St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ACETAZOLAMIDE ER 500 MG PO CP12

Facility

$4.29

Service Code	NDC 5074223301
Hospital Charge Code	5074223301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.15
Rate for Payer: Aetna Government	$2.15
Rate for Payer: Brighton Health Commercial	$3.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.92
Rate for Payer: EmblemHealth Commercial	$2.15
Rate for Payer: Group Health Inc Commercial	$2.15
Rate for Payer: Group Health Inc Medicare	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.15
Rate for Payer: Hamaspik Choice Inc Medicare	$2.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.79

ACETAZOLAMIDE SODIUM 500 MG IJ SOLR

Facility

$48.00

Service Code	HCPCS J1120
Hospital Charge Code	6745785350
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$38.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.13
Rate for Payer: Aetna Government	$20.13
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.64
Rate for Payer: EmblemHealth Commercial	$24.00
Rate for Payer: Group Health Inc Commercial	$24.00
Rate for Payer: Group Health Inc Medicare	$16.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.00
Rate for Payer: Hamaspik Choice Inc Medicare	$24.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.20

ACETAZOLAMIDE SODIUM 500 MG IJ SOLR

Facility

$47.64

Service Code	HCPCS J1120
Hospital Charge Code	2315531331
Hospital Revenue Code	250
Min. Negotiated Rate	$16.67
Max. Negotiated Rate	$38.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.13
Rate for Payer: Aetna Government	$20.13
Rate for Payer: Brighton Health Commercial	$35.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.40
Rate for Payer: EmblemHealth Commercial	$23.82
Rate for Payer: Group Health Inc Commercial	$23.82
Rate for Payer: Group Health Inc Medicare	$16.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.82
Rate for Payer: Hamaspik Choice Inc Medicare	$23.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.97

ACETAZOLAMIDE SODIUM 500 MG IJ SOLR

Facility

$48.00

Service Code	HCPCS J1120
Hospital Charge Code	6745785350
Hospital Revenue Code	250
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.00

ACETAZOLAMIDE SODIUM 500 MG IJ SOLR

Facility

$47.64

Service Code	HCPCS J1120
Hospital Charge Code	2315531331
Hospital Revenue Code	250
Min. Negotiated Rate	$23.82
Max. Negotiated Rate	$23.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.82

ACETAZOLAMIDE SODIUM 500 MG IJ SOLR

Facility

$39.38

Service Code	HCPCS J1120
Hospital Charge Code	3982201901
Hospital Revenue Code	250
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$31.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.13
Rate for Payer: Aetna Government	$20.13
Rate for Payer: Brighton Health Commercial	$29.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.78
Rate for Payer: EmblemHealth Commercial	$19.69
Rate for Payer: Group Health Inc Commercial	$19.69
Rate for Payer: Group Health Inc Medicare	$13.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.69
Rate for Payer: Hamaspik Choice Inc Medicare	$19.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.60

ACETAZOLAMIDE SODIUM 500 MG IJ SOLR

Facility

$39.38

Service Code	HCPCS J1120
Hospital Charge Code	3982201901
Hospital Revenue Code	250
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$19.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.69

ACETIC ACID 0.25 % IR SOLN

Facility

$0.01

Service Code	NDC 0338065604
Hospital Charge Code	0338065604
Hospital Revenue Code	250
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

ACETIC ACID 0.25 % IR SOLN

Facility

$0.01

Service Code	NDC 0338065604
Hospital Charge Code	0338065604
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ACETIC ACID 2 % OT SOLN

Facility

$3.20

Service Code	NDC 5281781615
Hospital Charge Code	5281781615
Hospital Revenue Code	250
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$1.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60

ACETIC ACID 2 % OT SOLN

Facility

$2.67

Service Code	NDC 6043274116
Hospital Charge Code	6043274116
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$2.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.33
Rate for Payer: Aetna Government	$1.33
Rate for Payer: Brighton Health Commercial	$2.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.81
Rate for Payer: EmblemHealth Commercial	$1.33
Rate for Payer: Group Health Inc Commercial	$1.33
Rate for Payer: Group Health Inc Medicare	$0.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.33
Rate for Payer: Hamaspik Choice Inc Medicare	$1.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.73

