St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OFLOXACIN 0.3 % OT SOLN

Facility

$30.86

Service Code	NDC 6050503631
Hospital Charge Code	6050503631
Hospital Revenue Code	250
Min. Negotiated Rate	$15.43
Max. Negotiated Rate	$15.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.43

OLANZAPINE 10 MG IM SOLR

Facility

$42.53

Service Code	NDC 5515030801
Hospital Charge Code	5515030801
Hospital Revenue Code	250
Min. Negotiated Rate	$21.27
Max. Negotiated Rate	$21.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.27

OLANZAPINE 10 MG IM SOLR

Facility

$41.50

Service Code	NDC 0781910572
Hospital Charge Code	0781910572
Hospital Revenue Code	250
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$33.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.75
Rate for Payer: Aetna Government	$20.75
Rate for Payer: Brighton Health Commercial	$31.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.22
Rate for Payer: EmblemHealth Commercial	$20.75
Rate for Payer: Group Health Inc Commercial	$20.75
Rate for Payer: Group Health Inc Medicare	$14.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.75
Rate for Payer: Hamaspik Choice Inc Medicare	$20.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.98

OLANZAPINE 10 MG IM SOLR

Facility

$41.50

Service Code	NDC 0781910572
Hospital Charge Code	0781910572
Hospital Revenue Code	250
Min. Negotiated Rate	$20.75
Max. Negotiated Rate	$20.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.75

OLANZAPINE 10 MG IM SOLR

Facility

$47.39

Service Code	NDC 0517095501
Hospital Charge Code	0517095501
Hospital Revenue Code	250
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.70

OLANZAPINE 10 MG IM SOLR

Facility

$60.31

Service Code	NDC 0002759701
Hospital Charge Code	0002759701
Hospital Revenue Code	250
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$30.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.16

OLANZAPINE 10 MG IM SOLR

Facility

$42.53

Service Code	NDC 5515030801
Hospital Charge Code	5515030801
Hospital Revenue Code	250
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$34.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.27
Rate for Payer: Aetna Government	$21.27
Rate for Payer: Brighton Health Commercial	$31.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.92
Rate for Payer: EmblemHealth Commercial	$21.27
Rate for Payer: Group Health Inc Commercial	$21.27
Rate for Payer: Group Health Inc Medicare	$14.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.27
Rate for Payer: Hamaspik Choice Inc Medicare	$21.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.64

OLANZAPINE 10 MG IM SOLR

Facility

$60.31

Service Code	NDC 0002759701
Hospital Charge Code	0002759701
Hospital Revenue Code	250
Min. Negotiated Rate	$21.11
Max. Negotiated Rate	$48.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.16
Rate for Payer: Aetna Government	$30.16
Rate for Payer: Brighton Health Commercial	$45.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$41.01
Rate for Payer: EmblemHealth Commercial	$30.16
Rate for Payer: Group Health Inc Commercial	$30.16
Rate for Payer: Group Health Inc Medicare	$21.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.16
Rate for Payer: Hamaspik Choice Inc Medicare	$30.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.20

OLANZAPINE 10 MG IM SOLR

Facility

$41.50

Service Code	NDC 0781315972
Hospital Charge Code	0781315972
Hospital Revenue Code	250
Min. Negotiated Rate	$20.75
Max. Negotiated Rate	$20.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.75

OLANZAPINE 10 MG IM SOLR

Facility

$41.50

Service Code	NDC 0781315972
Hospital Charge Code	0781315972
Hospital Revenue Code	250
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$33.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.75
Rate for Payer: Aetna Government	$20.75
Rate for Payer: Brighton Health Commercial	$31.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.22
Rate for Payer: EmblemHealth Commercial	$20.75
Rate for Payer: Group Health Inc Commercial	$20.75
Rate for Payer: Group Health Inc Medicare	$14.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.75
Rate for Payer: Hamaspik Choice Inc Medicare	$20.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.98

OLANZAPINE 10 MG IM SOLR

Facility

$47.39

Service Code	NDC 0517095501
Hospital Charge Code	0517095501
Hospital Revenue Code	250
Min. Negotiated Rate	$16.59
Max. Negotiated Rate	$37.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.70
Rate for Payer: Aetna Government	$23.70
Rate for Payer: Brighton Health Commercial	$35.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.23
Rate for Payer: EmblemHealth Commercial	$23.70
Rate for Payer: Group Health Inc Commercial	$23.70
Rate for Payer: Group Health Inc Medicare	$16.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.70
Rate for Payer: Hamaspik Choice Inc Medicare	$23.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.80

OLANZAPINE 10 MG PO TABS

Facility

$19.92

Service Code	NDC 4359816630
Hospital Charge Code	4359816630
Hospital Revenue Code	250
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$15.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.96
Rate for Payer: Aetna Government	$9.96
Rate for Payer: Brighton Health Commercial	$14.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.54
Rate for Payer: EmblemHealth Commercial	$9.96
Rate for Payer: Group Health Inc Commercial	$9.96
Rate for Payer: Group Health Inc Medicare	$6.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.96
Rate for Payer: Hamaspik Choice Inc Medicare	$9.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.94

