St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$5.97

Service Code	HCPCS J3411
Hospital Charge Code	2502150002
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.08
Rate for Payer: Aetna Government	$3.08
Rate for Payer: Brighton Health Commercial	$4.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.06
Rate for Payer: EmblemHealth Commercial	$2.98
Rate for Payer: Group Health Inc Commercial	$2.98
Rate for Payer: Group Health Inc Medicare	$2.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.98
Rate for Payer: Hamaspik Choice Inc Medicare	$2.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.88

THIAMINE MONONITRATE 100 MG PO TABS

Facility

$0.23

Service Code	NDC 6809411661
Hospital Charge Code	6809411661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: EmblemHealth Commercial	$0.11
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

THIAMINE MONONITRATE 100 MG PO TABS

Facility

$0.31

Service Code	NDC 5026885115
Hospital Charge Code	5026885115
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	$0.20

THIAMINE MONONITRATE 100 MG PO TABS

Facility

$0.31

Service Code	NDC 5026885115
Hospital Charge Code	5026885115
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16

THIAMINE MONONITRATE 100 MG PO TABS

Facility

$0.19

Service Code	NDC 7733393410
Hospital Charge Code	7733393410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

THIAMINE MONONITRATE 100 MG PO TABS

Facility

$0.19

Service Code	NDC 7733393425
Hospital Charge Code	7733393425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

THIAMINE MONONITRATE 100 MG PO TABS

Facility

$0.19

Service Code	NDC 7733393425
Hospital Charge Code	7733393425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

THIAMINE MONONITRATE 100 MG PO TABS

Facility

$0.19

Service Code	NDC 7733393410
Hospital Charge Code	7733393410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

THIAMINE MONONITRATE 100 MG PO TABS

Facility

$0.23

Service Code	NDC 6809411661
Hospital Charge Code	6809411661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

THIORIDAZINE HCL 100 MG PO TABS

Facility

$1.09

Service Code	NDC 5107958020
Hospital Charge Code	5107958020
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.54
Rate for Payer: Aetna Government	$0.54
Rate for Payer: Brighton Health Commercial	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.74
Rate for Payer: EmblemHealth Commercial	$0.54
Rate for Payer: Group Health Inc Commercial	$0.54
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54
Rate for Payer: Hamaspik Choice Inc Medicare	$0.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

THIORIDAZINE HCL 100 MG PO TABS

Facility

$1.09

Service Code	NDC 5107958020
Hospital Charge Code	5107958020
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54

THIORIDAZINE HCL 10 MG PO TABS

Facility

$0.54

Service Code	NDC 5107956520
Hospital Charge Code	5107956520
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

THIORIDAZINE HCL 10 MG PO TABS

Facility

$0.54

Service Code	NDC 5107956520
Hospital Charge Code	5107956520
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

THIORIDAZINE HCL 25 MG PO TABS

Facility

$0.76

Service Code	NDC 5107956620
Hospital Charge Code	5107956620
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: EmblemHealth Commercial	$0.38
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.50

THIORIDAZINE HCL 25 MG PO TABS

Facility

$0.76

Service Code	NDC 5107956620
Hospital Charge Code	5107956620
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38

THIOTHIXENE 10 MG PO CAPS

Facility

$3.36

Service Code	NDC 7095401710
Hospital Charge Code	7095401710
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$2.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$2.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.28
Rate for Payer: EmblemHealth Commercial	$1.68
Rate for Payer: Group Health Inc Commercial	$1.68
Rate for Payer: Group Health Inc Medicare	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.18

THIOTHIXENE 10 MG PO CAPS

Facility

$5.11

Service Code	NDC 5107958920
Hospital Charge Code	5107958920
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.55

THIOTHIXENE 10 MG PO CAPS

Facility

$5.11

Service Code	NDC 5107958920
Hospital Charge Code	5107958920
Hospital Revenue Code	250
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$4.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.55
Rate for Payer: Aetna Government	$2.55
Rate for Payer: Brighton Health Commercial	$3.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.47
Rate for Payer: EmblemHealth Commercial	$2.55
Rate for Payer: Group Health Inc Commercial	$2.55
Rate for Payer: Group Health Inc Medicare	$1.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.55
Rate for Payer: Hamaspik Choice Inc Medicare	$2.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.32

THIOTHIXENE 10 MG PO CAPS

Facility

$3.36

Service Code	NDC 7095401710
Hospital Charge Code	7095401710
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68

THIOTHIXENE 1 MG PO CAPS

Facility

$1.19

Service Code	NDC 7095401410
Hospital Charge Code	7095401410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59

THIOTHIXENE 1 MG PO CAPS

Facility

$1.19

Service Code	NDC 7095401410
Hospital Charge Code	7095401410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.59
Rate for Payer: Aetna Government	$0.59
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.81
Rate for Payer: EmblemHealth Commercial	$0.59
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

THIOTHIXENE 2 MG PO CAPS

Facility

$1.57

Service Code	NDC 7095401510
Hospital Charge Code	7095401510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.79

THIOTHIXENE 2 MG PO CAPS

Facility

$1.57

Service Code	NDC 7095401510
Hospital Charge Code	7095401510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$1.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.07
Rate for Payer: EmblemHealth Commercial	$0.79
Rate for Payer: Group Health Inc Commercial	$0.79
Rate for Payer: Group Health Inc Medicare	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.79
Rate for Payer: Hamaspik Choice Inc Medicare	$0.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.02

THIOTHIXENE 5 MG PO CAPS

Facility

$2.38

Service Code	NDC 7095401610
Hospital Charge Code	7095401610
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.19

THIOTHIXENE 5 MG PO CAPS

Facility

$2.38

Service Code	NDC 7095401610
Hospital Charge Code	7095401610
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.19
Rate for Payer: Aetna Government	$1.19
Rate for Payer: Brighton Health Commercial	$1.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.62
Rate for Payer: EmblemHealth Commercial	$1.19
Rate for Payer: Group Health Inc Commercial	$1.19
Rate for Payer: Group Health Inc Medicare	$0.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.55

Know your out-of-pocket cost for care.

All Charges