemHealth Commercial	$2.63
Rate for Payer: Group Health Inc Commercial	$2.63
Rate for Payer: Group Health Inc Medicare	$1.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.63
Rate for Payer: Hamaspik Choice Inc Medicare	$2.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.42

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$4.08

Service Code	NDC 1366842990
Hospital Charge Code	1366842990
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$5.27

Service Code	NDC 6586256099
Hospital Charge Code	6586256099
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$4.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.63
Rate for Payer: Aetna Government	$2.63
Rate for Payer: Brighton Health Commercial	$3.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.58
Rate for Payer: EmblemHealth Commercial	$2.63
Rate for Payer: Group Health Inc Commercial	$2.63
Rate for Payer: Group Health Inc Medicare	$1.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.63
Rate for Payer: Hamaspik Choice Inc Medicare	$2.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.42

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$5.27

Service Code	NDC 6586256099
Hospital Charge Code	6586256099
Hospital Revenue Code	250
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$2.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.63

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$5.27

Service Code	NDC 6586256090
Hospital Charge Code	6586256090
Hospital Revenue Code	250
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$2.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.63

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$4.09

Service Code	NDC 0904647461
Hospital Charge Code	0904647461
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04

PAPAVERINE HCL 30 MG/ML IJ SOLN

Facility

$22.50

Service Code	NDC 7251602410
Hospital Charge Code	7251602410
Hospital Revenue Code	250
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$18.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.25
Rate for Payer: Aetna Government	$11.25
Rate for Payer: Brighton Health Commercial	$16.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.30
Rate for Payer: EmblemHealth Commercial	$11.25
Rate for Payer: Group Health Inc Commercial	$11.25
Rate for Payer: Group Health Inc Medicare	$7.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.25
Rate for Payer: Hamaspik Choice Inc Medicare	$11.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.62

PAPAVERINE HCL 30 MG/ML IJ SOLN

Facility

$24.85

Service Code	NDC 0517400225
Hospital Charge Code	0517400225
Hospital Revenue Code	250
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$19.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.42
Rate for Payer: Aetna Government	$12.42
Rate for Payer: Brighton Health Commercial	$18.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.90
Rate for Payer: EmblemHealth Commercial	$12.42
Rate for Payer: Group Health Inc Commercial	$12.42
Rate for Payer: Group Health Inc Medicare	$8.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.42
Rate for Payer: Hamaspik Choice Inc Medicare	$12.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.15

PAPAVERINE HCL 30 MG/ML IJ SOLN

Facility

$19.50

Service Code	NDC 5428814210
Hospital Charge Code	5428814210
Hospital Revenue Code	250
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.75

PAPAVERINE HCL 30 MG/ML IJ SOLN

Facility

$24.85

Service Code	NDC 0517400225
Hospital Charge Code	0517400225
Hospital Revenue Code	250
Min. Negotiated Rate	$12.42
Max. Negotiated Rate	$12.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.42

PAPAVERINE HCL 30 MG/ML IJ SOLN

Facility

$19.50

Service Code	NDC 5428814201
Hospital Charge Code	5428814201
Hospital Revenue Code	250
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$15.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.75
Rate for Payer: Aetna Government	$9.75
Rate for Payer: Brighton Health Commercial	$14.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.26
Rate for Payer: EmblemHealth Commercial	$9.75
Rate for Payer: Group Health Inc Commercial	$9.75
Rate for Payer: Group Health Inc Medicare	$6.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.75
Rate for Payer: Hamaspik Choice Inc Medicare	$9.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.68

PAPAVERINE HCL 30 MG/ML IJ SOLN

Facility

$19.50

Service Code	NDC 5428814201
Hospital Charge Code	5428814201
Hospital Revenue Code	250
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.75

PAPAVERINE HCL 30 MG/ML IJ SOLN

Facility

$19.50

Service Code	NDC 5428814210
Hospital Charge Code	5428814210
Hospital Revenue Code	250
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$15.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.75
Rate for Payer: Aetna Government	$9.75
Rate for Payer: Brighton Health Commercial	$14.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.26
Rate for Payer: EmblemHealth Commercial	$9.75
Rate for Payer: Group Health Inc Commercial	$9.75
Rate for Payer: Group Health Inc Medicare	$6.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.75
Rate for Payer: Hamaspik Choice Inc Medicare	$9.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.68

PAPAVERINE HCL 30 MG/ML IJ SOLN

Facility

$22.50

Service Code	NDC 7251602410
Hospital Charge Code	7251602410
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.25

PAP SMEARS

Facility

$57.62

Service Code	EAPG 00392
Min. Negotiated Rate	$41.66
Max. Negotiated Rate	$57.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41.66
Rate for Payer: Healthfirst Commercial	$57.62

PARAGARD INTRAUTERINE COPPER IU IUD

Facility

$1.00

Service Code	HCPCS J7300
Hospital Charge Code	5936551291
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

PARAGARD INTRAUTERINE COPPER IU IUD

Facility

$1.00

Service Code	HCPCS J7300
Hospital Charge Code	5936551291
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$937.00
Rate for Payer: Aetna Government	$937.00
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: EmblemHealth Commercial	$0.50
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

PARAGARD INTRAUTERINE COPPER IU IUD

Facility

$1.00

Service Code	HCPCS J7300
Hospital Charge Code	5936551281
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

PARAGARD INTRAUTERINE COPPER IU IUD

Facility

$1.00

Service Code	HCPCS J7300
Hospital Charge Code	5936551281
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$937.00
Rate for Payer: Aetna Government	$937.00
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: EmblemHealth Commercial	$0.50
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

Know your out-of-pocket cost for care.

All Charges