St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DOCUSATE SODIUM 150 MG/15ML PO LIQD

Facility

$0.20

Service Code	NDC 4843322040
Hospital Charge Code	4843322040
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

DOCUSATE SODIUM 150 MG/15ML PO LIQD

Facility

$0.20

Service Code	NDC 4843322040
Hospital Charge Code	4843322040
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

DOLUTEGRAVIR-LAMIVUDINE 50-300 MG PO TABS

Facility

$119.07

Service Code	NDC 4970224613
Hospital Charge Code	4970224613
Hospital Revenue Code	250
Min. Negotiated Rate	$59.53
Max. Negotiated Rate	$59.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.53

DOLUTEGRAVIR-LAMIVUDINE 50-300 MG PO TABS

Facility

$119.07

Service Code	NDC 4970224613
Hospital Charge Code	4970224613
Hospital Revenue Code	250
Min. Negotiated Rate	$41.67
Max. Negotiated Rate	$95.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.53
Rate for Payer: Aetna Government	$59.53
Rate for Payer: Brighton Health Commercial	$89.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.96
Rate for Payer: EmblemHealth Commercial	$59.53
Rate for Payer: Group Health Inc Commercial	$59.53
Rate for Payer: Group Health Inc Medicare	$41.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.53
Rate for Payer: Hamaspik Choice Inc Medicare	$59.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$77.39

DOLUTEGRAVIR-LAMIVUDINE 50-300 MG PO TABS

Facility

$119.07

Service Code	NDC 4970224633
Hospital Charge Code	4970224633
Hospital Revenue Code	250
Min. Negotiated Rate	$41.67
Max. Negotiated Rate	$95.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.53
Rate for Payer: Aetna Government	$59.53
Rate for Payer: Brighton Health Commercial	$89.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.96
Rate for Payer: EmblemHealth Commercial	$59.53
Rate for Payer: Group Health Inc Commercial	$59.53
Rate for Payer: Group Health Inc Medicare	$41.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.53
Rate for Payer: Hamaspik Choice Inc Medicare	$59.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$77.39

DOLUTEGRAVIR-LAMIVUDINE 50-300 MG PO TABS

Facility

$119.07

Service Code	NDC 4970224633
Hospital Charge Code	4970224633
Hospital Revenue Code	250
Min. Negotiated Rate	$59.53
Max. Negotiated Rate	$59.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.53

DOLUTEGRAVIR-RILPIVIRINE 50-25 MG PO TABS

Facility

$140.49

Service Code	NDC 4970224213
Hospital Charge Code	4970224213
Hospital Revenue Code	250
Min. Negotiated Rate	$70.25
Max. Negotiated Rate	$70.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.25

DOLUTEGRAVIR-RILPIVIRINE 50-25 MG PO TABS

Facility

$140.49

Service Code	NDC 4970224213
Hospital Charge Code	4970224213
Hospital Revenue Code	250
Min. Negotiated Rate	$49.17
Max. Negotiated Rate	$112.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.25
Rate for Payer: Aetna Government	$70.25
Rate for Payer: Brighton Health Commercial	$105.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.53
Rate for Payer: EmblemHealth Commercial	$70.25
Rate for Payer: Group Health Inc Commercial	$70.25
Rate for Payer: Group Health Inc Medicare	$49.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.25
Rate for Payer: Hamaspik Choice Inc Medicare	$70.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$91.32

DOLUTEGRAVIR SODIUM 50 MG PO TABS

Facility

$90.30

Service Code	NDC 4970222813
Hospital Charge Code	4970222813
Hospital Revenue Code	250
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$45.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.15

DOLUTEGRAVIR SODIUM 50 MG PO TABS

Facility

$90.30

Service Code	NDC 4970222813
Hospital Charge Code	4970222813
Hospital Revenue Code	250
Min. Negotiated Rate	$31.60
Max. Negotiated Rate	$72.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.15
Rate for Payer: Aetna Government	$45.15
Rate for Payer: Brighton Health Commercial	$67.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$72.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.40
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Group Health Inc Commercial	$45.15
Rate for Payer: Group Health Inc Medicare	$31.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.15
Rate for Payer: Hamaspik Choice Inc Medicare	$45.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$58.69

