St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OXCARBAZEPINE 300 MG/5ML PO SUSP

Facility

$1.09

Service Code	NDC 6516264978
Hospital Charge Code	6516264978
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.74
Rate for Payer: EmblemHealth Commercial	$0.55
Rate for Payer: Group Health Inc Commercial	$0.55
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55
Rate for Payer: Hamaspik Choice Inc Medicare	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

OXCARBAZEPINE 300 MG/5ML PO SUSP

Facility

$1.74

Service Code	NDC 6809412359
Hospital Charge Code	6809412359
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87

OXCARBAZEPINE 300 MG/5ML PO SUSP

Facility

$1.74

Service Code	NDC 5026864912
Hospital Charge Code	5026864912
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.87
Rate for Payer: Aetna Government	$0.87
Rate for Payer: Brighton Health Commercial	$1.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.19
Rate for Payer: EmblemHealth Commercial	$0.87
Rate for Payer: Group Health Inc Commercial	$0.87
Rate for Payer: Group Health Inc Medicare	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87
Rate for Payer: Hamaspik Choice Inc Medicare	$0.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.13

OXCARBAZEPINE 300 MG/5ML PO SUSP

Facility

$2.29

Service Code	NDC 0078035752
Hospital Charge Code	0078035752
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.15

OXCARBAZEPINE 300 MG/5ML PO SUSP

Facility

$1.74

Service Code	NDC 5026864912
Hospital Charge Code	5026864912
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87

OXCARBAZEPINE 300 MG/5ML PO SUSP

Facility

$2.29

Service Code	NDC 0078035752
Hospital Charge Code	0078035752
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.15
Rate for Payer: Aetna Government	$1.15
Rate for Payer: Brighton Health Commercial	$1.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.56
Rate for Payer: EmblemHealth Commercial	$1.15
Rate for Payer: Group Health Inc Commercial	$1.15
Rate for Payer: Group Health Inc Medicare	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.15
Rate for Payer: Hamaspik Choice Inc Medicare	$1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.49

OXCARBAZEPINE 300 MG/5ML PO SUSP

Facility

$1.09

Service Code	NDC 6516264978
Hospital Charge Code	6516264978
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55

OXCARBAZEPINE 300 MG PO TABS

Facility

$2.76

Service Code	NDC 6068772201
Hospital Charge Code	6068772201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38

OXCARBAZEPINE 300 MG PO TABS

Facility

$1.01

Service Code	NDC 0904726361
Hospital Charge Code	0904726361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51

OXCARBAZEPINE 300 MG PO TABS

Facility

$1.01

Service Code	NDC 0904726361
Hospital Charge Code	0904726361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Brighton Health Commercial	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.69
Rate for Payer: EmblemHealth Commercial	$0.51
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

OXCARBAZEPINE 300 MG PO TABS

Facility

$2.76

Service Code	NDC 6068772211
Hospital Charge Code	6068772211
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38

OXCARBAZEPINE 300 MG PO TABS

Facility

$2.63

Service Code	NDC 5199129301
Hospital Charge Code	5199129301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.31

OXCARBAZEPINE 300 MG PO TABS

Facility

$2.63

Service Code	NDC 5199129301
Hospital Charge Code	5199129301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$2.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.31
Rate for Payer: Aetna Government	$1.31
Rate for Payer: Brighton Health Commercial	$1.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.78
Rate for Payer: EmblemHealth Commercial	$1.31
Rate for Payer: Group Health Inc Commercial	$1.31
Rate for Payer: Group Health Inc Medicare	$0.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.31
Rate for Payer: Hamaspik Choice Inc Medicare	$1.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.71

OXCARBAZEPINE 300 MG PO TABS

Facility

$1.01

Service Code	NDC 5026868011
Hospital Charge Code	5026868011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51

OXCARBAZEPINE 300 MG PO TABS

Facility

$1.01

Service Code	NDC 5026868011
Hospital Charge Code	5026868011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Brighton Health Commercial	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.69
Rate for Payer: EmblemHealth Commercial	$0.51
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

OXCARBAZEPINE 300 MG PO TABS

Facility

$1.01

Service Code	NDC 5026868015
Hospital Charge Code	5026868015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51

OXCARBAZEPINE 300 MG PO TABS

Facility

$2.64

Service Code	NDC 6275618488
Hospital Charge Code	6275618488
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.32

OXCARBAZEPINE 300 MG PO TABS

Facility

$1.01

Service Code	NDC 5026868015
Hospital Charge Code	5026868015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Brighton Health Commercial	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.69
Rate for Payer: EmblemHealth Commercial	$0.51
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

OXCARBAZEPINE 300 MG PO TABS

Facility

$2.64

Service Code	NDC 6275618488
Hospital Charge Code	6275618488
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$2.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.32
Rate for Payer: Aetna Government	$1.32
Rate for Payer: Brighton Health Commercial	$1.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.80
Rate for Payer: EmblemHealth Commercial	$1.32
Rate for Payer: Group Health Inc Commercial	$1.32
Rate for Payer: Group Health Inc Medicare	$0.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.32
Rate for Payer: Hamaspik Choice Inc Medicare	$1.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.72

OXCARBAZEPINE 300 MG PO TABS

Facility

$2.76

Service Code	NDC 6068772201
Hospital Charge Code	6068772201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.38
Rate for Payer: Aetna Government	$1.38
Rate for Payer: Brighton Health Commercial	$2.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.87
Rate for Payer: EmblemHealth Commercial	$1.38
Rate for Payer: Group Health Inc Commercial	$1.38
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.79

OXCARBAZEPINE 300 MG PO TABS

Facility

$2.76

Service Code	NDC 6068772211
Hospital Charge Code	6068772211
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.38
Rate for Payer: Aetna Government	$1.38
Rate for Payer: Brighton Health Commercial	$2.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.87
Rate for Payer: EmblemHealth Commercial	$1.38
Rate for Payer: Group Health Inc Commercial	$1.38
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.79

OXYBUTYNIN CHLORIDE 5 MG/5ML PO SOLN

Facility

$0.11

Service Code	NDC 5483851080
Hospital Charge Code	5483851080
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.06
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

OXYBUTYNIN CHLORIDE 5 MG/5ML PO SOLN

Facility

$0.11

Service Code	NDC 5483851080
Hospital Charge Code	5483851080
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

OXYBUTYNIN CHLORIDE 5 MG PO TABS

Facility

$0.76

Service Code	NDC 0832003800
Hospital Charge Code	0832003800
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: EmblemHealth Commercial	$0.38
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

OXYBUTYNIN CHLORIDE 5 MG PO TABS

Facility

$0.76

Service Code	NDC 0832003800
Hospital Charge Code	0832003800
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38

Know your out-of-pocket cost for care.

All Charges