St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS

Facility

$5.05

Service Code	NDC 0781185220
Hospital Charge Code	0781185220
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 4257116201
Hospital Charge Code	4257116201
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	$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

$5.15

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

$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 4257116242
Hospital Charge Code	4257116242
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

$7.64

Service Code	NDC 6068780311
Hospital Charge Code	6068780311
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$6.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.82
Rate for Payer: Aetna Government	$3.82
Rate for Payer: Brighton Health Commercial	$5.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.20
Rate for Payer: EmblemHealth Commercial	$3.82
Rate for Payer: Group Health Inc Commercial	$3.82
Rate for Payer: Group Health Inc Medicare	$2.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.82
Rate for Payer: Hamaspik Choice Inc Medicare	$3.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.97

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS

Facility

$5.05

Service Code	NDC 0781185220
Hospital Charge Code	0781185220
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 0093227534
Hospital Charge Code	0093227534
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

$5.07

Service Code	NDC 6586250320
Hospital Charge Code	6586250320
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$2.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.54

AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS

Facility

$5.05

Service Code	NDC 4257116201
Hospital Charge Code	4257116201
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

$4.95

Service Code	NDC 6586250301
Hospital Charge Code	6586250301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$3.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.48
Rate for Payer: Aetna Government	$2.48
Rate for Payer: Brighton Health Commercial	$3.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.37
Rate for Payer: EmblemHealth Commercial	$2.48
Rate for Payer: Group Health Inc Commercial	$2.48
Rate for Payer: Group Health Inc Medicare	$1.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.48
Rate for Payer: Hamaspik Choice Inc Medicare	$2.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.22

AMPHETAMINE-DEXTROAMPHET ER 10 MG PO CP24

Facility

$1.67

Service Code	NDC 4988484001
Hospital Charge Code	4988484001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$1.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.83
Rate for Payer: Aetna Government	$0.83
Rate for Payer: Brighton Health Commercial	$1.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.13
Rate for Payer: EmblemHealth Commercial	$0.83
Rate for Payer: Group Health Inc Commercial	$0.83
Rate for Payer: Group Health Inc Medicare	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.83
Rate for Payer: Hamaspik Choice Inc Medicare	$0.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.08

AMPHETAMINE-DEXTROAMPHET ER 10 MG PO CP24

Facility

$7.05

Service Code	NDC 0115148701
Hospital Charge Code	0115148701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$5.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.52
Rate for Payer: Aetna Government	$3.52
Rate for Payer: Brighton Health Commercial	$5.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.79
Rate for Payer: EmblemHealth Commercial	$3.52
Rate for Payer: Group Health Inc Commercial	$3.52
Rate for Payer: Group Health Inc Medicare	$2.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.58

AMPHETAMINE-DEXTROAMPHET ER 10 MG PO CP24

Facility

$7.05

Service Code	NDC 0115148701
Hospital Charge Code	0115148701
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$3.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.52

AMPHETAMINE-DEXTROAMPHET ER 10 MG PO CP24

Facility

$1.67

Service Code	NDC 4988484001
Hospital Charge Code	4988484001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.83

AMPHETAMINE-DEXTROAMPHET ER 5 MG PO CP24

Facility

$8.55

Service Code	NDC 5409238101
Hospital Charge Code	5409238101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$6.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.27
Rate for Payer: Aetna Government	$4.27
Rate for Payer: Brighton Health Commercial	$6.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.81
Rate for Payer: EmblemHealth Commercial	$4.27
Rate for Payer: Group Health Inc Commercial	$4.27
Rate for Payer: Group Health Inc Medicare	$2.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.27
Rate for Payer: Hamaspik Choice Inc Medicare	$4.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.56

AMPHETAMINE-DEXTROAMPHET ER 5 MG PO CP24

Facility

$8.55

Service Code	NDC 5409238101
Hospital Charge Code	5409238101
Hospital Revenue Code	250
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$4.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.27

AMPHOTERICIN B 50 MG IV SOLR

Facility

$60.00

Service Code	HCPCS J0285
Hospital Charge Code	3982210555
Hospital Revenue Code	258
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00

AMPHOTERICIN B 50 MG IV SOLR

Facility

$60.00

Service Code	HCPCS J0285
Hospital Charge Code	3982210555
Hospital Revenue Code	258
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$48.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.65
Rate for Payer: Aetna Government	$42.65
Rate for Payer: Brighton Health Commercial	$45.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.80
Rate for Payer: EmblemHealth Commercial	$30.00
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.00

AMPHOTERICIN B LIPOSOME 50 MG IV SUSR

Facility

$305.70

Service Code	HCPCS J0289
Hospital Charge Code	5515036501
Hospital Revenue Code	258
Min. Negotiated Rate	$152.85
Max. Negotiated Rate	$152.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.85

AMPHOTERICIN B LIPOSOME 50 MG IV SUSR

Facility

$305.69

Service Code	HCPCS J0289
Hospital Charge Code	6275623301
Hospital Revenue Code	258
Min. Negotiated Rate	$15.04
Max. Negotiated Rate	$244.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$168.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.48
Rate for Payer: Aetna Government	$21.48
Rate for Payer: Affinity Essential Plan 1&2	$15.04
Rate for Payer: Affinity Essential Plan 3&4	$15.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$15.04
Rate for Payer: Brighton Health Commercial	$229.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$244.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$207.87
Rate for Payer: Elderplan Medicare Advantage	$21.48
Rate for Payer: EmblemHealth Commercial	$21.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19.33
Rate for Payer: Fidelis Essential Plan Aliesa	$18.26
Rate for Payer: Fidelis Essential Plan QHP	$19.12
Rate for Payer: Fidelis Medicare Advantage	$21.48
Rate for Payer: Fidelis Qualified Health Plan	$19.12
Rate for Payer: Group Health Inc Commercial	$21.48
Rate for Payer: Group Health Inc Medicare	$21.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.48
Rate for Payer: Hamaspik Choice Inc Medicare	$21.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21.48
Rate for Payer: Healthfirst Medicare Advantage	$18.26
Rate for Payer: Healthfirst QHP	$21.48
Rate for Payer: Humana Medicare	$21.91
Rate for Payer: Senior Whole Health Medicare Advantage	$21.48
Rate for Payer: United Healthcare Medicare Advantage	$21.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$198.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.41
Rate for Payer: Wellcare Medicare	$20.41

AMPHOTERICIN B LIPOSOME 50 MG IV SUSR

Facility

$370.85

Service Code	HCPCS J0289
Hospital Charge Code	0469305130
Hospital Revenue Code	258
Min. Negotiated Rate	$185.43
Max. Negotiated Rate	$185.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.43

AMPHOTERICIN B LIPOSOME 50 MG IV SUSR

Facility

$305.69

Service Code	HCPCS J0289
Hospital Charge Code	6275623301
Hospital Revenue Code	258
Min. Negotiated Rate	$152.84
Max. Negotiated Rate	$152.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.84

Know your out-of-pocket cost for care.

All Charges