St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DORZOLAMIDE HCL 2 % OP SOLN

Facility

$4.08

Service Code	NDC 6931530410
Hospital Charge Code	6931530410
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.04
Rate for Payer: Aetna Government	$2.04
Rate for Payer: Brighton Health Commercial	$3.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.77
Rate for Payer: EmblemHealth Commercial	$2.04
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.65

DORZOLAMIDE HCL 2 % OP SOLN

Facility

$4.59

Service Code	NDC 2420848510
Hospital Charge Code	2420848510
Hospital Revenue Code	250
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$2.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.29

DORZOLAMIDE HCL 2 % OP SOLN

Facility

$6.68

Service Code	NDC 5038323210
Hospital Charge Code	5038323210
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$5.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.34
Rate for Payer: Aetna Government	$3.34
Rate for Payer: Brighton Health Commercial	$5.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.54
Rate for Payer: EmblemHealth Commercial	$3.34
Rate for Payer: Group Health Inc Commercial	$3.34
Rate for Payer: Group Health Inc Medicare	$2.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.34
Rate for Payer: Hamaspik Choice Inc Medicare	$3.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.34

DORZOLAMIDE HCL 2 % OP SOLN

Facility

$4.08

Service Code	NDC 6931530410
Hospital Charge Code	6931530410
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04

DORZOLAMIDE HCL 2 % OP SOLN

Facility

$6.68

Service Code	NDC 4257114126
Hospital Charge Code	4257114126
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$5.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.34
Rate for Payer: Aetna Government	$3.34
Rate for Payer: Brighton Health Commercial	$5.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.54
Rate for Payer: EmblemHealth Commercial	$3.34
Rate for Payer: Group Health Inc Commercial	$3.34
Rate for Payer: Group Health Inc Medicare	$2.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.34
Rate for Payer: Hamaspik Choice Inc Medicare	$3.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.34

DORZOLAMIDE HCL 2 % OP SOLN

Facility

$6.68

Service Code	NDC 4257114126
Hospital Charge Code	4257114126
Hospital Revenue Code	250
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$3.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.34

DORZOLAMIDE HCL 2 % OP SOLN

Facility

$6.68

Service Code	NDC 6131401910
Hospital Charge Code	6131401910
Hospital Revenue Code	250
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$3.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.34

DORZOLAMIDE HCL 2 % OP SOLN

Facility

$6.68

Service Code	NDC 6131401910
Hospital Charge Code	6131401910
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$5.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.34
Rate for Payer: Aetna Government	$3.34
Rate for Payer: Brighton Health Commercial	$5.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.54
Rate for Payer: EmblemHealth Commercial	$3.34
Rate for Payer: Group Health Inc Commercial	$3.34
Rate for Payer: Group Health Inc Medicare	$2.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.34
Rate for Payer: Hamaspik Choice Inc Medicare	$3.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.34

DOSTARLIMAB-GXLY 500 MG/10ML IV SOLN

Facility

$1.00

Service Code	HCPCS J9272
Hospital Charge Code	0173089803
Hospital Revenue Code	258
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$248.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$243.71
Rate for Payer: Aetna Government	$243.71
Rate for Payer: Affinity Essential Plan 1&2	$170.60
Rate for Payer: Affinity Essential Plan 3&4	$170.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$170.60
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$243.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$243.71
Rate for Payer: EmblemHealth Commercial	$243.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$219.34
Rate for Payer: Fidelis Essential Plan Aliesa	$207.15
Rate for Payer: Fidelis Essential Plan QHP	$216.90
Rate for Payer: Fidelis Medicare Advantage	$243.71
Rate for Payer: Fidelis Qualified Health Plan	$216.90
Rate for Payer: Group Health Inc Commercial	$243.71
Rate for Payer: Group Health Inc Medicare	$243.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.71
Rate for Payer: Hamaspik Choice Inc Medicare	$243.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$243.71
Rate for Payer: Healthfirst Medicare Advantage	$207.15
Rate for Payer: Healthfirst QHP	$243.71
Rate for Payer: Humana Medicare	$248.58
Rate for Payer: Senior Whole Health Medicare Advantage	$243.71
Rate for Payer: United Healthcare Medicare Advantage	$243.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$231.52
Rate for Payer: Wellcare Medicare	$231.52

