St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OLANZAPINE 20 MG PO TABS

Facility

$39.83

Service Code	NDC 5511116830
Hospital Charge Code	5511116830
Hospital Revenue Code	250
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$31.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.91
Rate for Payer: Aetna Government	$19.91
Rate for Payer: Brighton Health Commercial	$29.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.08
Rate for Payer: EmblemHealth Commercial	$19.91
Rate for Payer: Group Health Inc Commercial	$19.91
Rate for Payer: Group Health Inc Medicare	$13.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.91
Rate for Payer: Hamaspik Choice Inc Medicare	$19.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.89

OLANZAPINE 20 MG PO TABS

Facility

$0.95

Service Code	NDC 0904628761
Hospital Charge Code	0904628761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48

OLANZAPINE 20 MG PO TABS

Facility

$39.83

Service Code	NDC 6050531403
Hospital Charge Code	6050531403
Hospital Revenue Code	250
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$31.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.91
Rate for Payer: Aetna Government	$19.91
Rate for Payer: Brighton Health Commercial	$29.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.08
Rate for Payer: EmblemHealth Commercial	$19.91
Rate for Payer: Group Health Inc Commercial	$19.91
Rate for Payer: Group Health Inc Medicare	$13.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.91
Rate for Payer: Hamaspik Choice Inc Medicare	$19.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.89

OLANZAPINE 20 MG PO TABS

Facility

$39.83

Service Code	NDC 6050531403
Hospital Charge Code	6050531403
Hospital Revenue Code	250
Min. Negotiated Rate	$19.91
Max. Negotiated Rate	$19.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.91

OLANZAPINE 20 MG PO TABS

Facility

$39.83

Service Code	NDC 5511116830
Hospital Charge Code	5511116830
Hospital Revenue Code	250
Min. Negotiated Rate	$19.91
Max. Negotiated Rate	$19.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.91

OLANZAPINE 20 MG PO TABS

Facility

$0.95

Service Code	NDC 0904628761
Hospital Charge Code	0904628761
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

OLANZAPINE 20 MG PO TBDP

Facility

$40.89

Service Code	NDC 6050532780
Hospital Charge Code	6050532780
Hospital Revenue Code	250
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$32.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.44
Rate for Payer: Aetna Government	$20.44
Rate for Payer: Brighton Health Commercial	$30.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.80
Rate for Payer: EmblemHealth Commercial	$20.44
Rate for Payer: Group Health Inc Commercial	$20.44
Rate for Payer: Group Health Inc Medicare	$14.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.44
Rate for Payer: Hamaspik Choice Inc Medicare	$20.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.58

OLANZAPINE 20 MG PO TBDP

Facility

$40.89

Service Code	NDC 6050532780
Hospital Charge Code	6050532780
Hospital Revenue Code	250
Min. Negotiated Rate	$20.44
Max. Negotiated Rate	$20.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.44

OLANZAPINE 2.5 MG PO TABS

Facility

$11.20

Service Code	NDC 5511116330
Hospital Charge Code	5511116330
Hospital Revenue Code	250
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$8.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.60
Rate for Payer: Aetna Government	$5.60
Rate for Payer: Brighton Health Commercial	$8.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.61
Rate for Payer: EmblemHealth Commercial	$5.60
Rate for Payer: Group Health Inc Commercial	$5.60
Rate for Payer: Group Health Inc Medicare	$3.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.60
Rate for Payer: Hamaspik Choice Inc Medicare	$5.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.28

OLANZAPINE 2.5 MG PO TABS

Facility

$11.20

Service Code	NDC 5511116330
Hospital Charge Code	5511116330
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.60

OLANZAPINE 2.5 MG PO TABS

Facility

$11.20

Service Code	NDC 0904628361
Hospital Charge Code	0904628361
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.60

OLANZAPINE 2.5 MG PO TABS

Facility

$11.20

Service Code	NDC 0904628361
Hospital Charge Code	0904628361
Hospital Revenue Code	250
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$8.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.60
Rate for Payer: Aetna Government	$5.60
Rate for Payer: Brighton Health Commercial	$8.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.61
Rate for Payer: EmblemHealth Commercial	$5.60
Rate for Payer: Group Health Inc Commercial	$5.60
Rate for Payer: Group Health Inc Medicare	$3.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.60
Rate for Payer: Hamaspik Choice Inc Medicare	$5.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.28

