St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PHYTONADIONE 1 MG/0.5ML IJ SOLN

Facility

$59.35

Service Code	HCPCS J3430
Hospital Charge Code	7632912401
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$47.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.56
Rate for Payer: Aetna Government	$3.56
Rate for Payer: Brighton Health Commercial	$44.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.36
Rate for Payer: EmblemHealth Commercial	$29.68
Rate for Payer: Group Health Inc Commercial	$29.68
Rate for Payer: Group Health Inc Medicare	$20.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.68
Rate for Payer: Hamaspik Choice Inc Medicare	$29.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.58

PHYTONADIONE 1 MG/0.5ML IJ SOLN

Facility

$11.39

Service Code	HCPCS J3430
Hospital Charge Code	0409915701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$9.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.56
Rate for Payer: Aetna Government	$3.56
Rate for Payer: Brighton Health Commercial	$8.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.75
Rate for Payer: EmblemHealth Commercial	$5.70
Rate for Payer: Group Health Inc Commercial	$5.70
Rate for Payer: Group Health Inc Medicare	$3.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.70
Rate for Payer: Hamaspik Choice Inc Medicare	$5.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.40

PHYTONADIONE 1 MG/0.5ML IJ SOLN

Facility

$14.40

Service Code	HCPCS J3430
Hospital Charge Code	6909770996
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$11.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.56
Rate for Payer: Aetna Government	$3.56
Rate for Payer: Brighton Health Commercial	$10.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.79
Rate for Payer: EmblemHealth Commercial	$7.20
Rate for Payer: Group Health Inc Commercial	$7.20
Rate for Payer: Group Health Inc Medicare	$5.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.20
Rate for Payer: Hamaspik Choice Inc Medicare	$7.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.36

PHYTONADIONE 1 MG/0.5ML IJ SOLN

Facility

$11.39

Service Code	HCPCS J3430
Hospital Charge Code	0409915701
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.70

PHYTONADIONE 5 MG PO TABS

Facility

$102.71

Service Code	NDC 0904688210
Hospital Charge Code	0904688210
Hospital Revenue Code	250
Min. Negotiated Rate	$51.35
Max. Negotiated Rate	$51.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.35

PHYTONADIONE 5 MG PO TABS

Facility

$102.71

Service Code	NDC 0904688210
Hospital Charge Code	0904688210
Hospital Revenue Code	250
Min. Negotiated Rate	$35.95
Max. Negotiated Rate	$82.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.35
Rate for Payer: Aetna Government	$51.35
Rate for Payer: Brighton Health Commercial	$77.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.84
Rate for Payer: EmblemHealth Commercial	$51.35
Rate for Payer: Group Health Inc Commercial	$51.35
Rate for Payer: Group Health Inc Medicare	$35.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.35
Rate for Payer: Hamaspik Choice Inc Medicare	$51.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.76

PHYTONADIONE 5 MG PO TABS

Facility

$66.99

Service Code	NDC 6909799902
Hospital Charge Code	6909799902
Hospital Revenue Code	250
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$33.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.49

PHYTONADIONE 5 MG PO TABS

Facility

$66.99

Service Code	NDC 6909799902
Hospital Charge Code	6909799902
Hospital Revenue Code	250
Min. Negotiated Rate	$23.45
Max. Negotiated Rate	$53.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$33.49
Rate for Payer: Aetna Government	$33.49
Rate for Payer: Brighton Health Commercial	$50.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$45.55
Rate for Payer: EmblemHealth Commercial	$33.49
Rate for Payer: Group Health Inc Commercial	$33.49
Rate for Payer: Group Health Inc Medicare	$23.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.49
Rate for Payer: Hamaspik Choice Inc Medicare	$33.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.54

PILOCARPINE HCL 1 % OP SOLN

Facility

$6.57

Service Code	NDC 6923817458
Hospital Charge Code	6923817458
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$5.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.29
Rate for Payer: Aetna Government	$3.29
Rate for Payer: Brighton Health Commercial	$4.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.47
Rate for Payer: EmblemHealth Commercial	$3.29
Rate for Payer: Group Health Inc Commercial	$3.29
Rate for Payer: Group Health Inc Medicare	$2.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.29
Rate for Payer: Hamaspik Choice Inc Medicare	$3.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.27

PILOCARPINE HCL 1 % OP SOLN

Facility

$6.57

Service Code	NDC 6923817458
Hospital Charge Code	6923817458
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$3.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.29

