St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN

Facility

$1.52

Service Code	NDC 7006936101
Hospital Charge Code	7006936101
Hospital Revenue Code	258
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
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	$1.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.03
Rate for Payer: EmblemHealth Commercial	$0.76
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	$0.99

SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN

Facility

$1.52

Service Code	NDC 7006936101
Hospital Charge Code	7006936101
Hospital Revenue Code	258
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.76

SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN

Facility

$1.52

Service Code	NDC 7006936210
Hospital Charge Code	7006936210
Hospital Revenue Code	258
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
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	$1.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.03
Rate for Payer: EmblemHealth Commercial	$0.76
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	$0.99

SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN

Facility

$1.52

Service Code	NDC 7006936210
Hospital Charge Code	7006936210
Hospital Revenue Code	258
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.76

SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN

Facility

$1.52

Service Code	NDC 7006936201
Hospital Charge Code	7006936201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
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	$1.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.03
Rate for Payer: EmblemHealth Commercial	$0.76
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	$0.99

SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN

Facility

$1.52

Service Code	NDC 7006936201
Hospital Charge Code	7006936201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.76

SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS

Facility

$0.67

Service Code	NDC 6586241901
Hospital Charge Code	6586241901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS

Facility

$0.66

Service Code	NDC 5026872815
Hospital Charge Code	5026872815
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS

Facility

$0.67

Service Code	NDC 6586241901
Hospital Charge Code	6586241901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS

Facility

$0.66

Service Code	NDC 5026872815
Hospital Charge Code	5026872815
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS

Facility

$0.37

Service Code	NDC 0904272561
Hospital Charge Code	0904272561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19

SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS

Facility

$0.32

Service Code	NDC 6068761411
Hospital Charge Code	6068761411
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: EmblemHealth Commercial	$0.16
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.21

SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS

Facility

$0.91

Service Code	NDC 6586242005
Hospital Charge Code	6586242005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45

SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS

Facility

$1.15

Service Code	NDC 6586242001
Hospital Charge Code	6586242001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58

SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS

Facility

$1.15

Service Code	NDC 6586242001
Hospital Charge Code	6586242001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.63
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	$0.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: EmblemHealth Commercial	$0.58
Rate for Payer: Group Health Inc Commercial	$0.58
Rate for Payer: Group Health Inc Medicare	$0.40
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

SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS

Facility

$0.37

Service Code	NDC 0904272561
Hospital Charge Code	0904272561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Brighton Health Commercial	$0.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.25
Rate for Payer: EmblemHealth Commercial	$0.19
Rate for Payer: Group Health Inc Commercial	$0.19
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19
Rate for Payer: Hamaspik Choice Inc Medicare	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.24

SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS

Facility

$0.91

Service Code	NDC 6586242005
Hospital Charge Code	6586242005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.62
Rate for Payer: EmblemHealth Commercial	$0.45
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS

Facility

$0.32

Service Code	NDC 6068761411
Hospital Charge Code	6068761411
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16

SULFASALAZINE 500 MG PO TABS

Facility

$0.26

Service Code	NDC 0093323401
Hospital Charge Code	0093323401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

SULFASALAZINE 500 MG PO TABS

Facility

$1.93

Service Code	NDC 0013010110
Hospital Charge Code	0013010110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$1.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.31
Rate for Payer: EmblemHealth Commercial	$0.97
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.26

SULFASALAZINE 500 MG PO TABS

Facility

$0.26

Service Code	NDC 0093323401
Hospital Charge Code	0093323401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

SULFASALAZINE 500 MG PO TABS

Facility

$1.93

Service Code	NDC 0013010110
Hospital Charge Code	0013010110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97

SULFASALAZINE 500 MG PO TABS

Facility

$0.23

Service Code	NDC 5976250005
Hospital Charge Code	5976250005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: EmblemHealth Commercial	$0.12
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

SULFASALAZINE 500 MG PO TABS

Facility

$2.40

Service Code	NDC 6213596001
Hospital Charge Code	6213596001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.20
Rate for Payer: Aetna Government	$1.20
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.63
Rate for Payer: EmblemHealth Commercial	$1.20
Rate for Payer: Group Health Inc Commercial	$1.20
Rate for Payer: Group Health Inc Medicare	$0.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.20
Rate for Payer: Hamaspik Choice Inc Medicare	$1.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.56

SULFASALAZINE 500 MG PO TABS

Facility

$2.40

Service Code	NDC 6213596001
Hospital Charge Code	6213596001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.20

Know your out-of-pocket cost for care.

All Charges