St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

QUETIAPINE FUMARATE 300 MG PO TABS

Facility

$0.54

Service Code	NDC 0904664261
Hospital Charge Code	0904664261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

QUETIAPINE FUMARATE 300 MG PO TABS

Facility

$16.96

Service Code	NDC 2930015116
Hospital Charge Code	2930015116
Hospital Revenue Code	250
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$13.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.48
Rate for Payer: Aetna Government	$8.48
Rate for Payer: Brighton Health Commercial	$12.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.53
Rate for Payer: EmblemHealth Commercial	$8.48
Rate for Payer: Group Health Inc Commercial	$8.48
Rate for Payer: Group Health Inc Medicare	$5.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.48
Rate for Payer: Hamaspik Choice Inc Medicare	$8.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.03

QUETIAPINE FUMARATE 300 MG PO TABS

Facility

$16.96

Service Code	NDC 2930015116
Hospital Charge Code	2930015116
Hospital Revenue Code	250
Min. Negotiated Rate	$8.48
Max. Negotiated Rate	$8.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.48

QUETIAPINE FUMARATE 300 MG PO TABS

Facility

$0.54

Service Code	NDC 0904664261
Hospital Charge Code	0904664261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

QUETIAPINE FUMARATE 300 MG PO TABS

Facility

$10.15

Service Code	NDC 5026863415
Hospital Charge Code	5026863415
Hospital Revenue Code	250
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$5.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.07

QUETIAPINE FUMARATE 300 MG PO TABS

Facility

$10.15

Service Code	NDC 5026863415
Hospital Charge Code	5026863415
Hospital Revenue Code	250
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$8.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.07
Rate for Payer: Aetna Government	$5.07
Rate for Payer: Brighton Health Commercial	$7.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
Rate for Payer: EmblemHealth Commercial	$5.07
Rate for Payer: Group Health Inc Commercial	$5.07
Rate for Payer: Group Health Inc Medicare	$3.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.07
Rate for Payer: Hamaspik Choice Inc Medicare	$5.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.60

QUETIAPINE FUMARATE 400 MG PO TABS

Facility

$1.68

Service Code	NDC 0904664361
Hospital Charge Code	0904664361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84

QUETIAPINE FUMARATE 400 MG PO TABS

Facility

$1.68

Service Code	NDC 0904664361
Hospital Charge Code	0904664361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: EmblemHealth Commercial	$0.84
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

QUETIAPINE FUMARATE 400 MG PO TABS

Facility

$19.74

Service Code	NDC 6787724801
Hospital Charge Code	6787724801
Hospital Revenue Code	250
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$9.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.87

QUETIAPINE FUMARATE 400 MG PO TABS

Facility

$19.74

Service Code	NDC 6787724801
Hospital Charge Code	6787724801
Hospital Revenue Code	250
Min. Negotiated Rate	$6.91
Max. Negotiated Rate	$15.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.87
Rate for Payer: Aetna Government	$9.87
Rate for Payer: Brighton Health Commercial	$14.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.43
Rate for Payer: EmblemHealth Commercial	$9.87
Rate for Payer: Group Health Inc Commercial	$9.87
Rate for Payer: Group Health Inc Medicare	$6.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.87
Rate for Payer: Hamaspik Choice Inc Medicare	$9.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.83

QUETIAPINE FUMARATE 50 MG PO TABS

Facility

$6.40

Service Code	NDC 4733590318
Hospital Charge Code	4733590318
Hospital Revenue Code	250
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$5.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.20
Rate for Payer: Aetna Government	$3.20
Rate for Payer: Brighton Health Commercial	$4.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.35
Rate for Payer: EmblemHealth Commercial	$3.20
Rate for Payer: Group Health Inc Commercial	$3.20
Rate for Payer: Group Health Inc Medicare	$2.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.20
Rate for Payer: Hamaspik Choice Inc Medicare	$3.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.16

QUETIAPINE FUMARATE 50 MG PO TABS

Facility

$6.40

Service Code	NDC 4733590318
Hospital Charge Code	4733590318
Hospital Revenue Code	250
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$3.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.20

QUETIAPINE FUMARATE 50 MG PO TABS

Facility

$6.57

Service Code	NDC 6787724910
Hospital Charge Code	6787724910
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$3.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.29