OLANZAPINE 2.5 MG PO TABS

Facility

$11.20

Service Code	NDC 6050531100
Hospital Charge Code	6050531100
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.60

OLANZAPINE 2.5 MG PO TABS

Facility

$11.20

Service Code	NDC 6050531100
Hospital Charge Code	6050531100
Hospital Revenue Code	250
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$8.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.60
Rate for Payer: Aetna Government	$5.60
Rate for Payer: Brighton Health Commercial	$8.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.61
Rate for Payer: EmblemHealth Commercial	$5.60
Rate for Payer: Group Health Inc Commercial	$5.60
Rate for Payer: Group Health Inc Medicare	$3.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.60
Rate for Payer: Hamaspik Choice Inc Medicare	$5.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.28

OLANZAPINE 5 MG PO TABS

Facility

$13.22

Service Code	NDC 6050531110
Hospital Charge Code	6050531110
Hospital Revenue Code	250
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$6.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.61

OLANZAPINE 5 MG PO TABS

Facility

$12.29

Service Code	NDC 6954338130
Hospital Charge Code	6954338130
Hospital Revenue Code	250
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$9.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.14
Rate for Payer: Aetna Government	$6.14
Rate for Payer: Brighton Health Commercial	$9.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.36
Rate for Payer: EmblemHealth Commercial	$6.14
Rate for Payer: Group Health Inc Commercial	$6.14
Rate for Payer: Group Health Inc Medicare	$4.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.14
Rate for Payer: Hamaspik Choice Inc Medicare	$6.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.99

OLANZAPINE 5 MG PO TABS

Facility

$12.29

Service Code	NDC 6954338130
Hospital Charge Code	6954338130
Hospital Revenue Code	250
Min. Negotiated Rate	$6.14
Max. Negotiated Rate	$6.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.14

OLANZAPINE 5 MG PO TABS

Facility

$13.22

Service Code	NDC 0904637761
Hospital Charge Code	0904637761
Hospital Revenue Code	250
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$6.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.61

OLANZAPINE 5 MG PO TABS

Facility

$13.22

Service Code	NDC 4359816405
Hospital Charge Code	4359816405
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 5 MG PO TABS

Facility

$13.22

Service Code	NDC 0904637761
Hospital Charge Code	0904637761
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 5 MG PO TABS

Facility

$13.22

Service Code	NDC 6050531110
Hospital Charge Code	6050531110
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 5 MG PO TABS

Facility

$13.22

Service Code	NDC 4359816405
Hospital Charge Code	4359816405
Hospital Revenue Code	250
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$6.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.61

OLANZAPINE 5 MG PO TBDP

Facility

$14.27

Service Code	NDC 4988432055
Hospital Charge Code	4988432055
Hospital Revenue Code	250
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$11.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.14
Rate for Payer: Aetna Government	$7.14
Rate for Payer: Brighton Health Commercial	$10.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.71
Rate for Payer: EmblemHealth Commercial	$7.14
Rate for Payer: Group Health Inc Commercial	$7.14
Rate for Payer: Group Health Inc Medicare	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.14
Rate for Payer: Hamaspik Choice Inc Medicare	$7.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.28

OLANZAPINE 5 MG PO TBDP

Facility

$14.27

Service Code	NDC 4988432055
Hospital Charge Code	4988432055
Hospital Revenue Code	250
Min. Negotiated Rate	$7.14
Max. Negotiated Rate	$7.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.14

OLANZAPINE 5 MG PO TBDP

Facility

$2.08

Service Code	NDC 5511126281
Hospital Charge Code	5511126281
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$1.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.04
Rate for Payer: Aetna Government	$1.04
Rate for Payer: Brighton Health Commercial	$1.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.41
Rate for Payer: EmblemHealth Commercial	$1.04
Rate for Payer: Group Health Inc Commercial	$1.04
Rate for Payer: Group Health Inc Medicare	$0.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.04
Rate for Payer: Hamaspik Choice Inc Medicare	$1.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.35

Know your out-of-pocket cost for care.

All Charges