St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ATOMOXETINE HCL 40 MG PO CAPS

Facility

$15.47

Service Code	NDC 5511152130
Hospital Charge Code	5511152130
Hospital Revenue Code	250
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$7.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.73

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$10.06

Service Code	NDC 0121101618
Hospital Charge Code	0121101618
Hospital Revenue Code	250
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$5.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.03

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$2.74

Service Code	NDC 0904745925
Hospital Charge Code	0904745925
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$8.26

Service Code	NDC 0121101642
Hospital Charge Code	0121101642
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$6.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.13
Rate for Payer: Aetna Government	$4.13
Rate for Payer: Brighton Health Commercial	$6.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.62
Rate for Payer: EmblemHealth Commercial	$4.13
Rate for Payer: Group Health Inc Commercial	$4.13
Rate for Payer: Group Health Inc Medicare	$2.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.13
Rate for Payer: Hamaspik Choice Inc Medicare	$4.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.37

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$8.26

Service Code	NDC 5026808611
Hospital Charge Code	5026808611
Hospital Revenue Code	250
Min. Negotiated Rate	$4.13
Max. Negotiated Rate	$4.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.13

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$8.26

Service Code	NDC 6846242169
Hospital Charge Code	6846242169
Hospital Revenue Code	250
Min. Negotiated Rate	$4.13
Max. Negotiated Rate	$4.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.13

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$7.96

Service Code	NDC 0173054700
Hospital Charge Code	0173054700
Hospital Revenue Code	250
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$3.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.98

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$7.51

Service Code	NDC 3172262921
Hospital Charge Code	3172262921
Hospital Revenue Code	250
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.75

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$7.96

Service Code	NDC 0173054700
Hospital Charge Code	0173054700
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$6.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.98
Rate for Payer: Aetna Government	$3.98
Rate for Payer: Brighton Health Commercial	$5.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.41
Rate for Payer: EmblemHealth Commercial	$3.98
Rate for Payer: Group Health Inc Commercial	$3.98
Rate for Payer: Group Health Inc Medicare	$2.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.98
Rate for Payer: Hamaspik Choice Inc Medicare	$3.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.17

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$8.26

Service Code	NDC 8103310405
Hospital Charge Code	8103310405
Hospital Revenue Code	250
Min. Negotiated Rate	$4.13
Max. Negotiated Rate	$4.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.13

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$6.86

Service Code	NDC 6068753436
Hospital Charge Code	6068753436
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$5.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.43
Rate for Payer: Aetna Government	$3.43
Rate for Payer: Brighton Health Commercial	$5.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.66
Rate for Payer: EmblemHealth Commercial	$3.43
Rate for Payer: Group Health Inc Commercial	$3.43
Rate for Payer: Group Health Inc Medicare	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.43
Rate for Payer: Hamaspik Choice Inc Medicare	$3.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.46

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$4.43

Service Code	NDC 8103310442
Hospital Charge Code	8103310442
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.21

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$6.86

Service Code	NDC 6068753436
Hospital Charge Code	6068753436
Hospital Revenue Code	250
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$3.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.43

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$8.26

Service Code	NDC 0121101642
Hospital Charge Code	0121101642
Hospital Revenue Code	250
Min. Negotiated Rate	$4.13
Max. Negotiated Rate	$4.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.13

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$8.26

Service Code	NDC 5026808611
Hospital Charge Code	5026808611
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$6.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.13
Rate for Payer: Aetna Government	$4.13
Rate for Payer: Brighton Health Commercial	$6.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.62
Rate for Payer: EmblemHealth Commercial	$4.13
Rate for Payer: Group Health Inc Commercial	$4.13
Rate for Payer: Group Health Inc Medicare	$2.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.13
Rate for Payer: Hamaspik Choice Inc Medicare	$4.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.37

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$6.86

Service Code	NDC 0121101605
Hospital Charge Code	0121101605
Hospital Revenue Code	250
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$3.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.43