DOMEBORO EX PACK

Facility

$0.80

Service Code	NDC 5707400177
Hospital Charge Code	5707400177
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.40
Rate for Payer: Aetna Government	$0.40
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.54
Rate for Payer: EmblemHealth Commercial	$0.40
Rate for Payer: Group Health Inc Commercial	$0.40
Rate for Payer: Group Health Inc Medicare	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.40
Rate for Payer: Hamaspik Choice Inc Medicare	$0.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.52

DOMEBORO EX PACK

Facility

$0.80

Service Code	NDC 5707400177
Hospital Charge Code	5707400177
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.40

DONEPEZIL HCL 10 MG PO TABS

Facility

$0.78

Service Code	NDC 6068730311
Hospital Charge Code	6068730311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39

DONEPEZIL HCL 10 MG PO TABS

Facility

$0.16

Service Code	NDC 0904647861
Hospital Charge Code	0904647861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

DONEPEZIL HCL 10 MG PO TABS

Facility

$0.16

Service Code	NDC 0904647861
Hospital Charge Code	0904647861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

DONEPEZIL HCL 10 MG PO TABS

Facility

$0.78

Service Code	NDC 6068730311
Hospital Charge Code	6068730311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: EmblemHealth Commercial	$0.39
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.50

DONEPEZIL HCL 10 MG PO TABS

Facility

$8.66

Service Code	NDC 4354727603
Hospital Charge Code	4354727603
Hospital Revenue Code	250
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$6.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.33
Rate for Payer: Aetna Government	$4.33
Rate for Payer: Brighton Health Commercial	$6.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.89
Rate for Payer: EmblemHealth Commercial	$4.33
Rate for Payer: Group Health Inc Commercial	$4.33
Rate for Payer: Group Health Inc Medicare	$3.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.33
Rate for Payer: Hamaspik Choice Inc Medicare	$4.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.63

DONEPEZIL HCL 10 MG PO TABS

Facility

$8.66

Service Code	NDC 4354727603
Hospital Charge Code	4354727603
Hospital Revenue Code	250
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$4.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.33

DONEPEZIL HCL 5 MG PO TABS

Facility

$0.16

Service Code	NDC 0904647761
Hospital Charge Code	0904647761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

DONEPEZIL HCL 5 MG PO TABS

Facility

$8.65

Service Code	NDC 3172273730
Hospital Charge Code	3172273730
Hospital Revenue Code	250
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$6.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.33
Rate for Payer: Aetna Government	$4.33
Rate for Payer: Brighton Health Commercial	$6.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.88
Rate for Payer: EmblemHealth Commercial	$4.33
Rate for Payer: Group Health Inc Commercial	$4.33
Rate for Payer: Group Health Inc Medicare	$3.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.33
Rate for Payer: Hamaspik Choice Inc Medicare	$4.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.62

DONEPEZIL HCL 5 MG PO TABS

Facility

$8.65

Service Code	NDC 3172273730
Hospital Charge Code	3172273730
Hospital Revenue Code	250
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$4.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.33

DONEPEZIL HCL 5 MG PO TABS

Facility

$0.16

Service Code	NDC 0904647761
Hospital Charge Code	0904647761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

DOPAMINE-DEXTROSE 0.8-5 MG/ML-% IV SOLN

Facility

$0.06

Service Code	HCPCS J1265
Hospital Charge Code	0338100502
Hospital Revenue Code	258
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

DOPAMINE-DEXTROSE 0.8-5 MG/ML-% IV SOLN

Facility

$0.06

Service Code	HCPCS J1265
Hospital Charge Code	0338100502
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

DOPAMINE-DEXTROSE 3.2-5 MG/ML-% IV SOLN

Facility

$0.10

Service Code	HCPCS J1265
Hospital Charge Code	0409781022
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

Know your out-of-pocket cost for care.

All Charges