St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BUPROPION HCL 100 MG PO TABS

Facility

$1.97

Service Code	NDC 0904663661
Hospital Charge Code	0904663661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.98
Rate for Payer: Aetna Government	$0.98
Rate for Payer: Brighton Health Commercial	$1.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.34
Rate for Payer: EmblemHealth Commercial	$0.98
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.28

BUPROPION HCL 100 MG PO TABS

Facility

$2.12

Service Code	NDC 5026814315
Hospital Charge Code	5026814315
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.06

BUPROPION HCL 100 MG PO TABS

Facility

$1.06

Service Code	NDC 6050501571
Hospital Charge Code	6050501571
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53

BUPROPION HCL 100 MG PO TABS

Facility

$1.97

Service Code	NDC 0904663661
Hospital Charge Code	0904663661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98

BUPROPION HCL 100 MG PO TABS

Facility

$2.12

Service Code	NDC 5026814315
Hospital Charge Code	5026814315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$1.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.44
Rate for Payer: EmblemHealth Commercial	$1.06
Rate for Payer: Group Health Inc Commercial	$1.06
Rate for Payer: Group Health Inc Medicare	$0.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.38

BUPROPION HCL 75 MG PO TABS

Facility

$1.45

Service Code	NDC 0904663561
Hospital Charge Code	0904663561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73

BUPROPION HCL 75 MG PO TABS

Facility

$0.79

Service Code	NDC 6050501581
Hospital Charge Code	6050501581
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.40
Rate for Payer: Aetna Government	$0.40
Rate for Payer: Brighton Health Commercial	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.54
Rate for Payer: EmblemHealth Commercial	$0.40
Rate for Payer: Group Health Inc Commercial	$0.40
Rate for Payer: Group Health Inc Medicare	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.40
Rate for Payer: Hamaspik Choice Inc Medicare	$0.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.52

BUPROPION HCL 75 MG PO TABS

Facility

$1.45

Service Code	NDC 0904663561
Hospital Charge Code	0904663561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.73
Rate for Payer: Aetna Government	$0.73
Rate for Payer: Brighton Health Commercial	$1.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.99
Rate for Payer: EmblemHealth Commercial	$0.73
Rate for Payer: Group Health Inc Commercial	$0.73
Rate for Payer: Group Health Inc Medicare	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73
Rate for Payer: Hamaspik Choice Inc Medicare	$0.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.94

BUPROPION HCL 75 MG PO TABS

Facility

$0.79

Service Code	NDC 6050501581
Hospital Charge Code	6050501581
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.40

Burns with skin graft except extensive 3rd degree burns

Facility

$81,866.57

Service Code	APR-DRG 8422
Min. Negotiated Rate	$36,385.14
Max. Negotiated Rate	$81,866.57
Rate for Payer: Affinity Essential Plan 1&2	$81,866.57
Rate for Payer: Affinity Essential Plan 3&4	$81,866.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$36,385.14
Rate for Payer: Amida Care Medicaid	$36,385.14
Rate for Payer: EmblemHealth Essential Plan 1&2	$81,866.57
Rate for Payer: EmblemHealth Essential Plan 3&4	$36,385.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,385.14
Rate for Payer: Fidelis Qualified Health Plan	$43,662.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,385.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,385.14
Rate for Payer: Healthfirst Commercial	$65,412.00
Rate for Payer: Healthfirst Essential Plan	$81,866.57
Rate for Payer: Healthfirst QHP	$70,380.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,385.14
Rate for Payer: SOMOS Essential	$81,866.57
Rate for Payer: United Healthcare Essential Plan 1&2	$81,866.57
Rate for Payer: United Healthcare Essential Plan 3&4	$81,866.57
Rate for Payer: United Healthcare Medicaid	$36,385.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,385.14

Burns with skin graft except extensive 3rd degree burns

Facility

$69,921.16

Service Code	APR-DRG 8421
Min. Negotiated Rate	$31,076.07
Max. Negotiated Rate	$69,921.16
Rate for Payer: Affinity Essential Plan 1&2	$69,921.16
Rate for Payer: Affinity Essential Plan 3&4	$69,921.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,076.07
Rate for Payer: Amida Care Medicaid	$31,076.07
Rate for Payer: EmblemHealth Essential Plan 1&2	$69,921.16
Rate for Payer: EmblemHealth Essential Plan 3&4	$31,076.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,076.07
Rate for Payer: Fidelis Qualified Health Plan	$37,291.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,076.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,076.07
Rate for Payer: Healthfirst Commercial	$42,567.00
Rate for Payer: Healthfirst Essential Plan	$69,921.16
Rate for Payer: Healthfirst QHP	$31,652.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,076.07
Rate for Payer: SOMOS Essential	$69,921.16
Rate for Payer: United Healthcare Essential Plan 1&2	$69,921.16
Rate for Payer: United Healthcare Essential Plan 3&4	$69,921.16
Rate for Payer: United Healthcare Medicaid	$31,076.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,076.07

