St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OXYBUTYNIN CHLORIDE 5 MG PO TABS

Facility

$0.72

Service Code	NDC 0904702761
Hospital Charge Code	0904702761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

OXYBUTYNIN CHLORIDE 5 MG PO TABS

Facility

$0.72

Service Code	NDC 0904702761
Hospital Charge Code	0904702761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

OXYBUTYNIN CHLORIDE 5 MG PO TABS

Facility

$0.66

Service Code	NDC 0832003801
Hospital Charge Code	0832003801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

OXYBUTYNIN CHLORIDE 5 MG PO TABS

Facility

$0.66

Service Code	NDC 0832003801
Hospital Charge Code	0832003801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS

Facility

$1.37

Service Code	NDC 0406051201
Hospital Charge Code	0406051201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS

Facility

$1.37

Service Code	NDC 0406051201
Hospital Charge Code	0406051201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.68
Rate for Payer: Aetna Government	$0.68
Rate for Payer: Brighton Health Commercial	$1.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.93
Rate for Payer: EmblemHealth Commercial	$0.68
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS

Facility

$0.20

Service Code	NDC 4285810201
Hospital Charge Code	4285810201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS

Facility

$0.20

Service Code	NDC 4285810201
Hospital Charge Code	4285810201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS

Facility

$0.34

Service Code	NDC 0904709361
Hospital Charge Code	0904709361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS

Facility

$0.34

Service Code	NDC 0904709361
Hospital Charge Code	0904709361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.23
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS

Facility

$1.37

Service Code	NDC 0406051262
Hospital Charge Code	0406051262
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.68
Rate for Payer: Aetna Government	$0.68
Rate for Payer: Brighton Health Commercial	$1.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.93
Rate for Payer: EmblemHealth Commercial	$0.68
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS

Facility

$1.37

Service Code	NDC 0406051223
Hospital Charge Code	0406051223
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.69
Rate for Payer: Aetna Government	$0.69
Rate for Payer: Brighton Health Commercial	$1.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.93
Rate for Payer: EmblemHealth Commercial	$0.69
Rate for Payer: Group Health Inc Commercial	$0.69
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69
Rate for Payer: Hamaspik Choice Inc Medicare	$0.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS

Facility

$1.37

Service Code	NDC 0406051262
Hospital Charge Code	0406051262
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS

Facility

$1.37

Service Code	NDC 0406051223
Hospital Charge Code	0406051223
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69

OXYCODONE HCL 100 MG/5ML PO CONC

Facility

$7.29

Service Code	NDC 0121082601
Hospital Charge Code	0121082601
Hospital Revenue Code	250
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$3.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.65

OXYCODONE HCL 100 MG/5ML PO CONC

Facility

$7.29

Service Code	NDC 0121082601
Hospital Charge Code	0121082601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$5.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.65
Rate for Payer: Aetna Government	$3.65
Rate for Payer: Brighton Health Commercial	$5.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.96
Rate for Payer: EmblemHealth Commercial	$3.65
Rate for Payer: Group Health Inc Commercial	$3.65
Rate for Payer: Group Health Inc Medicare	$2.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.65
Rate for Payer: Hamaspik Choice Inc Medicare	$3.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.74

OXYCODONE HCL 100 MG/5ML PO CONC

Facility

$11.10

Service Code	NDC 0406855730
Hospital Charge Code	0406855730
Hospital Revenue Code	250
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$8.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.55
Rate for Payer: Aetna Government	$5.55
Rate for Payer: Brighton Health Commercial	$8.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.55
Rate for Payer: EmblemHealth Commercial	$5.55
Rate for Payer: Group Health Inc Commercial	$5.55
Rate for Payer: Group Health Inc Medicare	$3.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.55
Rate for Payer: Hamaspik Choice Inc Medicare	$5.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.21

OXYCODONE HCL 100 MG/5ML PO CONC

Facility

$11.10

Service Code	NDC 0406855730
Hospital Charge Code	0406855730
Hospital Revenue Code	250
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$5.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.55

OXYCODONE HCL 100 MG/5ML PO CONC

Facility

$11.34

Service Code	NDC 6830802003
Hospital Charge Code	6830802003
Hospital Revenue Code	250
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$9.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.67
Rate for Payer: Aetna Government	$5.67
Rate for Payer: Brighton Health Commercial	$8.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.71
Rate for Payer: EmblemHealth Commercial	$5.67
Rate for Payer: Group Health Inc Commercial	$5.67
Rate for Payer: Group Health Inc Medicare	$3.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.67
Rate for Payer: Hamaspik Choice Inc Medicare	$5.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.37

OXYCODONE HCL 100 MG/5ML PO CONC

Facility

$4.49

Service Code	NDC 6809480101
Hospital Charge Code	6809480101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$3.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.24
Rate for Payer: Aetna Government	$2.24
Rate for Payer: Brighton Health Commercial	$3.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.05
Rate for Payer: EmblemHealth Commercial	$2.24
Rate for Payer: Group Health Inc Commercial	$2.24
Rate for Payer: Group Health Inc Medicare	$1.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.24
Rate for Payer: Hamaspik Choice Inc Medicare	$2.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.92

OXYCODONE HCL 100 MG/5ML PO CONC

Facility

$4.49

Service Code	NDC 6809480101
Hospital Charge Code	6809480101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.24

OXYCODONE HCL 100 MG/5ML PO CONC

Facility

$11.34

Service Code	NDC 6830802003
Hospital Charge Code	6830802003
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.67

OXYCODONE HCL 10 MG PO TABS

Facility

$0.63

Service Code	NDC 6516204810
Hospital Charge Code	6516204810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31

OXYCODONE HCL 10 MG PO TABS

Facility

$0.69

Service Code	NDC 6808496811
Hospital Charge Code	6808496811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Brighton Health Commercial	$0.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
Rate for Payer: EmblemHealth Commercial	$0.35
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.45

OXYCODONE HCL 10 MG PO TABS

Facility

$0.69

Service Code	NDC 6808496811
Hospital Charge Code	6808496811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35

Know your out-of-pocket cost for care.

All Charges