St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

VALACYCLOVIR HCL 500 MG PO TABS

Facility

$2.92

Service Code	NDC 0904656561
Hospital Charge Code	0904656561
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$2.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.46
Rate for Payer: Aetna Government	$1.46
Rate for Payer: Brighton Health Commercial	$2.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.99
Rate for Payer: EmblemHealth Commercial	$1.46
Rate for Payer: Group Health Inc Commercial	$1.46
Rate for Payer: Group Health Inc Medicare	$1.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.90

VALACYCLOVIR HCL 500 MG PO TABS

Facility

$7.07

Service Code	NDC 6586244830
Hospital Charge Code	6586244830
Hospital Revenue Code	250
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$3.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.54

VALGANCICLOVIR 60 MG/ML ORAL LIQUID - COMPOUNDED

Facility

$7.92

Service Code	NDC 9999701486
Hospital Charge Code	9999701486
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$6.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.96
Rate for Payer: Aetna Government	$3.96
Rate for Payer: Brighton Health Commercial	$5.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.38
Rate for Payer: EmblemHealth Commercial	$3.96
Rate for Payer: Group Health Inc Commercial	$3.96
Rate for Payer: Group Health Inc Medicare	$2.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.96
Rate for Payer: Hamaspik Choice Inc Medicare	$3.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.15

VALGANCICLOVIR 60 MG/ML ORAL LIQUID - COMPOUNDED

Facility

$7.92

Service Code	NDC 9999701486
Hospital Charge Code	9999701486
Hospital Revenue Code	250
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$3.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.96

VALGANCICLOVIR HCL 450 MG PO TABS

Facility

$149.43

Service Code	NDC 5026878712
Hospital Charge Code	5026878712
Hospital Revenue Code	250
Min. Negotiated Rate	$74.71
Max. Negotiated Rate	$74.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.71

VALGANCICLOVIR HCL 450 MG PO TABS

Facility

$64.40

Service Code	NDC 3172283260
Hospital Charge Code	3172283260
Hospital Revenue Code	250
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$32.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.20

VALGANCICLOVIR HCL 450 MG PO TABS

Facility

$55.59

Service Code	NDC 0904679610
Hospital Charge Code	0904679610
Hospital Revenue Code	250
Min. Negotiated Rate	$27.80
Max. Negotiated Rate	$27.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.80

VALGANCICLOVIR HCL 450 MG PO TABS

Facility

$106.08

Service Code	NDC 0004003822
Hospital Charge Code	0004003822
Hospital Revenue Code	250
Min. Negotiated Rate	$37.13
Max. Negotiated Rate	$84.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$53.04
Rate for Payer: Aetna Government	$53.04
Rate for Payer: Brighton Health Commercial	$79.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.14
Rate for Payer: EmblemHealth Commercial	$53.04
Rate for Payer: Group Health Inc Commercial	$53.04
Rate for Payer: Group Health Inc Medicare	$37.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.04
Rate for Payer: Hamaspik Choice Inc Medicare	$53.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.95

VALGANCICLOVIR HCL 450 MG PO TABS

Facility

$149.43

Service Code	NDC 5026878711
Hospital Charge Code	5026878711
Hospital Revenue Code	250
Min. Negotiated Rate	$52.30
Max. Negotiated Rate	$119.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.71
Rate for Payer: Aetna Government	$74.71
Rate for Payer: Brighton Health Commercial	$112.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$101.61
Rate for Payer: EmblemHealth Commercial	$74.71
Rate for Payer: Group Health Inc Commercial	$74.71
Rate for Payer: Group Health Inc Medicare	$52.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.71
Rate for Payer: Hamaspik Choice Inc Medicare	$74.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.13

VALGANCICLOVIR HCL 450 MG PO TABS

Facility

$64.40

Service Code	NDC 3172283260
Hospital Charge Code	3172283260
Hospital Revenue Code	250
Min. Negotiated Rate	$22.54
Max. Negotiated Rate	$51.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.20
Rate for Payer: Aetna Government	$32.20
Rate for Payer: Brighton Health Commercial	$48.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.79
Rate for Payer: EmblemHealth Commercial	$32.20
Rate for Payer: Group Health Inc Commercial	$32.20
Rate for Payer: Group Health Inc Medicare	$22.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.20
Rate for Payer: Hamaspik Choice Inc Medicare	$32.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.86

VALGANCICLOVIR HCL 450 MG PO TABS

Facility

$149.43

Service Code	NDC 5026878712
Hospital Charge Code	5026878712
Hospital Revenue Code	250
Min. Negotiated Rate	$52.30
Max. Negotiated Rate	$119.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.71
Rate for Payer: Aetna Government	$74.71
Rate for Payer: Brighton Health Commercial	$112.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$101.61
Rate for Payer: EmblemHealth Commercial	$74.71
Rate for Payer: Group Health Inc Commercial	$74.71
Rate for Payer: Group Health Inc Medicare	$52.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.71
Rate for Payer: Hamaspik Choice Inc Medicare	$74.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.13