Burns with skin graft except extensive 3rd degree burns

Facility

$113,704.00

Service Code	APR-DRG 8423
Min. Negotiated Rate	$48,337.58
Max. Negotiated Rate	$113,704.00
Rate for Payer: Affinity Essential Plan 1&2	$108,759.55
Rate for Payer: Affinity Essential Plan 3&4	$108,759.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$48,337.58
Rate for Payer: Amida Care Medicaid	$48,337.58
Rate for Payer: EmblemHealth Essential Plan 1&2	$108,759.55
Rate for Payer: EmblemHealth Essential Plan 3&4	$48,337.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$48,337.58
Rate for Payer: Fidelis Qualified Health Plan	$58,005.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$48,337.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$48,337.58
Rate for Payer: Healthfirst Commercial	$113,704.00
Rate for Payer: Healthfirst Essential Plan	$108,759.55
Rate for Payer: Healthfirst QHP	$99,660.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48,337.58
Rate for Payer: SOMOS Essential	$108,759.55
Rate for Payer: United Healthcare Essential Plan 1&2	$108,759.55
Rate for Payer: United Healthcare Essential Plan 3&4	$108,759.55
Rate for Payer: United Healthcare Medicaid	$48,337.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$48,337.58

Burns with skin graft except extensive 3rd degree burns

Facility

$233,529.00

Service Code	APR-DRG 8424
Min. Negotiated Rate	$81,747.51
Max. Negotiated Rate	$233,529.00
Rate for Payer: Affinity Essential Plan 1&2	$183,931.90
Rate for Payer: Affinity Essential Plan 3&4	$183,931.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$81,747.51
Rate for Payer: Amida Care Medicaid	$81,747.51
Rate for Payer: EmblemHealth Essential Plan 1&2	$183,931.90
Rate for Payer: EmblemHealth Essential Plan 3&4	$81,747.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$81,747.51
Rate for Payer: Fidelis Qualified Health Plan	$98,097.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$81,747.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$81,747.51
Rate for Payer: Healthfirst Commercial	$213,461.00
Rate for Payer: Healthfirst Essential Plan	$183,931.90
Rate for Payer: Healthfirst QHP	$233,529.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$81,747.51
Rate for Payer: SOMOS Essential	$183,931.90
Rate for Payer: United Healthcare Essential Plan 1&2	$183,931.90
Rate for Payer: United Healthcare Essential Plan 3&4	$183,931.90
Rate for Payer: United Healthcare Medicaid	$81,747.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$81,747.51

BUSPIRONE HCL 10 MG PO TABS

Facility

$0.21

Service Code	NDC 0904712161
Hospital Charge Code	0904712161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

BUSPIRONE HCL 10 MG PO TABS

Facility

$0.21

Service Code	NDC 0904712161
Hospital Charge Code	0904712161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: EmblemHealth Commercial	$0.11
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

BUSPIRONE HCL 10 MG PO TABS

Facility

$1.35

Service Code	NDC 1672920201
Hospital Charge Code	1672920201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.08
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	$1.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.08
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

BUSPIRONE HCL 10 MG PO TABS

Facility

$1.35

Service Code	NDC 0093005401
Hospital Charge Code	0093005401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.08
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	$1.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.08
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

BUSPIRONE HCL 10 MG PO TABS

Facility

$1.35

Service Code	NDC 0093005401
Hospital Charge Code	0093005401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67

BUSPIRONE HCL 10 MG PO TABS

Facility

$1.35

Service Code	NDC 5107998620
Hospital Charge Code	5107998620
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.08
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	$1.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.08
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

BUSPIRONE HCL 10 MG PO TABS

Facility

$1.35

Service Code	NDC 1672920201
Hospital Charge Code	1672920201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67

BUSPIRONE HCL 10 MG PO TABS

Facility

$1.35

Service Code	NDC 5107998620
Hospital Charge Code	5107998620
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67

BUSPIRONE HCL 15 MG PO TABS

Facility

$2.02

Service Code	NDC 0093100301
Hospital Charge Code	0093100301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.01

BUSPIRONE HCL 15 MG PO TABS

Facility

$0.69

Service Code	NDC 5026813515
Hospital Charge Code	5026813515
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34

BUSPIRONE HCL 15 MG PO TABS

Facility

$0.65

Service Code	NDC 0904689961
Hospital Charge Code	0904689961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

BUSPIRONE HCL 15 MG PO TABS

Facility

$0.65

Service Code	NDC 0904689961
Hospital Charge Code	0904689961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

Know your out-of-pocket cost for care.

All Charges