St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DOXYCYCLINE HYCLATE 100 MG IV SOLR

Facility

$31.60

Service Code	NDC 6332313002
Hospital Charge Code	6332313002
Hospital Revenue Code	258
Min. Negotiated Rate	$15.80
Max. Negotiated Rate	$15.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.80

DOXYCYCLINE HYCLATE 100 MG IV SOLR

Facility

$30.20

Service Code	NDC 6838291010
Hospital Charge Code	6838291010
Hospital Revenue Code	258
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$24.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.10
Rate for Payer: Aetna Government	$15.10
Rate for Payer: Brighton Health Commercial	$22.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.54
Rate for Payer: EmblemHealth Commercial	$15.10
Rate for Payer: Group Health Inc Commercial	$15.10
Rate for Payer: Group Health Inc Medicare	$10.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.10
Rate for Payer: Hamaspik Choice Inc Medicare	$15.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.63

DOXYCYCLINE HYCLATE 100 MG IV SOLR

Facility

$31.60

Service Code	NDC 6332313011
Hospital Charge Code	6332313011
Hospital Revenue Code	258
Min. Negotiated Rate	$15.80
Max. Negotiated Rate	$15.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.80

DOXYCYCLINE HYCLATE 100 MG IV SOLR

Facility

$30.20

Service Code	NDC 7043603235
Hospital Charge Code	7043603235
Hospital Revenue Code	258
Min. Negotiated Rate	$15.10
Max. Negotiated Rate	$15.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.10

DOXYCYCLINE HYCLATE 100 MG IV SOLR

Facility

$30.20

Service Code	NDC 7043603235
Hospital Charge Code	7043603235
Hospital Revenue Code	258
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$24.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.10
Rate for Payer: Aetna Government	$15.10
Rate for Payer: Brighton Health Commercial	$22.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.54
Rate for Payer: EmblemHealth Commercial	$15.10
Rate for Payer: Group Health Inc Commercial	$15.10
Rate for Payer: Group Health Inc Medicare	$10.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.10
Rate for Payer: Hamaspik Choice Inc Medicare	$15.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.63

DOXYCYCLINE HYCLATE 100 MG IV SOLR

Facility

$31.60

Service Code	NDC 6332313011
Hospital Charge Code	6332313011
Hospital Revenue Code	258
Min. Negotiated Rate	$11.06
Max. Negotiated Rate	$25.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.80
Rate for Payer: Aetna Government	$15.80
Rate for Payer: Brighton Health Commercial	$23.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.49
Rate for Payer: EmblemHealth Commercial	$15.80
Rate for Payer: Group Health Inc Commercial	$15.80
Rate for Payer: Group Health Inc Medicare	$11.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.80
Rate for Payer: Hamaspik Choice Inc Medicare	$15.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.54

DOXYCYCLINE HYCLATE 100 MG IV SOLR

Facility

$30.20

Service Code	NDC 6838291010
Hospital Charge Code	6838291010
Hospital Revenue Code	258
Min. Negotiated Rate	$15.10
Max. Negotiated Rate	$15.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.10

DOXYCYCLINE HYCLATE 100 MG IV SOLR

Facility

$31.60

Service Code	NDC 6332313002
Hospital Charge Code	6332313002
Hospital Revenue Code	258
Min. Negotiated Rate	$11.06
Max. Negotiated Rate	$25.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.80
Rate for Payer: Aetna Government	$15.80
Rate for Payer: Brighton Health Commercial	$23.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.49
Rate for Payer: EmblemHealth Commercial	$15.80
Rate for Payer: Group Health Inc Commercial	$15.80
Rate for Payer: Group Health Inc Medicare	$11.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.80
Rate for Payer: Hamaspik Choice Inc Medicare	$15.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.54

DOXYCYCLINE HYCLATE 100 MG IV SOLR

Facility

$18.20

Service Code	NDC 6745743710
Hospital Charge Code	6745743710
Hospital Revenue Code	258
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$14.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.10
Rate for Payer: Aetna Government	$9.10
Rate for Payer: Brighton Health Commercial	$13.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.38
Rate for Payer: EmblemHealth Commercial	$9.10
Rate for Payer: Group Health Inc Commercial	$9.10
Rate for Payer: Group Health Inc Medicare	$6.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.10
Rate for Payer: Hamaspik Choice Inc Medicare	$9.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.83

DOXYCYCLINE HYCLATE 100 MG IV SOLR

Facility

$25.27

Service Code	NDC 0143938110
Hospital Charge Code	0143938110
Hospital Revenue Code	258
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$20.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.64
Rate for Payer: Aetna Government	$12.64
Rate for Payer: Brighton Health Commercial	$18.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.18
Rate for Payer: EmblemHealth Commercial	$12.64
Rate for Payer: Group Health Inc Commercial	$12.64
Rate for Payer: Group Health Inc Medicare	$8.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.64
Rate for Payer: Hamaspik Choice Inc Medicare	$12.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.43

