St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DTAP-IPV VACCINE IM SUSP

Facility

$148.09

Service Code	NDC 4928156258
Hospital Charge Code	4928156258
Hospital Revenue Code	250
Min. Negotiated Rate	$51.83
Max. Negotiated Rate	$118.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.05
Rate for Payer: Aetna Government	$74.05
Rate for Payer: Brighton Health Commercial	$111.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$118.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$100.70
Rate for Payer: EmblemHealth Commercial	$74.05
Rate for Payer: Group Health Inc Commercial	$74.05
Rate for Payer: Group Health Inc Medicare	$51.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.05
Rate for Payer: Hamaspik Choice Inc Medicare	$74.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.26

DTAP-IPV VACCINE IM SUSP

Facility

$148.09

Service Code	NDC 4928156210
Hospital Charge Code	4928156210
Hospital Revenue Code	250
Min. Negotiated Rate	$74.05
Max. Negotiated Rate	$74.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.05

DTAP-IPV VACCINE IM SUSP

Facility

$148.09

Service Code	NDC 4928156210
Hospital Charge Code	4928156210
Hospital Revenue Code	250
Min. Negotiated Rate	$51.83
Max. Negotiated Rate	$118.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.05
Rate for Payer: Aetna Government	$74.05
Rate for Payer: Brighton Health Commercial	$111.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$118.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$100.70
Rate for Payer: EmblemHealth Commercial	$74.05
Rate for Payer: Group Health Inc Commercial	$74.05
Rate for Payer: Group Health Inc Medicare	$51.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.05
Rate for Payer: Hamaspik Choice Inc Medicare	$74.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.26

DTAP-IPV VACCINE IM SUSP

Facility

$148.09

Service Code	NDC 4928156258
Hospital Charge Code	4928156258
Hospital Revenue Code	250
Min. Negotiated Rate	$74.05
Max. Negotiated Rate	$74.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.05

DULOXETINE HCL 20 MG PO CPEP

Facility

$7.00

Service Code	NDC 6818029407
Hospital Charge Code	6818029407
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: EmblemHealth Commercial	$3.50
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

DULOXETINE HCL 20 MG PO CPEP

Facility

$1.75

Service Code	NDC 0904704304
Hospital Charge Code	0904704304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.40
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	$1.40
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	$1.14

DULOXETINE HCL 20 MG PO CPEP

Facility

$7.00

Service Code	NDC 2724109706
Hospital Charge Code	2724109706
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50

DULOXETINE HCL 20 MG PO CPEP

Facility

$7.00

Service Code	NDC 6818029407
Hospital Charge Code	6818029407
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50

DULOXETINE HCL 20 MG PO CPEP

Facility

$8.17

Service Code	NDC 5026828615
Hospital Charge Code	5026828615
Hospital Revenue Code	250
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$6.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$6.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.55
Rate for Payer: EmblemHealth Commercial	$4.08
Rate for Payer: Group Health Inc Commercial	$4.08
Rate for Payer: Group Health Inc Medicare	$2.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.08
Rate for Payer: Hamaspik Choice Inc Medicare	$4.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.31

DULOXETINE HCL 20 MG PO CPEP

Facility

$7.00

Service Code	NDC 5723701760
Hospital Charge Code	5723701760
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: EmblemHealth Commercial	$3.50
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

DULOXETINE HCL 20 MG PO CPEP

Facility

$8.17

Service Code	NDC 5026828615
Hospital Charge Code	5026828615
Hospital Revenue Code	250
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.08

DULOXETINE HCL 20 MG PO CPEP

Facility

$1.75

Service Code	NDC 0904704304
Hospital Charge Code	0904704304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87

DULOXETINE HCL 20 MG PO CPEP

Facility

$7.00

Service Code	NDC 2724109706
Hospital Charge Code	2724109706
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: EmblemHealth Commercial	$3.50
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

DULOXETINE HCL 20 MG PO CPEP

Facility

$7.00

Service Code	NDC 5723701760
Hospital Charge Code	5723701760
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50

