St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SERTRALINE HCL 100 MG PO TABS

Facility

$0.55

Service Code	NDC 0904692661
Hospital Charge Code	0904692661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

SERTRALINE HCL 100 MG PO TABS

Facility

$0.55

Service Code	NDC 0904692661
Hospital Charge Code	0904692661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.44
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	$0.44
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	$0.36

SERTRALINE HCL 100 MG PO TABS

Facility

$2.85

Service Code	NDC 6586201330
Hospital Charge Code	6586201330
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42

SERTRALINE HCL 25 MG PO TABS

Facility

$2.85

Service Code	NDC 6586201130
Hospital Charge Code	6586201130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42

SERTRALINE HCL 25 MG PO TABS

Facility

$0.40

Service Code	NDC 6068723111
Hospital Charge Code	6068723111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

SERTRALINE HCL 25 MG PO TABS

Facility

$0.40

Service Code	NDC 6068723111
Hospital Charge Code	6068723111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

SERTRALINE HCL 25 MG PO TABS

Facility

$0.42

Service Code	NDC 0904692461
Hospital Charge Code	0904692461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.28
Rate for Payer: EmblemHealth Commercial	$0.21
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

SERTRALINE HCL 25 MG PO TABS

Facility

$0.40

Service Code	NDC 6068723101
Hospital Charge Code	6068723101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

SERTRALINE HCL 25 MG PO TABS

Facility

$0.42

Service Code	NDC 0904692461
Hospital Charge Code	0904692461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21

SERTRALINE HCL 25 MG PO TABS

Facility

$0.40

Service Code	NDC 6068723101
Hospital Charge Code	6068723101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

SERTRALINE HCL 25 MG PO TABS

Facility

$2.71

Service Code	NDC 6909783312
Hospital Charge Code	6909783312
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36

SERTRALINE HCL 25 MG PO TABS

Facility

$2.85

Service Code	NDC 6586201130
Hospital Charge Code	6586201130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.42
Rate for Payer: Aetna Government	$1.42
Rate for Payer: Brighton Health Commercial	$2.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.94
Rate for Payer: EmblemHealth Commercial	$1.42
Rate for Payer: Group Health Inc Commercial	$1.42
Rate for Payer: Group Health Inc Medicare	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.85

SERTRALINE HCL 25 MG PO TABS

Facility

$2.71

Service Code	NDC 6909783312
Hospital Charge Code	6909783312
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.36
Rate for Payer: Aetna Government	$1.36
Rate for Payer: Brighton Health Commercial	$2.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.85
Rate for Payer: EmblemHealth Commercial	$1.36
Rate for Payer: Group Health Inc Commercial	$1.36
Rate for Payer: Group Health Inc Medicare	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.76

SERTRALINE HCL 50 MG PO TABS

Facility

$2.71

Service Code	NDC 6909783412
Hospital Charge Code	6909783412
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36

SERTRALINE HCL 50 MG PO TABS

Facility

$2.71

Service Code	NDC 6909783412
Hospital Charge Code	6909783412
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.36
Rate for Payer: Aetna Government	$1.36
Rate for Payer: Brighton Health Commercial	$2.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.85
Rate for Payer: EmblemHealth Commercial	$1.36
Rate for Payer: Group Health Inc Commercial	$1.36
Rate for Payer: Group Health Inc Medicare	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.76

SERTRALINE HCL 50 MG PO TABS

Facility

$2.85

Service Code	NDC 6586201205
Hospital Charge Code	6586201205
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.42
Rate for Payer: Aetna Government	$1.42
Rate for Payer: Brighton Health Commercial	$2.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.94
Rate for Payer: EmblemHealth Commercial	$1.42
Rate for Payer: Group Health Inc Commercial	$1.42
Rate for Payer: Group Health Inc Medicare	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.85

SERTRALINE HCL 50 MG PO TABS

Facility

$0.48

Service Code	NDC 0904692561
Hospital Charge Code	0904692561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24

SERTRALINE HCL 50 MG PO TABS

Facility

$2.85

Service Code	NDC 6586201230
Hospital Charge Code	6586201230
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42

SERTRALINE HCL 50 MG PO TABS

Facility

$2.85

Service Code	NDC 6586201205
Hospital Charge Code	6586201205
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42

SERTRALINE HCL 50 MG PO TABS

Facility

$2.85

Service Code	NDC 6586201230
Hospital Charge Code	6586201230
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.42
Rate for Payer: Aetna Government	$1.42
Rate for Payer: Brighton Health Commercial	$2.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.94
Rate for Payer: EmblemHealth Commercial	$1.42
Rate for Payer: Group Health Inc Commercial	$1.42
Rate for Payer: Group Health Inc Medicare	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.85

SERTRALINE HCL 50 MG PO TABS

Facility

$0.48

Service Code	NDC 0904692561
Hospital Charge Code	0904692561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: EmblemHealth Commercial	$0.24
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

SEVELAMER CARBONATE 2.4 G PO PACK

Facility

$18.29

Service Code	NDC 6586293108
Hospital Charge Code	6586293108
Hospital Revenue Code	250
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$14.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.14
Rate for Payer: Aetna Government	$9.14
Rate for Payer: Brighton Health Commercial	$13.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.44
Rate for Payer: EmblemHealth Commercial	$9.14
Rate for Payer: Group Health Inc Commercial	$9.14
Rate for Payer: Group Health Inc Medicare	$6.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.14
Rate for Payer: Hamaspik Choice Inc Medicare	$9.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.89

SEVELAMER CARBONATE 2.4 G PO PACK

Facility

$18.29

Service Code	NDC 6586293108
Hospital Charge Code	6586293108
Hospital Revenue Code	250
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$9.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.14

SEVELAMER CARBONATE 2.4 G PO PACK

Facility

$18.29

Service Code	NDC 6586293190
Hospital Charge Code	6586293190
Hospital Revenue Code	250
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$14.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.14
Rate for Payer: Aetna Government	$9.14
Rate for Payer: Brighton Health Commercial	$13.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.43
Rate for Payer: EmblemHealth Commercial	$9.14
Rate for Payer: Group Health Inc Commercial	$9.14
Rate for Payer: Group Health Inc Medicare	$6.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.14
Rate for Payer: Hamaspik Choice Inc Medicare	$9.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.89

SEVELAMER CARBONATE 2.4 G PO PACK

Facility

$18.29

Service Code	NDC 6586293190
Hospital Charge Code	6586293190
Hospital Revenue Code	250
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$9.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.14

Know your out-of-pocket cost for care.

All Charges