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$6.86

Service Code	NDC 0121101605
Hospital Charge Code	0121101605
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$5.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.43
Rate for Payer: Aetna Government	$3.43
Rate for Payer: Brighton Health Commercial	$5.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.66
Rate for Payer: EmblemHealth Commercial	$3.43
Rate for Payer: Group Health Inc Commercial	$3.43
Rate for Payer: Group Health Inc Medicare	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.43
Rate for Payer: Hamaspik Choice Inc Medicare	$3.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.46

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$2.74

Service Code	NDC 0904745925
Hospital Charge Code	0904745925
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.37
Rate for Payer: Aetna Government	$1.37
Rate for Payer: Brighton Health Commercial	$2.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.86
Rate for Payer: EmblemHealth Commercial	$1.37
Rate for Payer: Group Health Inc Commercial	$1.37
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.78

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$8.26

Service Code	NDC 6846242169
Hospital Charge Code	6846242169
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$6.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.13
Rate for Payer: Aetna Government	$4.13
Rate for Payer: Brighton Health Commercial	$6.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.62
Rate for Payer: EmblemHealth Commercial	$4.13
Rate for Payer: Group Health Inc Commercial	$4.13
Rate for Payer: Group Health Inc Medicare	$2.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.13
Rate for Payer: Hamaspik Choice Inc Medicare	$4.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.37

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$8.26

Service Code	NDC 8103310405
Hospital Charge Code	8103310405
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$6.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.13
Rate for Payer: Aetna Government	$4.13
Rate for Payer: Brighton Health Commercial	$6.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.62
Rate for Payer: EmblemHealth Commercial	$4.13
Rate for Payer: Group Health Inc Commercial	$4.13
Rate for Payer: Group Health Inc Medicare	$2.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.13
Rate for Payer: Hamaspik Choice Inc Medicare	$4.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.37

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$7.51

Service Code	NDC 3172262921
Hospital Charge Code	3172262921
Hospital Revenue Code	250
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$6.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.75
Rate for Payer: Aetna Government	$3.75
Rate for Payer: Brighton Health Commercial	$5.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.11
Rate for Payer: EmblemHealth Commercial	$3.75
Rate for Payer: Group Health Inc Commercial	$3.75
Rate for Payer: Group Health Inc Medicare	$2.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.88

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$4.43

Service Code	NDC 8103310442
Hospital Charge Code	8103310442
Hospital Revenue Code	250
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$3.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.21
Rate for Payer: Aetna Government	$2.21
Rate for Payer: Brighton Health Commercial	$3.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.01
Rate for Payer: EmblemHealth Commercial	$2.21
Rate for Payer: Group Health Inc Commercial	$2.21
Rate for Payer: Group Health Inc Medicare	$1.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.21
Rate for Payer: Hamaspik Choice Inc Medicare	$2.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.88

ATOVAQUONE 750 MG/5ML PO SUSP

Facility

$10.06

Service Code	NDC 0121101618
Hospital Charge Code	0121101618
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$8.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.03
Rate for Payer: Aetna Government	$5.03
Rate for Payer: Brighton Health Commercial	$7.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.84
Rate for Payer: EmblemHealth Commercial	$5.03
Rate for Payer: Group Health Inc Commercial	$5.03
Rate for Payer: Group Health Inc Medicare	$3.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.03
Rate for Payer: Hamaspik Choice Inc Medicare	$5.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.54

ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS

Facility

$7.15

Service Code	NDC 6846240401
Hospital Charge Code	6846240401
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$5.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.57
Rate for Payer: Aetna Government	$3.57
Rate for Payer: Brighton Health Commercial	$5.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.86
Rate for Payer: EmblemHealth Commercial	$3.57
Rate for Payer: Group Health Inc Commercial	$3.57
Rate for Payer: Group Health Inc Medicare	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.57
Rate for Payer: Hamaspik Choice Inc Medicare	$3.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.65

ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS

Facility

$7.15

Service Code	NDC 6846240401
Hospital Charge Code	6846240401
Hospital Revenue Code	250
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$3.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.57

Know your out-of-pocket cost for care.

All Charges