St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CYANOCOBALAMIN 1000 MCG/ML IJ SOLN

Facility

$4.08

Service Code	HCPCS J3420
Hospital Charge Code	5515036425
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04

CYANOCOBALAMIN 1000 MCG/ML IJ SOLN

Facility

$8.29

Service Code	HCPCS J3420
Hospital Charge Code	6332304401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$6.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.12
Rate for Payer: Aetna Government	$2.12
Rate for Payer: Brighton Health Commercial	$6.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.64
Rate for Payer: EmblemHealth Commercial	$4.15
Rate for Payer: Group Health Inc Commercial	$4.15
Rate for Payer: Group Health Inc Medicare	$2.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.15
Rate for Payer: Hamaspik Choice Inc Medicare	$4.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.39

CYANOCOBALAMIN 1000 MCG/ML IJ SOLN

Facility

$4.45

Service Code	HCPCS J3420
Hospital Charge Code	7006900501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$3.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.12
Rate for Payer: Aetna Government	$2.12
Rate for Payer: Brighton Health Commercial	$3.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.03
Rate for Payer: EmblemHealth Commercial	$2.23
Rate for Payer: Group Health Inc Commercial	$2.23
Rate for Payer: Group Health Inc Medicare	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.23
Rate for Payer: Hamaspik Choice Inc Medicare	$2.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.89

CYANOCOBALAMIN 1000 MCG/ML IJ SOLN

Facility

$3.86

Service Code	HCPCS J3420
Hospital Charge Code	6968011225
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.93

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$1.09

Service Code	NDC 4354740011
Hospital Charge Code	4354740011
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	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$0.82
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	$0.55
Rate for Payer: Group Health Inc Commercial	$0.55
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55
Rate for Payer: Hamaspik Choice Inc Medicare	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$0.21

Service Code	NDC 5026819111
Hospital Charge Code	5026819111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$1.16

Service Code	NDC 7288801401
Hospital Charge Code	7288801401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.64
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	$0.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.79
Rate for Payer: EmblemHealth Commercial	$0.58
Rate for Payer: Group Health Inc Commercial	$0.58
Rate for Payer: Group Health Inc Medicare	$0.41
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

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$1.64

Service Code	NDC 1657178301
Hospital Charge Code	1657178301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$1.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.12
Rate for Payer: EmblemHealth Commercial	$0.82
Rate for Payer: Group Health Inc Commercial	$0.82
Rate for Payer: Group Health Inc Medicare	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82
Rate for Payer: Hamaspik Choice Inc Medicare	$0.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.07

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$1.75

Service Code	NDC 0904740161
Hospital Charge Code	0904740161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.88

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$1.16

Service Code	NDC 6909784607
Hospital Charge Code	6909784607
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.64
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	$0.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.79
Rate for Payer: EmblemHealth Commercial	$0.58
Rate for Payer: Group Health Inc Commercial	$0.58
Rate for Payer: Group Health Inc Medicare	$0.41
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

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$1.09

Service Code	NDC 4354740011
Hospital Charge Code	4354740011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$1.75

Service Code	NDC 0904740161
Hospital Charge Code	0904740161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.88
Rate for Payer: Aetna Government	$0.88
Rate for Payer: Brighton Health Commercial	$1.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.19
Rate for Payer: EmblemHealth Commercial	$0.88
Rate for Payer: Group Health Inc Commercial	$0.88
Rate for Payer: Group Health Inc Medicare	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.88
Rate for Payer: Hamaspik Choice Inc Medicare	$0.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.14

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$1.16

Service Code	NDC 7288801401
Hospital Charge Code	7288801401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$0.21

Service Code	NDC 6068755811
Hospital Charge Code	6068755811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
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	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
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	$0.07
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	$0.14

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$0.21

Service Code	NDC 6068755801
Hospital Charge Code	6068755801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
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	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
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	$0.07
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	$0.14

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$1.16

Service Code	NDC 6909784607
Hospital Charge Code	6909784607
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$1.64

Service Code	NDC 1657178301
Hospital Charge Code	1657178301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$0.21

Service Code	NDC 6068755801
Hospital Charge Code	6068755801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$0.21

Service Code	NDC 5026819111
Hospital Charge Code	5026819111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
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	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
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	$0.07
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	$0.14

CYCLOBENZAPRINE HCL 10 MG PO TABS

Facility

$0.21

Service Code	NDC 6068755811
Hospital Charge Code	6068755811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

CYCLOBENZAPRINE HCL 5 MG PO TABS

Facility

$1.73

Service Code	NDC 1070200601
Hospital Charge Code	1070200601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.87
Rate for Payer: Aetna Government	$0.87
Rate for Payer: Brighton Health Commercial	$1.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.18
Rate for Payer: EmblemHealth Commercial	$0.87
Rate for Payer: Group Health Inc Commercial	$0.87
Rate for Payer: Group Health Inc Medicare	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87
Rate for Payer: Hamaspik Choice Inc Medicare	$0.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.13

CYCLOBENZAPRINE HCL 5 MG PO TABS

Facility

$0.85

Service Code	NDC 6808475365
Hospital Charge Code	6808475365
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

CYCLOBENZAPRINE HCL 5 MG PO TABS

Facility

$1.23

Service Code	NDC 5026819011
Hospital Charge Code	5026819011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62

CYCLOBENZAPRINE HCL 5 MG PO TABS

Facility

$1.64

Service Code	NDC 7288801201
Hospital Charge Code	7288801201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82

CYCLOBENZAPRINE HCL 5 MG PO TABS

Facility

$1.64

Service Code	NDC 4354739910
Hospital Charge Code	4354739910
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82

Know your out-of-pocket cost for care.

All Charges