St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OXYCODONE HCL 10 MG PO TABS

Facility

$0.63

Service Code	NDC 6516204810
Hospital Charge Code	6516204810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.43
Rate for Payer: EmblemHealth Commercial	$0.31
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.41

OXYCODONE HCL 10 MG PO TABS

Facility

$0.89

Service Code	NDC 4285800210
Hospital Charge Code	4285800210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: EmblemHealth Commercial	$0.45
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.58

OXYCODONE HCL 10 MG PO TABS

Facility

$1.46

Service Code	NDC 0406851062
Hospital Charge Code	0406851062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73

OXYCODONE HCL 10 MG PO TABS

Facility

$0.89

Service Code	NDC 4285800210
Hospital Charge Code	4285800210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45

OXYCODONE HCL 10 MG PO TABS

Facility

$1.46

Service Code	NDC 0406851062
Hospital Charge Code	0406851062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.73
Rate for Payer: Aetna Government	$0.73
Rate for Payer: Brighton Health Commercial	$1.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.99
Rate for Payer: EmblemHealth Commercial	$0.73
Rate for Payer: Group Health Inc Commercial	$0.73
Rate for Payer: Group Health Inc Medicare	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73
Rate for Payer: Hamaspik Choice Inc Medicare	$0.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.95

OXYCODONE HCL 5 MG PO TABS

Facility

$0.54

Service Code	NDC 1070201801
Hospital Charge Code	1070201801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

OXYCODONE HCL 5 MG PO TABS

Facility

$0.54

Service Code	NDC 0406055262
Hospital Charge Code	0406055262
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

OXYCODONE HCL 5 MG PO TABS

Facility

$0.54

Service Code	NDC 0406055223
Hospital Charge Code	0406055223
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

OXYCODONE HCL 5 MG PO TABS

Facility

$0.54

Service Code	NDC 0406055262
Hospital Charge Code	0406055262
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

OXYCODONE HCL 5 MG PO TABS

Facility

$0.39

Service Code	NDC 0904696661
Hospital Charge Code	0904696661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

OXYCODONE HCL 5 MG PO TABS

Facility

$0.54

Service Code	NDC 1070201801
Hospital Charge Code	1070201801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

OXYCODONE HCL 5 MG PO TABS

Facility

$0.39

Service Code	NDC 0904696661
Hospital Charge Code	0904696661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

OXYCODONE HCL 5 MG PO TABS

Facility

$0.54

Service Code	NDC 0406055223
Hospital Charge Code	0406055223
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

OXYCODONE HCL 5 MG PO TABS

Facility

$0.08

Service Code	NDC 4285800101
Hospital Charge Code	4285800101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

OXYCODONE HCL 5 MG PO TABS

Facility

$0.62

Service Code	NDC 4285800110
Hospital Charge Code	4285800110
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 5 MG PO TABS

Facility

$0.62

Service Code	NDC 4285800110
Hospital Charge Code	4285800110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.42
Rate for Payer: EmblemHealth Commercial	$0.31
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.40

OXYCODONE HCL 5 MG PO TABS

Facility

$0.08

Service Code	NDC 4285800101
Hospital Charge Code	4285800101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

OXYCODONE HCL ER 10 MG PO T12A

Facility

$6.57

Service Code	NDC 5901141020
Hospital Charge Code	5901141020
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$5.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.29
Rate for Payer: Aetna Government	$3.29
Rate for Payer: Brighton Health Commercial	$4.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.47
Rate for Payer: EmblemHealth Commercial	$3.29
Rate for Payer: Group Health Inc Commercial	$3.29
Rate for Payer: Group Health Inc Medicare	$2.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.29
Rate for Payer: Hamaspik Choice Inc Medicare	$3.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.27

OXYCODONE HCL ER 10 MG PO T12A

Facility

$3.02

Service Code	NDC 0093573101
Hospital Charge Code	0093573101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51

OXYCODONE HCL ER 10 MG PO T12A

Facility

$3.02

Service Code	NDC 0093573101
Hospital Charge Code	0093573101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.51
Rate for Payer: Aetna Government	$1.51
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: EmblemHealth Commercial	$1.51
Rate for Payer: Group Health Inc Commercial	$1.51
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51
Rate for Payer: Hamaspik Choice Inc Medicare	$1.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.96

OXYCODONE HCL ER 10 MG PO T12A

Facility

$6.57

Service Code	NDC 5901141020
Hospital Charge Code	5901141020
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$3.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.29

OXYCODONE HCL ER 40 MG PO T12A

Facility

$20.95

Service Code	NDC 5901144020
Hospital Charge Code	5901144020
Hospital Revenue Code	250
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$10.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.48

OXYCODONE HCL ER 40 MG PO T12A

Facility

$20.95

Service Code	NDC 5901144020
Hospital Charge Code	5901144020
Hospital Revenue Code	250
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$16.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.48
Rate for Payer: Aetna Government	$10.48
Rate for Payer: Brighton Health Commercial	$15.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.25
Rate for Payer: EmblemHealth Commercial	$10.48
Rate for Payer: Group Health Inc Commercial	$10.48
Rate for Payer: Group Health Inc Medicare	$7.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.48
Rate for Payer: Hamaspik Choice Inc Medicare	$10.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.62

OXYCODONE HCL ER 80 MG PO T12A

Facility

$36.58

Service Code	NDC 5901148020
Hospital Charge Code	5901148020
Hospital Revenue Code	250
Min. Negotiated Rate	$18.29
Max. Negotiated Rate	$18.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.29

OXYCODONE HCL ER 80 MG PO T12A

Facility

$36.58

Service Code	NDC 5901148020
Hospital Charge Code	5901148020
Hospital Revenue Code	250
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$29.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.29
Rate for Payer: Aetna Government	$18.29
Rate for Payer: Brighton Health Commercial	$27.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.87
Rate for Payer: EmblemHealth Commercial	$18.29
Rate for Payer: Group Health Inc Commercial	$18.29
Rate for Payer: Group Health Inc Medicare	$12.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.29
Rate for Payer: Hamaspik Choice Inc Medicare	$18.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.78

Know your out-of-pocket cost for care.

All Charges