St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OLANZAPINE 5 MG PO TBDP

Facility

$2.08

Service Code	NDC 5511126281
Hospital Charge Code	5511126281
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.04

OLANZAPINE 5 MG PO TBDP

Facility

$2.08

Service Code	NDC 5511126279
Hospital Charge Code	5511126279
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

OLANZAPINE 5 MG PO TBDP

Facility

$20.08

Service Code	NDC 0002445385
Hospital Charge Code	0002445385
Hospital Revenue Code	250
Min. Negotiated Rate	$7.03
Max. Negotiated Rate	$16.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.04
Rate for Payer: Aetna Government	$10.04
Rate for Payer: Brighton Health Commercial	$15.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.65
Rate for Payer: EmblemHealth Commercial	$10.04
Rate for Payer: Group Health Inc Commercial	$10.04
Rate for Payer: Group Health Inc Medicare	$7.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.04
Rate for Payer: Hamaspik Choice Inc Medicare	$10.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.05

OLANZAPINE 5 MG PO TBDP

Facility

$20.08

Service Code	NDC 0002445385
Hospital Charge Code	0002445385
Hospital Revenue Code	250
Min. Negotiated Rate	$10.04
Max. Negotiated Rate	$10.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.04

OLANZAPINE 5 MG PO TBDP

Facility

$14.27

Service Code	NDC 6050532750
Hospital Charge Code	6050532750
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	$10.71
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 6050532750
Hospital Charge Code	6050532750
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

$14.27

Service Code	NDC 4988432052
Hospital Charge Code	4988432052
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

$14.27

Service Code	NDC 4988432052
Hospital Charge Code	4988432052
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

$2.08

Service Code	NDC 5511126279
Hospital Charge Code	5511126279
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.04

OLANZAPINE 7.5 MG PO TABS

Facility

$16.08

Service Code	NDC 6050531120
Hospital Charge Code	6050531120
Hospital Revenue Code	250
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$8.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.04

OLANZAPINE 7.5 MG PO TABS

Facility

$16.08

Service Code	NDC 4359816530
Hospital Charge Code	4359816530
Hospital Revenue Code	250
Min. Negotiated Rate	$5.63
Max. Negotiated Rate	$12.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.04
Rate for Payer: Aetna Government	$8.04
Rate for Payer: Brighton Health Commercial	$12.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.94
Rate for Payer: EmblemHealth Commercial	$8.04
Rate for Payer: Group Health Inc Commercial	$8.04
Rate for Payer: Group Health Inc Medicare	$5.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.04
Rate for Payer: Hamaspik Choice Inc Medicare	$8.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.45

OLANZAPINE 7.5 MG PO TABS

Facility

$16.08

Service Code	NDC 6050531120
Hospital Charge Code	6050531120
Hospital Revenue Code	250
Min. Negotiated Rate	$5.63
Max. Negotiated Rate	$12.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.04
Rate for Payer: Aetna Government	$8.04
Rate for Payer: Brighton Health Commercial	$12.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.94
Rate for Payer: EmblemHealth Commercial	$8.04
Rate for Payer: Group Health Inc Commercial	$8.04
Rate for Payer: Group Health Inc Medicare	$5.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.04
Rate for Payer: Hamaspik Choice Inc Medicare	$8.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.45

OLANZAPINE 7.5 MG PO TABS

Facility

$16.08

Service Code	NDC 4359816530
Hospital Charge Code	4359816530
Hospital Revenue Code	250
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$8.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.04

OLOPATADINE HCL 0.1 % OP SOLN

Facility

$3.65

Service Code	NDC 0536130840
Hospital Charge Code	0536130840
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$2.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.82
Rate for Payer: Aetna Government	$1.82
Rate for Payer: Brighton Health Commercial	$2.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.48
Rate for Payer: EmblemHealth Commercial	$1.82
Rate for Payer: Group Health Inc Commercial	$1.82
Rate for Payer: Group Health Inc Medicare	$1.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.37

OLOPATADINE HCL 0.1 % OP SOLN

Facility

$3.65

Service Code	NDC 0536130840
Hospital Charge Code	0536130840
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$1.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.82

OLOPATADINE HCL 0.1 % OP SOLN

Facility

$6.25

Service Code	NDC 7006900701
Hospital Charge Code	7006900701
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12

OLOPATADINE HCL 0.1 % OP SOLN

Facility

$6.25

Service Code	NDC 7006900701
Hospital Charge Code	7006900701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$5.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.12
Rate for Payer: Aetna Government	$3.12
Rate for Payer: Brighton Health Commercial	$4.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.25
Rate for Payer: EmblemHealth Commercial	$3.12
Rate for Payer: Group Health Inc Commercial	$3.12
Rate for Payer: Group Health Inc Medicare	$2.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.06

OMALIZUMAB 150 MG/ML SC SOAJ

Facility

$1.00

Service Code	NDC 5024221555
Hospital Charge Code	5024221555
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