DULOXETINE HCL 30 MG PO CPEP

Facility

$1.72

Service Code	NDC 0904704461
Hospital Charge Code	0904704461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86

DULOXETINE HCL 30 MG PO CPEP

Facility

$7.85

Service Code	NDC 6818029509
Hospital Charge Code	6818029509
Hospital Revenue Code	250
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$3.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93

DULOXETINE HCL 30 MG PO CPEP

Facility

$7.84

Service Code	NDC 4354738003
Hospital Charge Code	4354738003
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$6.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.92
Rate for Payer: Aetna Government	$3.92
Rate for Payer: Brighton Health Commercial	$5.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.33
Rate for Payer: EmblemHealth Commercial	$3.92
Rate for Payer: Group Health Inc Commercial	$3.92
Rate for Payer: Group Health Inc Medicare	$2.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.92
Rate for Payer: Hamaspik Choice Inc Medicare	$3.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.10

DULOXETINE HCL 30 MG PO CPEP

Facility

$7.85

Service Code	NDC 2724109809
Hospital Charge Code	2724109809
Hospital Revenue Code	250
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$3.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93

DULOXETINE HCL 30 MG PO CPEP

Facility

$7.85

Service Code	NDC 2724109809
Hospital Charge Code	2724109809
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$6.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.93
Rate for Payer: Aetna Government	$3.93
Rate for Payer: Brighton Health Commercial	$5.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.34
Rate for Payer: EmblemHealth Commercial	$3.93
Rate for Payer: Group Health Inc Commercial	$3.93
Rate for Payer: Group Health Inc Medicare	$2.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93
Rate for Payer: Hamaspik Choice Inc Medicare	$3.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.10

DULOXETINE HCL 30 MG PO CPEP

Facility

$7.85

Service Code	NDC 6818029503
Hospital Charge Code	6818029503
Hospital Revenue Code	250
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$3.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93

DULOXETINE HCL 30 MG PO CPEP

Facility

$7.85

Service Code	NDC 6818029509
Hospital Charge Code	6818029509
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$6.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.93
Rate for Payer: Aetna Government	$3.93
Rate for Payer: Brighton Health Commercial	$5.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.34
Rate for Payer: EmblemHealth Commercial	$3.93
Rate for Payer: Group Health Inc Commercial	$3.93
Rate for Payer: Group Health Inc Medicare	$2.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93
Rate for Payer: Hamaspik Choice Inc Medicare	$3.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.10

DULOXETINE HCL 30 MG PO CPEP

Facility

$7.85

Service Code	NDC 6818029503
Hospital Charge Code	6818029503
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$6.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.93
Rate for Payer: Aetna Government	$3.93
Rate for Payer: Brighton Health Commercial	$5.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.34
Rate for Payer: EmblemHealth Commercial	$3.93
Rate for Payer: Group Health Inc Commercial	$3.93
Rate for Payer: Group Health Inc Medicare	$2.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93
Rate for Payer: Hamaspik Choice Inc Medicare	$3.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.10

DULOXETINE HCL 30 MG PO CPEP

Facility

$7.85

Service Code	NDC 2724109810
Hospital Charge Code	2724109810
Hospital Revenue Code	250
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$3.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93

DULOXETINE HCL 30 MG PO CPEP

Facility

$7.84

Service Code	NDC 4354738003
Hospital Charge Code	4354738003
Hospital Revenue Code	250
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$3.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.92

DULOXETINE HCL 30 MG PO CPEP

Facility

$7.85

Service Code	NDC 5723701830
Hospital Charge Code	5723701830
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$6.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.93
Rate for Payer: Aetna Government	$3.93
Rate for Payer: Brighton Health Commercial	$5.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.34
Rate for Payer: EmblemHealth Commercial	$3.93
Rate for Payer: Group Health Inc Commercial	$3.93
Rate for Payer: Group Health Inc Medicare	$2.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93
Rate for Payer: Hamaspik Choice Inc Medicare	$3.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.10

Know your out-of-pocket cost for care.

All Charges