DOXYCYCLINE HYCLATE 100 MG IV SOLR

Facility

$18.20

Service Code	NDC 6745743710
Hospital Charge Code	6745743710
Hospital Revenue Code	258
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$9.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.10

DOXYCYCLINE HYCLATE 100 MG IV SOLR

Facility

$25.27

Service Code	NDC 0143938110
Hospital Charge Code	0143938110
Hospital Revenue Code	258
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$12.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.64

DOXYCYCLINE HYCLATE 100 MG PO CAPS

Facility

$3.28

Service Code	NDC 6213598550
Hospital Charge Code	6213598550
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.64

DOXYCYCLINE HYCLATE 100 MG PO CAPS

Facility

$4.00

Service Code	NDC 5026827815
Hospital Charge Code	5026827815
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00

DOXYCYCLINE HYCLATE 100 MG PO CAPS

Facility

$2.01

Service Code	NDC 6068751311
Hospital Charge Code	6068751311
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

DOXYCYCLINE HYCLATE 100 MG PO CAPS

Facility

$5.53

Service Code	NDC 0143980305
Hospital Charge Code	0143980305
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.77

DOXYCYCLINE HYCLATE 100 MG PO CAPS

Facility

$9.62

Service Code	NDC 6923811002
Hospital Charge Code	6923811002
Hospital Revenue Code	250
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$4.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.81

DOXYCYCLINE HYCLATE 100 MG PO CAPS

Facility

$5.53

Service Code	NDC 0143980305
Hospital Charge Code	0143980305
Hospital Revenue Code	250
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$4.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.77
Rate for Payer: Aetna Government	$2.77
Rate for Payer: Brighton Health Commercial	$4.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.76
Rate for Payer: EmblemHealth Commercial	$2.77
Rate for Payer: Group Health Inc Commercial	$2.77
Rate for Payer: Group Health Inc Medicare	$1.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.77
Rate for Payer: Hamaspik Choice Inc Medicare	$2.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.60

DOXYCYCLINE HYCLATE 100 MG PO CAPS

Facility

$9.62

Service Code	NDC 6923811002
Hospital Charge Code	6923811002
Hospital Revenue Code	250
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$7.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.81
Rate for Payer: Aetna Government	$4.81
Rate for Payer: Brighton Health Commercial	$7.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.54
Rate for Payer: EmblemHealth Commercial	$4.81
Rate for Payer: Group Health Inc Commercial	$4.81
Rate for Payer: Group Health Inc Medicare	$3.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.81
Rate for Payer: Hamaspik Choice Inc Medicare	$4.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.25

DOXYCYCLINE HYCLATE 100 MG PO CAPS

Facility

$2.45

Service Code	NDC 0904042806
Hospital Charge Code	0904042806
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23

DOXYCYCLINE HYCLATE 100 MG PO CAPS

Facility

$4.00

Service Code	NDC 5026827815
Hospital Charge Code	5026827815
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: EmblemHealth Commercial	$2.00
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

DOXYCYCLINE HYCLATE 100 MG PO CAPS

Facility

$2.45

Service Code	NDC 0904042806
Hospital Charge Code	0904042806
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.23
Rate for Payer: Aetna Government	$1.23
Rate for Payer: Brighton Health Commercial	$1.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.67
Rate for Payer: EmblemHealth Commercial	$1.23
Rate for Payer: Group Health Inc Commercial	$1.23
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23
Rate for Payer: Hamaspik Choice Inc Medicare	$1.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.59

DOXYCYCLINE HYCLATE 100 MG PO CAPS

Facility

$3.28

Service Code	NDC 6213598550
Hospital Charge Code	6213598550
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$2.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.64
Rate for Payer: Aetna Government	$1.64
Rate for Payer: Brighton Health Commercial	$2.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.23
Rate for Payer: EmblemHealth Commercial	$1.64
Rate for Payer: Group Health Inc Commercial	$1.64
Rate for Payer: Group Health Inc Medicare	$1.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.64
Rate for Payer: Hamaspik Choice Inc Medicare	$1.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.13

DOXYCYCLINE HYCLATE 100 MG PO CAPS

Facility

$2.01

Service Code	NDC 6068751311
Hospital Charge Code	6068751311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.37
Rate for Payer: EmblemHealth Commercial	$1.00
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.31

DRONABINOL 2.5 MG PO CAPS

Facility

$5.67

Service Code	HCPCS Q0167
Hospital Charge Code	0904714461
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83

Know your out-of-pocket cost for care.

All Charges