QUETIAPINE FUMARATE 50 MG PO TABS

Facility

$6.57

Service Code	NDC 6787724910
Hospital Charge Code	6787724910
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

QUETIAPINE FUMARATE 50 MG PO TABS

Facility

$6.19

Service Code	NDC 5026863115
Hospital Charge Code	5026863115
Hospital Revenue Code	250
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$3.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.09

QUETIAPINE FUMARATE 50 MG PO TABS

Facility

$6.19

Service Code	NDC 5026863115
Hospital Charge Code	5026863115
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$4.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.09
Rate for Payer: Aetna Government	$3.09
Rate for Payer: Brighton Health Commercial	$4.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.21
Rate for Payer: EmblemHealth Commercial	$3.09
Rate for Payer: Group Health Inc Commercial	$3.09
Rate for Payer: Group Health Inc Medicare	$2.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.09
Rate for Payer: Hamaspik Choice Inc Medicare	$3.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.02

QUETIAPINE FUMARATE 50 MG PO TABS

Facility

$0.56

Service Code	NDC 0904663961
Hospital Charge Code	0904663961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: EmblemHealth Commercial	$0.28
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.37

QUETIAPINE FUMARATE 50 MG PO TABS

Facility

$0.56

Service Code	NDC 0904663961
Hospital Charge Code	0904663961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28

QUINIDINE GLUCONATE ER 324 MG PO TBCR

Facility

$15.30

Service Code	NDC 5140728801
Hospital Charge Code	5140728801
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.65

QUINIDINE GLUCONATE ER 324 MG PO TBCR

Facility

$9.06

Service Code	NDC 5348914101
Hospital Charge Code	5348914101
Hospital Revenue Code	250
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$4.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.53

QUINIDINE GLUCONATE ER 324 MG PO TBCR

Facility

$9.06

Service Code	NDC 5348914101
Hospital Charge Code	5348914101
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$7.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.53
Rate for Payer: Aetna Government	$4.53
Rate for Payer: Brighton Health Commercial	$6.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.16
Rate for Payer: EmblemHealth Commercial	$4.53
Rate for Payer: Group Health Inc Commercial	$4.53
Rate for Payer: Group Health Inc Medicare	$3.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.53
Rate for Payer: Hamaspik Choice Inc Medicare	$4.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.89

QUINIDINE GLUCONATE ER 324 MG PO TBCR

Facility

$15.30

Service Code	NDC 5140728801
Hospital Charge Code	5140728801
Hospital Revenue Code	250
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$12.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.65
Rate for Payer: Aetna Government	$7.65
Rate for Payer: Brighton Health Commercial	$11.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.40
Rate for Payer: EmblemHealth Commercial	$7.65
Rate for Payer: Group Health Inc Commercial	$7.65
Rate for Payer: Group Health Inc Medicare	$5.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.65
Rate for Payer: Hamaspik Choice Inc Medicare	$7.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.95

QUINIDINE SULFATE 200 MG PO TABS

Facility

$15.09

Service Code	NDC 4280651330
Hospital Charge Code	4280651330
Hospital Revenue Code	250
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$12.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.54
Rate for Payer: Aetna Government	$7.54
Rate for Payer: Brighton Health Commercial	$11.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.26
Rate for Payer: EmblemHealth Commercial	$7.54
Rate for Payer: Group Health Inc Commercial	$7.54
Rate for Payer: Group Health Inc Medicare	$5.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.54
Rate for Payer: Hamaspik Choice Inc Medicare	$7.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.81

QUINIDINE SULFATE 200 MG PO TABS

Facility

$15.09

Service Code	NDC 4280651330
Hospital Charge Code	4280651330
Hospital Revenue Code	250
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$7.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.54

QUINIDINE SULFATE 300 MG PO TABS

Facility

$15.90

Service Code	NDC 4280651230
Hospital Charge Code	4280651230
Hospital Revenue Code	250
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$12.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.95
Rate for Payer: Aetna Government	$7.95
Rate for Payer: Brighton Health Commercial	$11.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.81
Rate for Payer: EmblemHealth Commercial	$7.95
Rate for Payer: Group Health Inc Commercial	$7.95
Rate for Payer: Group Health Inc Medicare	$5.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.95
Rate for Payer: Hamaspik Choice Inc Medicare	$7.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.34

Know your out-of-pocket cost for care.

All Charges