OLANZAPINE 10 MG PO TABS

Facility

$19.92

Service Code	NDC 6050531130
Hospital Charge Code	6050531130
Hospital Revenue Code	250
Min. Negotiated Rate	$9.96
Max. Negotiated Rate	$9.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.96

OLANZAPINE 10 MG PO TABS

Facility

$13.22

Service Code	NDC 0904637661
Hospital Charge Code	0904637661
Hospital Revenue Code	250
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$10.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.61
Rate for Payer: Aetna Government	$6.61
Rate for Payer: Brighton Health Commercial	$9.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.99
Rate for Payer: EmblemHealth Commercial	$6.61
Rate for Payer: Group Health Inc Commercial	$6.61
Rate for Payer: Group Health Inc Medicare	$4.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.61
Rate for Payer: Hamaspik Choice Inc Medicare	$6.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.59

OLANZAPINE 10 MG PO TABS

Facility

$19.92

Service Code	NDC 4359816605
Hospital Charge Code	4359816605
Hospital Revenue Code	250
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$15.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.96
Rate for Payer: Aetna Government	$9.96
Rate for Payer: Brighton Health Commercial	$14.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.54
Rate for Payer: EmblemHealth Commercial	$9.96
Rate for Payer: Group Health Inc Commercial	$9.96
Rate for Payer: Group Health Inc Medicare	$6.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.96
Rate for Payer: Hamaspik Choice Inc Medicare	$9.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.94

OLANZAPINE 10 MG PO TABS

Facility

$19.92

Service Code	NDC 4359816605
Hospital Charge Code	4359816605
Hospital Revenue Code	250
Min. Negotiated Rate	$9.96
Max. Negotiated Rate	$9.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.96

OLANZAPINE 10 MG PO TABS

Facility

$19.92

Service Code	NDC 6050531130
Hospital Charge Code	6050531130
Hospital Revenue Code	250
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$15.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.96
Rate for Payer: Aetna Government	$9.96
Rate for Payer: Brighton Health Commercial	$14.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.54
Rate for Payer: EmblemHealth Commercial	$9.96
Rate for Payer: Group Health Inc Commercial	$9.96
Rate for Payer: Group Health Inc Medicare	$6.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.96
Rate for Payer: Hamaspik Choice Inc Medicare	$9.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.95

OLANZAPINE 10 MG PO TABS

Facility

$13.22

Service Code	NDC 0904637661
Hospital Charge Code	0904637661
Hospital Revenue Code	250
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$6.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.61

OLANZAPINE 10 MG PO TABS

Facility

$19.92

Service Code	NDC 4359816630
Hospital Charge Code	4359816630
Hospital Revenue Code	250
Min. Negotiated Rate	$9.96
Max. Negotiated Rate	$9.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.96

OLANZAPINE 10 MG PO TBDP

Facility

$3.05

Service Code	NDC 5511126379
Hospital Charge Code	5511126379
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.52
Rate for Payer: Aetna Government	$1.52
Rate for Payer: Brighton Health Commercial	$2.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: EmblemHealth Commercial	$1.52
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.98

OLANZAPINE 10 MG PO TBDP

Facility

$3.05

Service Code	NDC 5511126381
Hospital Charge Code	5511126381
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.52
Rate for Payer: Aetna Government	$1.52
Rate for Payer: Brighton Health Commercial	$2.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: EmblemHealth Commercial	$1.52
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.98

OLANZAPINE 10 MG PO TBDP

Facility

$3.05

Service Code	NDC 5511126379
Hospital Charge Code	5511126379
Hospital Revenue Code	250
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$1.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52

OLANZAPINE 10 MG PO TBDP

Facility

$3.05

Service Code	NDC 5511126381
Hospital Charge Code	5511126381
Hospital Revenue Code	250
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$1.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52

OLANZAPINE 10 MG PO TBDP

Facility

$20.97

Service Code	NDC 6050532760
Hospital Charge Code	6050532760
Hospital Revenue Code	250
Min. Negotiated Rate	$7.34
Max. Negotiated Rate	$16.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.49
Rate for Payer: Aetna Government	$10.49
Rate for Payer: Brighton Health Commercial	$15.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.26
Rate for Payer: EmblemHealth Commercial	$10.49
Rate for Payer: Group Health Inc Commercial	$10.49
Rate for Payer: Group Health Inc Medicare	$7.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.49
Rate for Payer: Hamaspik Choice Inc Medicare	$10.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.63

OLANZAPINE 10 MG PO TBDP

Facility

$20.97

Service Code	NDC 6050532760
Hospital Charge Code	6050532760
Hospital Revenue Code	250
Min. Negotiated Rate	$10.49
Max. Negotiated Rate	$10.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.49

Know your out-of-pocket cost for care.

All Charges