St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LINEZOLID 600 MG PO TABS

Facility

$183.00

Service Code	NDC 0904655304
Hospital Charge Code	0904655304
Hospital Revenue Code	250
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.50

LINEZOLID 600 MG PO TABS

Facility

$183.66

Service Code	NDC 6787741933
Hospital Charge Code	6787741933
Hospital Revenue Code	250
Min. Negotiated Rate	$64.28
Max. Negotiated Rate	$146.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$91.83
Rate for Payer: Aetna Government	$91.83
Rate for Payer: Brighton Health Commercial	$137.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.89
Rate for Payer: EmblemHealth Commercial	$91.83
Rate for Payer: Group Health Inc Commercial	$91.83
Rate for Payer: Group Health Inc Medicare	$64.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.83
Rate for Payer: Hamaspik Choice Inc Medicare	$91.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$119.38

LINEZOLID 600 MG PO TABS

Facility

$183.00

Service Code	NDC 0904655304
Hospital Charge Code	0904655304
Hospital Revenue Code	250
Min. Negotiated Rate	$64.05
Max. Negotiated Rate	$146.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$91.50
Rate for Payer: Aetna Government	$91.50
Rate for Payer: Brighton Health Commercial	$137.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.44
Rate for Payer: EmblemHealth Commercial	$91.50
Rate for Payer: Group Health Inc Commercial	$91.50
Rate for Payer: Group Health Inc Medicare	$64.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.50
Rate for Payer: Hamaspik Choice Inc Medicare	$91.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$118.95

LIOTHYRONINE SODIUM 25 MCG PO TABS

Facility

$1.04

Service Code	NDC 7037711512
Hospital Charge Code	7037711512
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52

LIOTHYRONINE SODIUM 25 MCG PO TABS

Facility

$1.04

Service Code	NDC 7037711512
Hospital Charge Code	7037711512
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.52
Rate for Payer: Aetna Government	$0.52
Rate for Payer: Brighton Health Commercial	$0.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.71
Rate for Payer: EmblemHealth Commercial	$0.52
Rate for Payer: Group Health Inc Commercial	$0.52
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52
Rate for Payer: Hamaspik Choice Inc Medicare	$0.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.68

LIOTHYRONINE SODIUM 25 MCG PO TABS

Facility

$1.04

Service Code	NDC 6275659088
Hospital Charge Code	6275659088
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.52
Rate for Payer: Aetna Government	$0.52
Rate for Payer: Brighton Health Commercial	$0.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.71
Rate for Payer: EmblemHealth Commercial	$0.52
Rate for Payer: Group Health Inc Commercial	$0.52
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52
Rate for Payer: Hamaspik Choice Inc Medicare	$0.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.68

LIOTHYRONINE SODIUM 25 MCG PO TABS

Facility

$1.04

Service Code	NDC 6275659088
Hospital Charge Code	6275659088
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52

LIOTHYRONINE SODIUM 5 MCG PO TABS

Facility

$1.89

Service Code	NDC 5186232001
Hospital Charge Code	5186232001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.95

LIOTHYRONINE SODIUM 5 MCG PO TABS

Facility

$0.79

Service Code	NDC 6275658988
Hospital Charge Code	6275658988
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.40

LIOTHYRONINE SODIUM 5 MCG PO TABS

Facility

$1.89

Service Code	NDC 5186232001
Hospital Charge Code	5186232001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$1.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.29
Rate for Payer: EmblemHealth Commercial	$0.95
Rate for Payer: Group Health Inc Commercial	$0.95
Rate for Payer: Group Health Inc Medicare	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.95
Rate for Payer: Hamaspik Choice Inc Medicare	$0.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.23

LIOTHYRONINE SODIUM 5 MCG PO TABS

Facility

$0.79

Service Code	NDC 6275658988
Hospital Charge Code	6275658988
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	$0.51

LISINOPRIL 10 MG PO TABS

Facility

$0.99

Service Code	NDC 6818098001
Hospital Charge Code	6818098001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: EmblemHealth Commercial	$0.50
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

LISINOPRIL 10 MG PO TABS

Facility

$0.15

Service Code	NDC 6068732511
Hospital Charge Code	6068732511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

LISINOPRIL 10 MG PO TABS

Facility

$0.98

Service Code	NDC 0591040710
Hospital Charge Code	0591040710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49

LISINOPRIL 10 MG PO TABS

Facility

$0.98

Service Code	NDC 6818098003
Hospital Charge Code	6818098003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49

LISINOPRIL 10 MG PO TABS

Facility

$0.15

Service Code	NDC 6068732511
Hospital Charge Code	6068732511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

LISINOPRIL 10 MG PO TABS

Facility

$0.98

Service Code	NDC 0591040710
Hospital Charge Code	0591040710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.67
Rate for Payer: EmblemHealth Commercial	$0.49
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.64

LISINOPRIL 10 MG PO TABS

Facility

$0.06

Service Code	NDC 0904679861
Hospital Charge Code	0904679861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

LISINOPRIL 10 MG PO TABS

Facility

$0.99

Service Code	NDC 6818098001
Hospital Charge Code	6818098001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

LISINOPRIL 10 MG PO TABS

Facility

$0.98

Service Code	NDC 6818098003
Hospital Charge Code	6818098003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.67
Rate for Payer: EmblemHealth Commercial	$0.49
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.64

LISINOPRIL 10 MG PO TABS

Facility

$0.06

Service Code	NDC 0904679861
Hospital Charge Code	0904679861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

LISINOPRIL 20 MG PO TABS

Facility

$0.08

Service Code	NDC 0904679961
Hospital Charge Code	0904679961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

LISINOPRIL 20 MG PO TABS

Facility

$1.06

Service Code	NDC 6818098101
Hospital Charge Code	6818098101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$0.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.72
Rate for Payer: EmblemHealth Commercial	$0.53
Rate for Payer: Group Health Inc Commercial	$0.53
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53
Rate for Payer: Hamaspik Choice Inc Medicare	$0.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.69

LISINOPRIL 20 MG PO TABS

Facility

$0.08

Service Code	NDC 0904679961
Hospital Charge Code	0904679961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

LISINOPRIL 20 MG PO TABS

Facility

$1.06

Service Code	NDC 6818098101
Hospital Charge Code	6818098101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53

Know your out-of-pocket cost for care.

All Charges