St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DIVALPROEX SODIUM 125 MG PO CSDR

Facility

$2.24

Service Code	NDC 0074611413
Hospital Charge Code	0074611413
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Brighton Health Commercial	$1.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.52
Rate for Payer: EmblemHealth Commercial	$1.12
Rate for Payer: Group Health Inc Commercial	$1.12
Rate for Payer: Group Health Inc Medicare	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.46

DIVALPROEX SODIUM 125 MG PO CSDR

Facility

$1.07

Service Code	NDC 0904661561
Hospital Charge Code	0904661561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54

DIVALPROEX SODIUM 125 MG PO CSDR

Facility

$1.12

Service Code	NDC 6838210601
Hospital Charge Code	6838210601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56

DIVALPROEX SODIUM 125 MG PO CSDR

Facility

$2.24

Service Code	NDC 0074611413
Hospital Charge Code	0074611413
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.12

DIVALPROEX SODIUM 125 MG PO CSDR

Facility

$1.12

Service Code	NDC 2724111501
Hospital Charge Code	2724111501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56

DIVALPROEX SODIUM 125 MG PO CSDR

Facility

$1.12

Service Code	NDC 5511153201
Hospital Charge Code	5511153201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.56
Rate for Payer: Aetna Government	$0.56
Rate for Payer: Brighton Health Commercial	$0.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.76
Rate for Payer: EmblemHealth Commercial	$0.56
Rate for Payer: Group Health Inc Commercial	$0.56
Rate for Payer: Group Health Inc Medicare	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56
Rate for Payer: Hamaspik Choice Inc Medicare	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.73

DIVALPROEX SODIUM 125 MG PO CSDR

Facility

$1.42

Service Code	NDC 6808431311
Hospital Charge Code	6808431311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.71
Rate for Payer: Aetna Government	$0.71
Rate for Payer: Brighton Health Commercial	$1.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: EmblemHealth Commercial	$0.71
Rate for Payer: Group Health Inc Commercial	$0.71
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71
Rate for Payer: Hamaspik Choice Inc Medicare	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.92

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.74

Service Code	NDC 6275679713
Hospital Charge Code	6275679713
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.07

Service Code	NDC 0832712389
Hospital Charge Code	0832712389
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
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	$0.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.73
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	$0.70

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.74

Service Code	NDC 5723704701
Hospital Charge Code	5723704701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.07

Service Code	NDC 0832712389
Hospital Charge Code	0832712389
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.07

Service Code	NDC 0832712301
Hospital Charge Code	0832712301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
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	$0.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.73
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	$0.70

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.76

Service Code	NDC 2930013905
Hospital Charge Code	2930013905
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.88

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.76

Service Code	NDC 6808477601
Hospital Charge Code	6808477601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.88

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.74

Service Code	NDC 6275679788
Hospital Charge Code	6275679788
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.74

Service Code	NDC 6275679788
Hospital Charge Code	6275679788
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.87
Rate for Payer: Aetna Government	$0.87
Rate for Payer: Brighton Health Commercial	$1.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.19
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

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$0.24

Service Code	NDC 0904686061
Hospital Charge Code	0904686061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.74

Service Code	NDC 5723704701
Hospital Charge Code	5723704701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.87
Rate for Payer: Aetna Government	$0.87
Rate for Payer: Brighton Health Commercial	$1.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.19
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

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.76

Service Code	NDC 6808477601
Hospital Charge Code	6808477601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.88
Rate for Payer: Aetna Government	$0.88
Rate for Payer: Brighton Health Commercial	$1.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.20
Rate for Payer: EmblemHealth Commercial	$0.88
Rate for Payer: Group Health Inc Commercial	$0.88
Rate for Payer: Group Health Inc Medicare	$0.62
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	$1.15

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.85

Service Code	NDC 6068786811
Hospital Charge Code	6068786811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$0.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.93

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.76

Service Code	NDC 2930013905
Hospital Charge Code	2930013905
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.88
Rate for Payer: Aetna Government	$0.88
Rate for Payer: Brighton Health Commercial	$1.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.20
Rate for Payer: EmblemHealth Commercial	$0.88
Rate for Payer: Group Health Inc Commercial	$0.88
Rate for Payer: Group Health Inc Medicare	$0.62
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	$1.15

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.74

Service Code	NDC 6275679713
Hospital Charge Code	6275679713
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.87
Rate for Payer: Aetna Government	$0.87
Rate for Payer: Brighton Health Commercial	$1.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.19
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

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$0.24

Service Code	NDC 0904686061
Hospital Charge Code	0904686061
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

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.85

Service Code	NDC 6068786811
Hospital Charge Code	6068786811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.93
Rate for Payer: Aetna Government	$0.93
Rate for Payer: Brighton Health Commercial	$1.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.26
Rate for Payer: EmblemHealth Commercial	$0.93
Rate for Payer: Group Health Inc Commercial	$0.93
Rate for Payer: Group Health Inc Medicare	$0.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.93
Rate for Payer: Hamaspik Choice Inc Medicare	$0.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.20

DIVALPROEX SODIUM 250 MG PO TBEC

Facility

$1.07

Service Code	NDC 0832712301
Hospital Charge Code	0832712301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54

Know your out-of-pocket cost for care.

All Charges