PILOCARPINE HCL 1 % OP SOLN

Facility

$6.57

Service Code	NDC 6131420315
Hospital Charge Code	6131420315
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$5.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.29
Rate for Payer: Aetna Government	$3.29
Rate for Payer: Brighton Health Commercial	$4.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.47
Rate for Payer: EmblemHealth Commercial	$3.29
Rate for Payer: Group Health Inc Commercial	$3.29
Rate for Payer: Group Health Inc Medicare	$2.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.29
Rate for Payer: Hamaspik Choice Inc Medicare	$3.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.27

PILOCARPINE HCL 1 % OP SOLN

Facility

$6.57

Service Code	NDC 6131420315
Hospital Charge Code	6131420315
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$3.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.29

PILOCARPINE HCL 2 % OP SOLN

Facility

$6.72

Service Code	NDC 6131420415
Hospital Charge Code	6131420415
Hospital Revenue Code	250
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$5.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Brighton Health Commercial	$5.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.57
Rate for Payer: EmblemHealth Commercial	$3.36
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.37

PILOCARPINE HCL 2 % OP SOLN

Facility

$6.72

Service Code	NDC 6131420415
Hospital Charge Code	6131420415
Hospital Revenue Code	250
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$3.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36

PILOCARPINE HCL 4 % OP SOLN

Facility

$7.05

Service Code	NDC 6131420615
Hospital Charge Code	6131420615
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$3.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.52

PILOCARPINE HCL 4 % OP SOLN

Facility

$7.05

Service Code	NDC 6131420615
Hospital Charge Code	6131420615
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$5.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.52
Rate for Payer: Aetna Government	$3.52
Rate for Payer: Brighton Health Commercial	$5.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.79
Rate for Payer: EmblemHealth Commercial	$3.52
Rate for Payer: Group Health Inc Commercial	$3.52
Rate for Payer: Group Health Inc Medicare	$2.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.58

PILOCARPINE HCL 4 % OP SOLN

Facility

$6.63

Service Code	NDC 7006920101
Hospital Charge Code	7006920101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$5.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.31
Rate for Payer: Aetna Government	$3.31
Rate for Payer: Brighton Health Commercial	$4.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.51
Rate for Payer: EmblemHealth Commercial	$3.31
Rate for Payer: Group Health Inc Commercial	$3.31
Rate for Payer: Group Health Inc Medicare	$2.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.31
Rate for Payer: Hamaspik Choice Inc Medicare	$3.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.31

PILOCARPINE HCL 4 % OP SOLN

Facility

$6.63

Service Code	NDC 7006920101
Hospital Charge Code	7006920101
Hospital Revenue Code	250
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$3.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.31

PIMOZIDE 2 MG PO TABS

Facility

$2.44

Service Code	NDC 4988434801
Hospital Charge Code	4988434801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22

PIMOZIDE 2 MG PO TABS

Facility

$2.44

Service Code	NDC 4988434801
Hospital Charge Code	4988434801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.95
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	$1.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.66
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	$1.59

PIOGLITAZONE HCL 15 MG PO TABS

Facility

$7.01

Service Code	NDC 5723721930
Hospital Charge Code	5723721930
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50

PIOGLITAZONE HCL 15 MG PO TABS

Facility

$7.01

Service Code	NDC 5723721930
Hospital Charge Code	5723721930
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: EmblemHealth Commercial	$3.50
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

PIOGLITAZONE HCL 15 MG PO TABS

Facility

$1.56

Service Code	NDC 0904709061
Hospital Charge Code	0904709061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.78
Rate for Payer: Aetna Government	$0.78
Rate for Payer: Brighton Health Commercial	$1.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.06
Rate for Payer: EmblemHealth Commercial	$0.78
Rate for Payer: Group Health Inc Commercial	$0.78
Rate for Payer: Group Health Inc Medicare	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78
Rate for Payer: Hamaspik Choice Inc Medicare	$0.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.02

PIOGLITAZONE HCL 15 MG PO TABS

Facility

$1.56

Service Code	NDC 0904709061
Hospital Charge Code	0904709061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78

PIOGLITAZONE HCL 45 MG PO TABS

Facility

$11.61

Service Code	NDC 5723722190
Hospital Charge Code	5723722190
Hospital Revenue Code	250
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$5.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.81

Know your out-of-pocket cost for care.

All Charges