St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CYCLOBENZAPRINE HCL 5 MG PO TABS

Facility

$1.64

Service Code	NDC 4354739910
Hospital Charge Code	4354739910
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
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 5 MG PO TABS

Facility

$1.64

Service Code	NDC 7288801201
Hospital Charge Code	7288801201
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 5 MG PO TABS

Facility

$1.23

Service Code	NDC 5026819015
Hospital Charge Code	5026819015
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

$1.23

Service Code	NDC 5026819011
Hospital Charge Code	5026819011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.62
Rate for Payer: Aetna Government	$0.62
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.84
Rate for Payer: EmblemHealth Commercial	$0.62
Rate for Payer: Group Health Inc Commercial	$0.62
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.80

CYCLOBENZAPRINE HCL 5 MG PO TABS

Facility

$1.72

Service Code	NDC 1070200610
Hospital Charge Code	1070200610
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86

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

$0.85

Service Code	NDC 6808475311
Hospital Charge Code	6808475311
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

$0.85

Service Code	NDC 6808475311
Hospital Charge Code	6808475311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

CYCLOBENZAPRINE HCL 5 MG PO TABS

Facility

$1.64

Service Code	NDC 6909784507
Hospital Charge Code	6909784507
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

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

$0.32

Service Code	NDC 0904740006
Hospital Charge Code	0904740006
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
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	$0.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.22
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

CYCLOBENZAPRINE HCL 5 MG PO TABS

Facility

$1.64

Service Code	NDC 6909784507
Hospital Charge Code	6909784507
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 5 MG PO TABS

Facility

$0.85

Service Code	NDC 6808475365
Hospital Charge Code	6808475365
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

CYCLOBENZAPRINE HCL 5 MG PO TABS

Facility

$1.64

Service Code	NDC 5281733010
Hospital Charge Code	5281733010
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

$1.25

Service Code	NDC 6808475395
Hospital Charge Code	6808475395
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$1.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.85
Rate for Payer: EmblemHealth Commercial	$0.63
Rate for Payer: Group Health Inc Commercial	$0.63
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.81

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

$0.32

Service Code	NDC 0904740006
Hospital Charge Code	0904740006
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16

CYCLOBENZAPRINE HCL 5 MG PO TABS

Facility

$1.73

Service Code	NDC 1070200601
Hospital Charge Code	1070200601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87

CYCLOPENTOLATE HCL 0.5 % OP SOLN

Facility

$7.71

Service Code	NDC 0065039515
Hospital Charge Code	0065039515
Hospital Revenue Code	250
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$3.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.86

CYCLOPENTOLATE HCL 0.5 % OP SOLN

Facility

$7.71

Service Code	NDC 0065039515
Hospital Charge Code	0065039515
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.86
Rate for Payer: Aetna Government	$3.86
Rate for Payer: Brighton Health Commercial	$5.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.24
Rate for Payer: EmblemHealth Commercial	$3.86
Rate for Payer: Group Health Inc Commercial	$3.86
Rate for Payer: Group Health Inc Medicare	$2.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.86
Rate for Payer: Hamaspik Choice Inc Medicare	$3.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.01

CYCLOPENTOLATE HCL 1 % OP SOLN

Facility

$8.40

Service Code	NDC 6131439601
Hospital Charge Code	6131439601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$6.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.20
Rate for Payer: Aetna Government	$4.20
Rate for Payer: Brighton Health Commercial	$6.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.71
Rate for Payer: EmblemHealth Commercial	$4.20
Rate for Payer: Group Health Inc Commercial	$4.20
Rate for Payer: Group Health Inc Medicare	$2.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.20
Rate for Payer: Hamaspik Choice Inc Medicare	$4.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.46

CYCLOPENTOLATE HCL 1 % OP SOLN

Facility

$7.39

Service Code	NDC 1747810002
Hospital Charge Code	1747810002
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$5.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.69
Rate for Payer: Aetna Government	$3.69
Rate for Payer: Brighton Health Commercial	$5.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.02
Rate for Payer: EmblemHealth Commercial	$3.69
Rate for Payer: Group Health Inc Commercial	$3.69
Rate for Payer: Group Health Inc Medicare	$2.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.69
Rate for Payer: Hamaspik Choice Inc Medicare	$3.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.80

CYCLOPENTOLATE HCL 1 % OP SOLN

Facility

$2.70

Service Code	NDC 6131439603
Hospital Charge Code	6131439603
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.35

CYCLOPENTOLATE HCL 1 % OP SOLN

Facility

$14.56

Service Code	NDC 0065039605
Hospital Charge Code	0065039605
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$7.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.28

Know your out-of-pocket cost for care.

All Charges