DOSTARLIMAB-GXLY 500 MG/10ML IV SOLN

Facility

$1.00

Service Code	HCPCS J9272
Hospital Charge Code	0173089803
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

DOXAZOSIN MESYLATE 1 MG PO TABS

Facility

$1.02

Service Code	NDC 0904552261
Hospital Charge Code	0904552261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Brighton Health Commercial	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.69
Rate for Payer: EmblemHealth Commercial	$0.51
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

DOXAZOSIN MESYLATE 1 MG PO TABS

Facility

$1.35

Service Code	NDC 1672921101
Hospital Charge Code	1672921101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.67
Rate for Payer: Aetna Government	$0.67
Rate for Payer: Brighton Health Commercial	$1.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.92
Rate for Payer: EmblemHealth Commercial	$0.67
Rate for Payer: Group Health Inc Commercial	$0.67
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67
Rate for Payer: Hamaspik Choice Inc Medicare	$0.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.88

DOXAZOSIN MESYLATE 1 MG PO TABS

Facility

$1.35

Service Code	NDC 1672921101
Hospital Charge Code	1672921101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67

DOXAZOSIN MESYLATE 1 MG PO TABS

Facility

$1.02

Service Code	NDC 0904552261
Hospital Charge Code	0904552261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51

DOXAZOSIN MESYLATE 2 MG PO TABS

Facility

$0.72

Service Code	NDC 0904552361
Hospital Charge Code	0904552361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

DOXAZOSIN MESYLATE 2 MG PO TABS

Facility

$1.35

Service Code	NDC 1672941401
Hospital Charge Code	1672941401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.67
Rate for Payer: Aetna Government	$0.67
Rate for Payer: Brighton Health Commercial	$1.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.92
Rate for Payer: EmblemHealth Commercial	$0.67
Rate for Payer: Group Health Inc Commercial	$0.67
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67
Rate for Payer: Hamaspik Choice Inc Medicare	$0.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.88

DOXAZOSIN MESYLATE 2 MG PO TABS

Facility

$0.72

Service Code	NDC 0904552361
Hospital Charge Code	0904552361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

DOXAZOSIN MESYLATE 2 MG PO TABS

Facility

$1.35

Service Code	NDC 1672941401
Hospital Charge Code	1672941401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67

DOXAZOSIN MESYLATE 4 MG PO TABS

Facility

$1.03

Service Code	NDC 0904552461
Hospital Charge Code	0904552461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51

DOXAZOSIN MESYLATE 4 MG PO TABS

Facility

$1.03

Service Code	NDC 0904552461
Hospital Charge Code	0904552461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Brighton Health Commercial	$0.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.70
Rate for Payer: EmblemHealth Commercial	$0.51
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.67

DOXEPIN HCL 10 MG PO CAPS

Facility

$0.64

Service Code	NDC 5107943601
Hospital Charge Code	5107943601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: EmblemHealth Commercial	$0.32
Rate for Payer: Group Health Inc Commercial	$0.32
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32
Rate for Payer: Hamaspik Choice Inc Medicare	$0.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

DOXEPIN HCL 10 MG PO CAPS

Facility

$0.64

Service Code	NDC 5107943620
Hospital Charge Code	5107943620
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.43
Rate for Payer: EmblemHealth Commercial	$0.32
Rate for Payer: Group Health Inc Commercial	$0.32
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32
Rate for Payer: Hamaspik Choice Inc Medicare	$0.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

DOXEPIN HCL 10 MG PO CAPS

Facility

$0.31

Service Code	NDC 5167242171
Hospital Charge Code	5167242171
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15

DOXEPIN HCL 10 MG PO CAPS

Facility

$0.64

Service Code	NDC 5107943620
Hospital Charge Code	5107943620
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32

DOXEPIN HCL 10 MG PO CAPS

Facility

$0.31

Service Code	NDC 5167242171
Hospital Charge Code	5167242171
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: EmblemHealth Commercial	$0.15
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

Know your out-of-pocket cost for care.

All Charges