OMALIZUMAB 150 MG/ML SC SOAJ

Facility

$1.00

Service Code	NDC 5024221555
Hospital Charge Code	5024221555
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

OMALIZUMAB 150 MG/ML SC SOSY

Facility

$1.00

Service Code	HCPCS J2357
Hospital Charge Code	5024221501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

OMALIZUMAB 150 MG/ML SC SOSY

Facility

$1.00

Service Code	HCPCS J2357
Hospital Charge Code	5024221501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$45.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.60
Rate for Payer: Aetna Government	$44.60
Rate for Payer: Affinity Essential Plan 1&2	$31.22
Rate for Payer: Affinity Essential Plan 3&4	$31.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$31.22
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$44.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$44.60
Rate for Payer: EmblemHealth Commercial	$44.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40.14
Rate for Payer: Fidelis Essential Plan Aliesa	$37.91
Rate for Payer: Fidelis Essential Plan QHP	$39.69
Rate for Payer: Fidelis Medicare Advantage	$44.60
Rate for Payer: Fidelis Qualified Health Plan	$39.69
Rate for Payer: Group Health Inc Commercial	$44.60
Rate for Payer: Group Health Inc Medicare	$44.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.60
Rate for Payer: Hamaspik Choice Inc Medicare	$44.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44.60
Rate for Payer: Healthfirst Medicare Advantage	$37.91
Rate for Payer: Healthfirst QHP	$44.60
Rate for Payer: Humana Medicare	$45.49
Rate for Payer: Senior Whole Health Medicare Advantage	$44.60
Rate for Payer: United Healthcare Medicare Advantage	$44.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42.37
Rate for Payer: Wellcare Medicare	$42.37

OMALIZUMAB 150 MG/ML SC SOSY

Facility

$1.00

Service Code	HCPCS J2357
Hospital Charge Code	5024221503
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

OMALIZUMAB 150 MG/ML SC SOSY

Facility

$1.00

Service Code	HCPCS J2357
Hospital Charge Code	5024221503
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$45.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.60
Rate for Payer: Aetna Government	$44.60
Rate for Payer: Affinity Essential Plan 1&2	$31.22
Rate for Payer: Affinity Essential Plan 3&4	$31.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$31.22
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$44.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$44.60
Rate for Payer: EmblemHealth Commercial	$44.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40.14
Rate for Payer: Fidelis Essential Plan Aliesa	$37.91
Rate for Payer: Fidelis Essential Plan QHP	$39.69
Rate for Payer: Fidelis Medicare Advantage	$44.60
Rate for Payer: Fidelis Qualified Health Plan	$39.69
Rate for Payer: Group Health Inc Commercial	$44.60
Rate for Payer: Group Health Inc Medicare	$44.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.60
Rate for Payer: Hamaspik Choice Inc Medicare	$44.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44.60
Rate for Payer: Healthfirst Medicare Advantage	$37.91
Rate for Payer: Healthfirst QHP	$44.60
Rate for Payer: Humana Medicare	$45.49
Rate for Payer: Senior Whole Health Medicare Advantage	$44.60
Rate for Payer: United Healthcare Medicare Advantage	$44.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42.37
Rate for Payer: Wellcare Medicare	$42.37

OMALIZUMAB 150 MG/ML SC SOSY

Facility

$1.00

Service Code	HCPCS J2357
Hospital Charge Code	5024221586
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$45.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.60
Rate for Payer: Aetna Government	$44.60
Rate for Payer: Affinity Essential Plan 1&2	$31.22
Rate for Payer: Affinity Essential Plan 3&4	$31.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$31.22
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$44.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$44.60
Rate for Payer: EmblemHealth Commercial	$44.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40.14
Rate for Payer: Fidelis Essential Plan Aliesa	$37.91
Rate for Payer: Fidelis Essential Plan QHP	$39.69
Rate for Payer: Fidelis Medicare Advantage	$44.60
Rate for Payer: Fidelis Qualified Health Plan	$39.69
Rate for Payer: Group Health Inc Commercial	$44.60
Rate for Payer: Group Health Inc Medicare	$44.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.60
Rate for Payer: Hamaspik Choice Inc Medicare	$44.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44.60
Rate for Payer: Healthfirst Medicare Advantage	$37.91
Rate for Payer: Healthfirst QHP	$44.60
Rate for Payer: Humana Medicare	$45.49
Rate for Payer: Senior Whole Health Medicare Advantage	$44.60
Rate for Payer: United Healthcare Medicare Advantage	$44.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42.37
Rate for Payer: Wellcare Medicare	$42.37

OMALIZUMAB 150 MG/ML SC SOSY

Facility

$1.00

Service Code	HCPCS J2357
Hospital Charge Code	5024221586
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

Know your out-of-pocket cost for care.

All Charges