St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR

Facility

$0.67

Service Code	NDC 0143998275
Hospital Charge Code	0143998275
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34

AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR

Facility

$0.74

Service Code	NDC 0143998201
Hospital Charge Code	0143998201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.37
Rate for Payer: Aetna Government	$0.37
Rate for Payer: Brighton Health Commercial	$0.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.50
Rate for Payer: EmblemHealth Commercial	$0.37
Rate for Payer: Group Health Inc Commercial	$0.37
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37
Rate for Payer: Hamaspik Choice Inc Medicare	$0.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.48

AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR

Facility

$0.67

Service Code	NDC 0143998275
Hospital Charge Code	0143998275
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.34
Rate for Payer: Aetna Government	$0.34
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.46
Rate for Payer: EmblemHealth Commercial	$0.34
Rate for Payer: Group Health Inc Commercial	$0.34
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.44

AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR

Facility

$0.76

Service Code	NDC 0143998250
Hospital Charge Code	0143998250
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.51
Rate for Payer: EmblemHealth Commercial	$0.38
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR

Facility

$0.76

Service Code	NDC 0143998250
Hospital Charge Code	0143998250
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38

AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR

Facility

$0.70

Service Code	NDC 6668510120
Hospital Charge Code	6668510120
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Brighton Health Commercial	$0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: EmblemHealth Commercial	$0.35
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR

Facility

$0.70

Service Code	NDC 6586253450
Hospital Charge Code	6586253450
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35

AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR

Facility

$0.70

Service Code	NDC 6586253450
Hospital Charge Code	6586253450
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Brighton Health Commercial	$0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: EmblemHealth Commercial	$0.35
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR

Facility

$0.70

Service Code	NDC 6668510120
Hospital Charge Code	6668510120
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35

AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR

Facility

$0.74

Service Code	NDC 0143998201
Hospital Charge Code	0143998201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37

AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS

Facility

$3.79

Service Code	NDC 4257116142
Hospital Charge Code	4257116142
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$1.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.89

AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS

Facility

$3.79

Service Code	NDC 6586250220
Hospital Charge Code	6586250220
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$3.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.89
Rate for Payer: Aetna Government	$1.89
Rate for Payer: Brighton Health Commercial	$2.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.57
Rate for Payer: EmblemHealth Commercial	$1.89
Rate for Payer: Group Health Inc Commercial	$1.89
Rate for Payer: Group Health Inc Medicare	$1.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.89
Rate for Payer: Hamaspik Choice Inc Medicare	$1.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.46

AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS

Facility

$3.79

Service Code	NDC 4257116142
Hospital Charge Code	4257116142
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$3.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.89
Rate for Payer: Aetna Government	$1.89
Rate for Payer: Brighton Health Commercial	$2.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.57
Rate for Payer: EmblemHealth Commercial	$1.89
Rate for Payer: Group Health Inc Commercial	$1.89
Rate for Payer: Group Health Inc Medicare	$1.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.89
Rate for Payer: Hamaspik Choice Inc Medicare	$1.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.46

AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS

Facility

$3.79

Service Code	NDC 0093227434
Hospital Charge Code	0093227434
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$3.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.89
Rate for Payer: Aetna Government	$1.89
Rate for Payer: Brighton Health Commercial	$2.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.57
Rate for Payer: EmblemHealth Commercial	$1.89
Rate for Payer: Group Health Inc Commercial	$1.89
Rate for Payer: Group Health Inc Medicare	$1.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.89
Rate for Payer: Hamaspik Choice Inc Medicare	$1.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.46

AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS

Facility

$3.79

Service Code	NDC 6586250220
Hospital Charge Code	6586250220
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$1.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.89

AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS

Facility

$3.79

Service Code	NDC 0093227434
Hospital Charge Code	0093227434
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$1.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.89

AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS

Facility

$3.79

Service Code	NDC 0781183120
Hospital Charge Code	0781183120
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$1.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.89

AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS

Facility

$3.79

Service Code	NDC 0781183120
Hospital Charge Code	0781183120
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$3.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.89
Rate for Payer: Aetna Government	$1.89
Rate for Payer: Brighton Health Commercial	$2.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.57
Rate for Payer: EmblemHealth Commercial	$1.89
Rate for Payer: Group Health Inc Commercial	$1.89
Rate for Payer: Group Health Inc Medicare	$1.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.89
Rate for Payer: Hamaspik Choice Inc Medicare	$1.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.46

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS

Facility

$5.05

Service Code	NDC 0143924920
Hospital Charge Code	0143924920
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.53

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS

Facility

$5.07

Service Code	NDC 6586250320
Hospital Charge Code	6586250320
Hospital Revenue Code	250
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$4.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.54
Rate for Payer: Aetna Government	$2.54
Rate for Payer: Brighton Health Commercial	$3.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.45
Rate for Payer: EmblemHealth Commercial	$2.54
Rate for Payer: Group Health Inc Commercial	$2.54
Rate for Payer: Group Health Inc Medicare	$1.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.54
Rate for Payer: Hamaspik Choice Inc Medicare	$2.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.30

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS

Facility

$5.15

Service Code	NDC 8196422114
Hospital Charge Code	8196422114
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$4.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.58
Rate for Payer: Aetna Government	$2.58
Rate for Payer: Brighton Health Commercial	$3.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.50
Rate for Payer: EmblemHealth Commercial	$2.58
Rate for Payer: Group Health Inc Commercial	$2.58
Rate for Payer: Group Health Inc Medicare	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.35

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS

Facility

$7.64

Service Code	NDC 6068780311
Hospital Charge Code	6068780311
Hospital Revenue Code	250
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$3.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.82

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS

Facility

$5.05

Service Code	NDC 0143924920
Hospital Charge Code	0143924920
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$4.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Brighton Health Commercial	$3.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.44
Rate for Payer: EmblemHealth Commercial	$2.53
Rate for Payer: Group Health Inc Commercial	$2.53
Rate for Payer: Group Health Inc Medicare	$1.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.53
Rate for Payer: Hamaspik Choice Inc Medicare	$2.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.28

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS

Facility

$5.05

Service Code	NDC 6668510010
Hospital Charge Code	6668510010
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.53

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS

Facility

$5.05

Service Code	NDC 0093227534
Hospital Charge Code	0093227534
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.53

Know your out-of-pocket cost for care.

All Charges