VALGANCICLOVIR HCL 450 MG PO TABS

Facility

$55.59

Service Code	NDC 0904679610
Hospital Charge Code	0904679610
Hospital Revenue Code	250
Min. Negotiated Rate	$19.46
Max. Negotiated Rate	$44.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.80
Rate for Payer: Aetna Government	$27.80
Rate for Payer: Brighton Health Commercial	$41.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.80
Rate for Payer: EmblemHealth Commercial	$27.80
Rate for Payer: Group Health Inc Commercial	$27.80
Rate for Payer: Group Health Inc Medicare	$19.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.80
Rate for Payer: Hamaspik Choice Inc Medicare	$27.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.13

VALGANCICLOVIR HCL 450 MG PO TABS

Facility

$106.08

Service Code	NDC 0004003822
Hospital Charge Code	0004003822
Hospital Revenue Code	250
Min. Negotiated Rate	$53.04
Max. Negotiated Rate	$53.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.04

VALGANCICLOVIR HCL 450 MG PO TABS

Facility

$149.43

Service Code	NDC 5026878711
Hospital Charge Code	5026878711
Hospital Revenue Code	250
Min. Negotiated Rate	$74.71
Max. Negotiated Rate	$74.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.71

VALGANCICLOVIR HCL 50 MG/ML PO SOLR

Facility

$14.59

Service Code	NDC 0004003909
Hospital Charge Code	0004003909
Hospital Revenue Code	250
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$11.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.30
Rate for Payer: Aetna Government	$7.30
Rate for Payer: Brighton Health Commercial	$10.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.92
Rate for Payer: EmblemHealth Commercial	$7.30
Rate for Payer: Group Health Inc Commercial	$7.30
Rate for Payer: Group Health Inc Medicare	$5.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.30
Rate for Payer: Hamaspik Choice Inc Medicare	$7.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.49

VALGANCICLOVIR HCL 50 MG/ML PO SOLR

Facility

$14.59

Service Code	NDC 0004003909
Hospital Charge Code	0004003909
Hospital Revenue Code	250
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$7.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.30

VALGANCICLOVIR HCL 50 MG/ML PO SOLR

Facility

$11.37

Service Code	NDC 7220501901
Hospital Charge Code	7220501901
Hospital Revenue Code	250
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$5.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.68

VALGANCICLOVIR HCL 50 MG/ML PO SOLR

Facility

$11.37

Service Code	NDC 0591257920
Hospital Charge Code	0591257920
Hospital Revenue Code	250
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$9.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.68
Rate for Payer: Aetna Government	$5.68
Rate for Payer: Brighton Health Commercial	$8.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.73
Rate for Payer: EmblemHealth Commercial	$5.68
Rate for Payer: Group Health Inc Commercial	$5.68
Rate for Payer: Group Health Inc Medicare	$3.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.68
Rate for Payer: Hamaspik Choice Inc Medicare	$5.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.39

VALGANCICLOVIR HCL 50 MG/ML PO SOLR

Facility

$11.37

Service Code	NDC 7220501901
Hospital Charge Code	7220501901
Hospital Revenue Code	250
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$9.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.68
Rate for Payer: Aetna Government	$5.68
Rate for Payer: Brighton Health Commercial	$8.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.73
Rate for Payer: EmblemHealth Commercial	$5.68
Rate for Payer: Group Health Inc Commercial	$5.68
Rate for Payer: Group Health Inc Medicare	$3.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.68
Rate for Payer: Hamaspik Choice Inc Medicare	$5.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.39

VALGANCICLOVIR HCL 50 MG/ML PO SOLR

Facility

$11.37

Service Code	NDC 0591257920
Hospital Charge Code	0591257920
Hospital Revenue Code	250
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$5.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.68

VALPROATE SODIUM 100 MG/ML IV SOLN

Facility

$1.61

Service Code	NDC 6332349405
Hospital Charge Code	6332349405
Hospital Revenue Code	258
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80

VALPROATE SODIUM 100 MG/ML IV SOLN

Facility

$1.61

Service Code	NDC 6332349405
Hospital Charge Code	6332349405
Hospital Revenue Code	258
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: EmblemHealth Commercial	$0.80
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.05

VALPROATE SODIUM 100 MG/ML IV SOLN

Facility

$0.49

Service Code	NDC 6332349416
Hospital Charge Code	6332349416
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

VALPROATE SODIUM 100 MG/ML IV SOLN

Facility

$1.61

Service Code	NDC 6332349401
Hospital Charge Code	6332349401
Hospital Revenue Code	258
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: EmblemHealth Commercial	$0.80
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.05

VALPROATE SODIUM 100 MG/ML IV SOLN

Facility

$4.15

Service Code	NDC 0143978510
Hospital Charge Code	0143978510
Hospital Revenue Code	258
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$3.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.07
Rate for Payer: Aetna Government	$2.07
Rate for Payer: Brighton Health Commercial	$3.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.82
Rate for Payer: EmblemHealth Commercial	$2.07
Rate for Payer: Group Health Inc Commercial	$2.07
Rate for Payer: Group Health Inc Medicare	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.07
Rate for Payer: Hamaspik Choice Inc Medicare	$2.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.70

Know your out-of-pocket cost for care.

All Charges