St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HYDROSET XT INJ BONE 897005

Facility

$5,212.00

Hospital Charge Code	64906696
Hospital Revenue Code	279
Min. Negotiated Rate	$1,824.20
Max. Negotiated Rate	$4,169.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,866.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,606.00
Rate for Payer: Aetna Government	$2,606.00
Rate for Payer: Brighton Health Commercial	$3,909.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,169.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,544.16
Rate for Payer: Group Health Inc Commercial	$2,606.00
Rate for Payer: Group Health Inc Medicare	$1,824.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,606.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,606.00

HYDROXOCOBALAMIN 5G INJ

Facility

$1,862.80

Hospital Charge Code	41656597
Hospital Revenue Code	250
Min. Negotiated Rate	$651.98
Max. Negotiated Rate	$1,490.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,024.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$931.40
Rate for Payer: Aetna Government	$931.40
Rate for Payer: Brighton Health Commercial	$1,397.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,490.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,266.70
Rate for Payer: Group Health Inc Commercial	$931.40
Rate for Payer: Group Health Inc Medicare	$651.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$931.40
Rate for Payer: Hamaspik Choice Inc Medicare	$931.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,210.82

HYDROXOCOBALAMIN 5G INJ

Facility

$1,862.80

Hospital Charge Code	41646597
Hospital Revenue Code	250
Min. Negotiated Rate	$651.98
Max. Negotiated Rate	$1,490.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,024.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$931.40
Rate for Payer: Aetna Government	$931.40
Rate for Payer: Brighton Health Commercial	$1,397.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,490.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,266.70
Rate for Payer: Group Health Inc Commercial	$931.40
Rate for Payer: Group Health Inc Medicare	$651.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$931.40
Rate for Payer: Hamaspik Choice Inc Medicare	$931.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,210.82

HYDROXOCOBALAMIN 5 G IV SOLR [111437]

Facility

$1,162.80

Service Code	NDC 50633031011
Hospital Charge Code	50633031011
Hospital Revenue Code	278
Min. Negotiated Rate	$406.98
Max. Negotiated Rate	$1,220.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$639.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$581.40
Rate for Payer: Aetna Government	$581.40
Rate for Payer: Brighton Health Commercial	$697.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$581.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$668.61
Rate for Payer: EmblemHealth Commercial	$581.40
Rate for Payer: Fidelis Medicare Advantage	$1,220.94
Rate for Payer: Group Health Inc Commercial	$581.40
Rate for Payer: Group Health Inc Medicare	$406.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$581.40
Rate for Payer: Hamaspik Choice Inc Medicare	$581.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$755.82

HYDROXOCOBALAMIN 5 G IV SOLR [111437]

Facility

$1,162.80

Service Code	NDC 50633031011
Hospital Charge Code	50633031011
Hospital Revenue Code	278
Min. Negotiated Rate	$581.40
Max. Negotiated Rate	$581.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$581.40
Rate for Payer: Hamaspik Choice Inc Medicare	$581.40

HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS [10235]

Facility

$1.52

Service Code	NDC 00904704606
Hospital Charge Code	00904704606
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Brighton Health Commercial	$1.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.03
Rate for Payer: Group Health Inc Commercial	$0.76
Rate for Payer: Group Health Inc Medicare	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.76
Rate for Payer: Hamaspik Choice Inc Medicare	$0.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.98

HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS [10235]

Facility

$4.09

Service Code	NDC 43598072101
Hospital Charge Code	43598072101
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	$3.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.78
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

HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS [10235]

Facility

$4.09

Service Code	NDC 00781599401
Hospital Charge Code	00781599401
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	$3.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.78
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

HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS [10235]

Facility

$4.36

Service Code	NDC 16571068701
Hospital Charge Code	16571068701
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$3.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.18
Rate for Payer: Aetna Government	$2.18
Rate for Payer: Brighton Health Commercial	$3.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.96
Rate for Payer: Group Health Inc Commercial	$2.18
Rate for Payer: Group Health Inc Medicare	$1.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.18
Rate for Payer: Hamaspik Choice Inc Medicare	$2.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.83

HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS [10235]

Facility

$4.07

Service Code	NDC 16729048501
Hospital Charge Code	16729048501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
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	$3.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.77
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.42
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

HYDROXYPROPYLMETHYLCELLULOSE 2.5% OPHTHA

Facility

$7.64

Hospital Charge Code	41643549
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$6.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.82
Rate for Payer: Aetna Government	$3.82
Rate for Payer: Brighton Health Commercial	$5.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.20
Rate for Payer: Group Health Inc Commercial	$3.82
Rate for Payer: Group Health Inc Medicare	$2.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.82
Rate for Payer: Hamaspik Choice Inc Medicare	$3.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.97

HYDROXYPROPYLMETHYLCELLULOSE 2.5% OPHTHA

Facility

$7.64

Hospital Charge Code	41653549
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$6.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.82
Rate for Payer: Aetna Government	$3.82
Rate for Payer: Brighton Health Commercial	$5.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.20
Rate for Payer: Group Health Inc Commercial	$3.82
Rate for Payer: Group Health Inc Medicare	$2.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.82
Rate for Payer: Hamaspik Choice Inc Medicare	$3.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.97

HYDROXYUREA 100MG/ML ORAL SOLN

Facility

$0.17

Service Code	HCPCS J8999
Hospital Charge Code	41657277
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

HYDROXYUREA 100MG/ML ORAL SOLN

Facility

$0.17

Service Code	HCPCS J8999
Hospital Charge Code	41657277
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09

HYDROXYUREA 100MG/ML ORAL SOLN

Facility

$0.17

Service Code	HCPCS J8999
Hospital Charge Code	41647277
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09

HYDROXYUREA 100MG/ML ORAL SOLN

Facility

$0.17

Service Code	HCPCS J8999
Hospital Charge Code	41647277
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

HYDROXYUREA 500 MG CAP

Facility

$0.82

Service Code	HCPCS S0176
Hospital Charge Code	41650941
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
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	$0.53

HYDROXYUREA 500 MG CAP

Facility

$0.82

Service Code	HCPCS S0176
Hospital Charge Code	41650941
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41

HYDROXYUREA 500 MG CAP

Facility

$0.82

Service Code	HCPCS S0176
Hospital Charge Code	41640941
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
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	$0.53

HYDROXYUREA 500 MG CAP

Facility

$0.82

Service Code	HCPCS S0176
Hospital Charge Code	41640941
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41

HYDROXYUREA 500 MG PO CAPS [10236]

Facility

$1.47

Service Code	NDC 00555088202
Hospital Charge Code	00555088202
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.74
Rate for Payer: Aetna Government	$0.74
Rate for Payer: Brighton Health Commercial	$1.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.00
Rate for Payer: Group Health Inc Commercial	$0.74
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.74
Rate for Payer: Hamaspik Choice Inc Medicare	$0.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.96

HYDROXYUREA 500 MG PO CAPS [10236]

Facility

$1.16

Service Code	NDC 00904693961
Hospital Charge Code	00904693961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.58
Rate for Payer: Aetna Government	$0.58
Rate for Payer: Brighton Health Commercial	$0.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.79
Rate for Payer: Group Health Inc Commercial	$0.58
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58
Rate for Payer: Hamaspik Choice Inc Medicare	$0.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.75

HYDROXYZINE 25MG/1ML INJ

Facility

$5.00

Service Code	HCPCS J3410
Hospital Charge Code	41646015
Hospital Revenue Code	636
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$14.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.03
Rate for Payer: Aetna Government	$9.03
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.88
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$14.70
Rate for Payer: SOMOS Essential	$14.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

HYDROXYZINE 25MG/1ML INJ

Facility

$5.00

Service Code	HCPCS J3410
Hospital Charge Code	41646015
Hospital Revenue Code	636
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50

HYDROXYZINE HCL 10 MG/5ML PO SYRP [3771]

Facility

$1.27

Service Code	NDC 62135050247
Hospital Charge Code	62135050247
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$1.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: Group Health Inc Commercial	$0.63
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.82

Know your out-of-pocket cost for care.

All Charges