ACETIC ACID 2 % OT SOLN

Facility

$3.20

Service Code	NDC 5281781615
Hospital Charge Code	5281781615
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$2.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.60
Rate for Payer: Aetna Government	$1.60
Rate for Payer: Brighton Health Commercial	$2.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.18
Rate for Payer: EmblemHealth Commercial	$1.60
Rate for Payer: Group Health Inc Commercial	$1.60
Rate for Payer: Group Health Inc Medicare	$1.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.08

ACETIC ACID 2 % OT SOLN

Facility

$2.67

Service Code	NDC 6043274116
Hospital Charge Code	6043274116
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$1.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.33

ACETYLCHOLINE CHLORIDE 20 MG IO SOLR

Facility

$154.37

Service Code	NDC 2420853920
Hospital Charge Code	2420853920
Hospital Revenue Code	250
Min. Negotiated Rate	$77.19
Max. Negotiated Rate	$77.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.19

ACETYLCHOLINE CHLORIDE 20 MG IO SOLR

Facility

$154.37

Service Code	NDC 2420853920
Hospital Charge Code	2420853920
Hospital Revenue Code	250
Min. Negotiated Rate	$54.03
Max. Negotiated Rate	$123.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.19
Rate for Payer: Aetna Government	$77.19
Rate for Payer: Brighton Health Commercial	$115.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$123.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.97
Rate for Payer: EmblemHealth Commercial	$77.19
Rate for Payer: Group Health Inc Commercial	$77.19
Rate for Payer: Group Health Inc Medicare	$54.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.19
Rate for Payer: Hamaspik Choice Inc Medicare	$77.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.34

ACETYLCYSTEINE 10 % IN SOLN

Facility

$12.22

Service Code	HCPCS J7608
Hospital Charge Code	7006901801
Hospital Revenue Code	250
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$9.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$9.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.31
Rate for Payer: EmblemHealth Commercial	$6.11
Rate for Payer: Group Health Inc Commercial	$6.11
Rate for Payer: Group Health Inc Medicare	$4.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.11
Rate for Payer: Hamaspik Choice Inc Medicare	$6.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.94

ACETYLCYSTEINE 10 % IN SOLN

Facility

$1.60

Service Code	HCPCS J7608
Hospital Charge Code	6332369310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80

ACETYLCYSTEINE 10 % IN SOLN

Facility

$2.98

Service Code	HCPCS J7608
Hospital Charge Code	0517750401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$8.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$2.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.03
Rate for Payer: EmblemHealth Commercial	$1.49
Rate for Payer: Group Health Inc Commercial	$1.49
Rate for Payer: Group Health Inc Medicare	$1.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.49
Rate for Payer: Hamaspik Choice Inc Medicare	$1.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.94

ACETYLCYSTEINE 10 % IN SOLN

Facility

$3.36

Service Code	HCPCS J7608
Hospital Charge Code	6332369504
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$8.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$2.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.28
Rate for Payer: EmblemHealth Commercial	$1.68
Rate for Payer: Group Health Inc Commercial	$1.68
Rate for Payer: Group Health Inc Medicare	$1.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.18

ACETYLCYSTEINE 10 % IN SOLN

Facility

$12.22

Service Code	HCPCS J7608
Hospital Charge Code	7006901801
Hospital Revenue Code	250
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$6.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.11

ACETYLCYSTEINE 10 % IN SOLN

Facility

$3.36

Service Code	HCPCS J7608
Hospital Charge Code	6332369504
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68

ACETYLCYSTEINE 10 % IN SOLN

Facility

$0.73

Service Code	HCPCS J7608
Hospital Charge Code	6332369130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37

ACETYLCYSTEINE 10 % IN SOLN

Facility

$0.73

Service Code	HCPCS J7608
Hospital Charge Code	6332369130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$8.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.50
Rate for Payer: EmblemHealth Commercial	$0.37
Rate for Payer: Group Health Inc Commercial	$0.37
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37
Rate for Payer: Hamaspik Choice Inc Medicare	$0.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

ACETYLCYSTEINE 10 % IN SOLN

Facility

$1.60

Service Code	HCPCS J7608
Hospital Charge Code	6332369310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$8.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.08
Rate for Payer: Aetna Government	$6.08
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: EmblemHealth Commercial	$0.80
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.04

ACETYLCYSTEINE 10 % IN SOLN

Facility

$2.98

Service Code	HCPCS J7608
Hospital Charge Code	0517750401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$1.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.49

Know your out-of-pocket cost for care.

All Charges