St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DIAZEPAM 2.5 MG RE GEL

Facility

$306.90

Service Code	NDC 6868265020
Hospital Charge Code	6868265020
Hospital Revenue Code	250
Min. Negotiated Rate	$153.45
Max. Negotiated Rate	$153.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.45

DIAZEPAM 2 MG PO TABS

Facility

$0.24

Service Code	NDC 5107928401
Hospital Charge Code	5107928401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12

DIAZEPAM 2 MG PO TABS

Facility

$0.24

Service Code	NDC 5107928420
Hospital Charge Code	5107928420
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	$0.18
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	$0.16

DIAZEPAM 2 MG PO TABS

Facility

$0.24

Service Code	NDC 5107928401
Hospital Charge Code	5107928401
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	$0.18
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	$0.16

DIAZEPAM 2 MG PO TABS

Facility

$0.13

Service Code	NDC 0172392560
Hospital Charge Code	0172392560
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.06
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

DIAZEPAM 2 MG PO TABS

Facility

$0.13

Service Code	NDC 0172392560
Hospital Charge Code	0172392560
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

DIAZEPAM 2 MG PO TABS

Facility

$0.24

Service Code	NDC 5107928420
Hospital Charge Code	5107928420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12

DIAZEPAM 5 MG/5ML PO SOLN

Facility

$0.92

Service Code	NDC 6809475059
Hospital Charge Code	6809475059
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.46
Rate for Payer: Aetna Government	$0.46
Rate for Payer: Brighton Health Commercial	$0.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.63
Rate for Payer: EmblemHealth Commercial	$0.46
Rate for Payer: Group Health Inc Commercial	$0.46
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.60

DIAZEPAM 5 MG/5ML PO SOLN

Facility

$0.92

Service Code	NDC 6809475059
Hospital Charge Code	6809475059
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46

DIAZEPAM 5 MG/5ML PO SOLN

Facility

$0.92

Service Code	NDC 0121090505
Hospital Charge Code	0121090505
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46

DIAZEPAM 5 MG/5ML PO SOLN

Facility

$0.92

Service Code	NDC 0121090505
Hospital Charge Code	0121090505
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.46
Rate for Payer: Aetna Government	$0.46
Rate for Payer: Brighton Health Commercial	$0.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.63
Rate for Payer: EmblemHealth Commercial	$0.46
Rate for Payer: Group Health Inc Commercial	$0.46
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.60

DIAZEPAM 5 MG/ML IJ SOLN

Facility

$20.20

Service Code	HCPCS J3360
Hospital Charge Code	0409127332
Hospital Revenue Code	250
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.10

DIAZEPAM 5 MG/ML IJ SOLN

Facility

$14.77

Service Code	HCPCS J3360
Hospital Charge Code	6933913634
Hospital Revenue Code	250
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$11.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.79
Rate for Payer: Aetna Government	$5.79
Rate for Payer: Brighton Health Commercial	$11.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.04
Rate for Payer: EmblemHealth Commercial	$7.38
Rate for Payer: Group Health Inc Commercial	$7.38
Rate for Payer: Group Health Inc Medicare	$5.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.38
Rate for Payer: Hamaspik Choice Inc Medicare	$7.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.60

DIAZEPAM 5 MG/ML IJ SOLN

Facility

$14.77

Service Code	HCPCS J3360
Hospital Charge Code	0641624410
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$7.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.38

DIAZEPAM 5 MG/ML IJ SOLN

Facility

$20.20

Service Code	HCPCS J3360
Hospital Charge Code	0409127332
Hospital Revenue Code	250
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$16.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.79
Rate for Payer: Aetna Government	$5.79
Rate for Payer: Brighton Health Commercial	$15.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.73
Rate for Payer: EmblemHealth Commercial	$10.10
Rate for Payer: Group Health Inc Commercial	$10.10
Rate for Payer: Group Health Inc Medicare	$7.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.10
Rate for Payer: Hamaspik Choice Inc Medicare	$10.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.13

DIAZEPAM 5 MG/ML IJ SOLN

Facility

$14.77

Service Code	HCPCS J3360
Hospital Charge Code	6933913634
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$7.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.38

DIAZEPAM 5 MG/ML IJ SOLN

Facility

$14.77

Service Code	HCPCS J3360
Hospital Charge Code	0641624410
Hospital Revenue Code	250
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$11.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.79
Rate for Payer: Aetna Government	$5.79
Rate for Payer: Brighton Health Commercial	$11.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.04
Rate for Payer: EmblemHealth Commercial	$7.38
Rate for Payer: Group Health Inc Commercial	$7.38
Rate for Payer: Group Health Inc Medicare	$5.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.38
Rate for Payer: Hamaspik Choice Inc Medicare	$7.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.60

DIAZEPAM 5 MG PO TABS

Facility

$0.32

Service Code	NDC 5107928501
Hospital Charge Code	5107928501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16

DIAZEPAM 5 MG PO TABS

Facility

$0.32

Service Code	NDC 5107928501
Hospital Charge Code	5107928501
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

DIAZEPAM 5 MG PO TABS

Facility

$0.20

Service Code	NDC 0172392660
Hospital Charge Code	0172392660
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	$0.14
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

DIAZEPAM 5 MG PO TABS

Facility

$0.32

Service Code	NDC 5107928520
Hospital Charge Code	5107928520
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16

DIAZEPAM 5 MG PO TABS

Facility

$0.32

Service Code	NDC 5107928520
Hospital Charge Code	5107928520
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

DIAZEPAM 5 MG PO TABS

Facility

$0.20

Service Code	NDC 0172392660
Hospital Charge Code	0172392660
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

DIAZOXIDE 50 MG/ML PO SUSP

Facility

$12.40

Service Code	NDC 0254101019
Hospital Charge Code	0254101019
Hospital Revenue Code	250
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.20
Rate for Payer: Aetna Government	$6.20
Rate for Payer: Brighton Health Commercial	$9.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.43
Rate for Payer: EmblemHealth Commercial	$6.20
Rate for Payer: Group Health Inc Commercial	$6.20
Rate for Payer: Group Health Inc Medicare	$4.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.20
Rate for Payer: Hamaspik Choice Inc Medicare	$6.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.06

DIAZOXIDE 50 MG/ML PO SUSP

Facility

$12.40

Service Code	NDC 0254101019
Hospital Charge Code	0254101019
Hospital Revenue Code	250
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$6.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.20

Know your out-of-pocket cost for care.

All Charges