St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MEGESTROL ACETATE 800 MG/20ML PO SUSP

Facility

$0.55

Service Code	NDC 6809417459
Hospital Charge Code	6809417459
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28

MEGESTROL ACETATE 800 MG/20ML PO SUSP

Facility

$0.55

Service Code	NDC 6809417459
Hospital Charge Code	6809417459
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: EmblemHealth Commercial	$0.28
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.36

MEMANTINE HCL 10 MG PO TABS

Facility

$6.10

Service Code	NDC 0591387560
Hospital Charge Code	0591387560
Hospital Revenue Code	250
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05

MEMANTINE HCL 10 MG PO TABS

Facility

$6.10

Service Code	NDC 2930017216
Hospital Charge Code	2930017216
Hospital Revenue Code	250
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05

MEMANTINE HCL 10 MG PO TABS

Facility

$0.95

Service Code	NDC 0904650661
Hospital Charge Code	0904650661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.65
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

MEMANTINE HCL 10 MG PO TABS

Facility

$0.95

Service Code	NDC 0904650661
Hospital Charge Code	0904650661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48

MEMANTINE HCL 10 MG PO TABS

Facility

$6.10

Service Code	NDC 2930017216
Hospital Charge Code	2930017216
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: EmblemHealth Commercial	$3.05
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

MEMANTINE HCL 10 MG PO TABS

Facility

$6.10

Service Code	NDC 7257800414
Hospital Charge Code	7257800414
Hospital Revenue Code	250
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05

MEMANTINE HCL 10 MG PO TABS

Facility

$6.10

Service Code	NDC 0591387560
Hospital Charge Code	0591387560
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.15
Rate for Payer: EmblemHealth Commercial	$3.05
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.97

MEMANTINE HCL 10 MG PO TABS

Facility

$6.10

Service Code	NDC 7257800414
Hospital Charge Code	7257800414
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.15
Rate for Payer: EmblemHealth Commercial	$3.05
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

MEMANTINE HCL 10 MG PO TABS

Facility

$6.10

Service Code	NDC 0591387544
Hospital Charge Code	0591387544
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.15
Rate for Payer: EmblemHealth Commercial	$3.05
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.97

MEMANTINE HCL 10 MG PO TABS

Facility

$6.10

Service Code	NDC 0591387544
Hospital Charge Code	0591387544
Hospital Revenue Code	250
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05

MEMANTINE HCL 5 MG PO TABS

Facility

$0.49

Service Code	NDC 0904650506
Hospital Charge Code	0904650506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24

MEMANTINE HCL 5 MG PO TABS

Facility

$6.10

Service Code	NDC 0591387044
Hospital Charge Code	0591387044
Hospital Revenue Code	250
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05

MEMANTINE HCL 5 MG PO TABS

Facility

$0.95

Service Code	NDC 0904650561
Hospital Charge Code	0904650561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48

MEMANTINE HCL 5 MG PO TABS

Facility

$0.49

Service Code	NDC 0904650506
Hospital Charge Code	0904650506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: EmblemHealth Commercial	$0.24
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

MEMANTINE HCL 5 MG PO TABS

Facility

$6.09

Service Code	NDC 4733532186
Hospital Charge Code	4733532186
Hospital Revenue Code	250
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05

MEMANTINE HCL 5 MG PO TABS

Facility

$8.90

Service Code	NDC 0456320560
Hospital Charge Code	0456320560
Hospital Revenue Code	250
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.45

MEMANTINE HCL 5 MG PO TABS

Facility

$6.10

Service Code	NDC 0591387044
Hospital Charge Code	0591387044
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.15
Rate for Payer: EmblemHealth Commercial	$3.05
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.97

MEMANTINE HCL 5 MG PO TABS

Facility

$6.09

Service Code	NDC 4733532186
Hospital Charge Code	4733532186
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: EmblemHealth Commercial	$3.05
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

MEMANTINE HCL 5 MG PO TABS

Facility

$0.95

Service Code	NDC 0904650561
Hospital Charge Code	0904650561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.65
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

MEMANTINE HCL 5 MG PO TABS

Facility

$8.90

Service Code	NDC 0456320560
Hospital Charge Code	0456320560
Hospital Revenue Code	250
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$7.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.45
Rate for Payer: Aetna Government	$4.45
Rate for Payer: Brighton Health Commercial	$6.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.05
Rate for Payer: EmblemHealth Commercial	$4.45
Rate for Payer: Group Health Inc Commercial	$4.45
Rate for Payer: Group Health Inc Medicare	$3.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.45
Rate for Payer: Hamaspik Choice Inc Medicare	$4.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.78

MENING ACY&W-135 DIPHTH CONJ IM SOLN

Facility

$356.70

Service Code	NDC 4928158958
Hospital Charge Code	4928158958
Hospital Revenue Code	250
Min. Negotiated Rate	$124.84
Max. Negotiated Rate	$285.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$178.35
Rate for Payer: Aetna Government	$178.35
Rate for Payer: Brighton Health Commercial	$267.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$285.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$242.55
Rate for Payer: EmblemHealth Commercial	$178.35
Rate for Payer: Group Health Inc Commercial	$178.35
Rate for Payer: Group Health Inc Medicare	$124.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.35
Rate for Payer: Hamaspik Choice Inc Medicare	$178.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.85

MENING ACY&W-135 DIPHTH CONJ IM SOLN

Facility

$356.70

Service Code	NDC 4928158958
Hospital Charge Code	4928158958
Hospital Revenue Code	250
Min. Negotiated Rate	$178.35
Max. Negotiated Rate	$178.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.35

MENING ACY&W-135 TETANUS CONJ IM SOLN

Facility

$400.46

Service Code	NDC 4928159005
Hospital Charge Code	4928159005
Hospital Revenue Code	250
Min. Negotiated Rate	$200.23
Max. Negotiated Rate	$200.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.23

Know your out-of-pocket cost for care.

All Charges