St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GABAPENTIN 300 MG PO CAPS

Facility

$1.38

Service Code	NDC 6068759111
Hospital Charge Code	6068759111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69

GABAPENTIN 300 MG PO CAPS

Facility

$1.33

Service Code	NDC 5122411950
Hospital Charge Code	5122411950
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67

GABAPENTIN 300 MG PO CAPS

Facility

$0.20

Service Code	NDC 0904666661
Hospital Charge Code	0904666661
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	$0.13
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

GABAPENTIN 300 MG PO CAPS

Facility

$1.33

Service Code	NDC 4596355650
Hospital Charge Code	4596355650
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67

GABAPENTIN 300 MG PO CAPS

Facility

$1.33

Service Code	NDC 5122411950
Hospital Charge Code	5122411950
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.67
Rate for Payer: Aetna Government	$0.67
Rate for Payer: Brighton Health Commercial	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
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	$0.86

GABAPENTIN 300 MG PO CAPS

Facility

$1.33

Service Code	NDC 6787722305
Hospital Charge Code	6787722305
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.67
Rate for Payer: Aetna Government	$0.67
Rate for Payer: Brighton Health Commercial	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.91
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	$0.87

GABAPENTIN 300 MG PO CAPS

Facility

$1.33

Service Code	NDC 5122411960
Hospital Charge Code	5122411960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67

GABAPENTIN 300 MG PO CAPS

Facility

$0.20

Service Code	NDC 0904666661
Hospital Charge Code	0904666661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

GABAPENTIN 300 MG PO CAPS

Facility

$1.33

Service Code	NDC 6787722310
Hospital Charge Code	6787722310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67

GABAPENTIN 300 MG PO CAPS

Facility

$1.33

Service Code	NDC 6787722310
Hospital Charge Code	6787722310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.67
Rate for Payer: Aetna Government	$0.67
Rate for Payer: Brighton Health Commercial	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.91
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	$0.87

GABAPENTIN 300 MG PO CAPS

Facility

$1.33

Service Code	NDC 4596355650
Hospital Charge Code	4596355650
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.67
Rate for Payer: Aetna Government	$0.67
Rate for Payer: Brighton Health Commercial	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
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	$0.86

GABAPENTIN 300 MG PO CAPS

Facility

$1.34

Service Code	NDC 6787722301
Hospital Charge Code	6787722301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.07
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	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.91
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	$0.87

GABAPENTIN 300 MG PO CAPS

Facility

$0.20

Service Code	NDC 6373990310
Hospital Charge Code	6373990310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

GABAPENTIN 300 MG PO CAPS

Facility

$1.38

Service Code	NDC 6068759111
Hospital Charge Code	6068759111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.69
Rate for Payer: Aetna Government	$0.69
Rate for Payer: Brighton Health Commercial	$1.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.94
Rate for Payer: EmblemHealth Commercial	$0.69
Rate for Payer: Group Health Inc Commercial	$0.69
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69
Rate for Payer: Hamaspik Choice Inc Medicare	$0.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.90

GABAPENTIN 300 MG PO CAPS

Facility

$1.33

Service Code	NDC 5122411960
Hospital Charge Code	5122411960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.67
Rate for Payer: Aetna Government	$0.67
Rate for Payer: Brighton Health Commercial	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
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	$0.86

GABAPENTIN 300 MG PO CAPS

Facility

$1.34

Service Code	NDC 6787722301
Hospital Charge Code	6787722301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67

GABAPENTIN 300 MG PO CAPS

Facility

$1.33

Service Code	NDC 6787722305
Hospital Charge Code	6787722305
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67

GABAPENTIN 300 MG PO CAPS

Facility

$0.20

Service Code	NDC 6373990310
Hospital Charge Code	6373990310
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	$0.13
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

GABAPENTIN 400 MG PO CAPS

Facility

$0.25

Service Code	NDC 0904666761
Hospital Charge Code	0904666761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
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	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: EmblemHealth Commercial	$0.12
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.09
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

GABAPENTIN 400 MG PO CAPS

Facility

$1.61

Service Code	NDC 6787722410
Hospital Charge Code	6787722410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: EmblemHealth Commercial	$0.80
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.04

GABAPENTIN 400 MG PO CAPS

Facility

$1.60

Service Code	NDC 6586220005
Hospital Charge Code	6586220005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: EmblemHealth Commercial	$0.80
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.04

GABAPENTIN 400 MG PO CAPS

Facility

$1.61

Service Code	NDC 6787722405
Hospital Charge Code	6787722405
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: EmblemHealth Commercial	$0.80
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.04

GABAPENTIN 400 MG PO CAPS

Facility

$1.60

Service Code	NDC 6586220005
Hospital Charge Code	6586220005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80

GABAPENTIN 400 MG PO CAPS

Facility

$0.25

Service Code	NDC 0904666761
Hospital Charge Code	0904666761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12

GABAPENTIN 400 MG PO CAPS

Facility

$1.61

Service Code	NDC 6787722405
Hospital Charge Code	6787722405
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80

Know your out-of-pocket cost for care.

All Charges