St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$3.56

Service Code	NDC 7128860010
Hospital Charge Code	7128860010
Hospital Revenue Code	258
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$2.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.78
Rate for Payer: Aetna Government	$1.78
Rate for Payer: Brighton Health Commercial	$2.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.42
Rate for Payer: EmblemHealth Commercial	$1.78
Rate for Payer: Group Health Inc Commercial	$1.78
Rate for Payer: Group Health Inc Medicare	$1.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.78
Rate for Payer: Hamaspik Choice Inc Medicare	$1.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.32

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$6.10

Service Code	NDC 0008400101
Hospital Charge Code	0008400101
Hospital Revenue Code	258
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.15
Rate for Payer: EmblemHealth Commercial	$3.05
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$6.10

Service Code	NDC 0008400101
Hospital Charge Code	0008400101
Hospital Revenue Code	258
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$8.50

Service Code	NDC 5515020210
Hospital Charge Code	5515020210
Hospital Revenue Code	258
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$6.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.25
Rate for Payer: Aetna Government	$4.25
Rate for Payer: Brighton Health Commercial	$6.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.78
Rate for Payer: EmblemHealth Commercial	$4.25
Rate for Payer: Group Health Inc Commercial	$4.25
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.53

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$8.50

Service Code	NDC 6275612944
Hospital Charge Code	6275612944
Hospital Revenue Code	258
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$8.50

Service Code	NDC 6275612944
Hospital Charge Code	6275612944
Hospital Revenue Code	258
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$6.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.25
Rate for Payer: Aetna Government	$4.25
Rate for Payer: Brighton Health Commercial	$6.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.78
Rate for Payer: EmblemHealth Commercial	$4.25
Rate for Payer: Group Health Inc Commercial	$4.25
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.53

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$6.10

Service Code	NDC 0008092351
Hospital Charge Code	0008092351
Hospital Revenue Code	258
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.15
Rate for Payer: EmblemHealth Commercial	$3.05
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$6.10

Service Code	NDC 0008092351
Hospital Charge Code	0008092351
Hospital Revenue Code	258
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$6.13

Service Code	NDC 0781323295
Hospital Charge Code	0781323295
Hospital Revenue Code	258
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$8.50

Service Code	NDC 5515020210
Hospital Charge Code	5515020210
Hospital Revenue Code	258
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$6.13

Service Code	NDC 0781323295
Hospital Charge Code	0781323295
Hospital Revenue Code	258
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.17
Rate for Payer: EmblemHealth Commercial	$3.06
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$6.13

Service Code	NDC 0781323294
Hospital Charge Code	0781323294
Hospital Revenue Code	258
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.17
Rate for Payer: EmblemHealth Commercial	$3.06
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$6.13

Service Code	NDC 0781323294
Hospital Charge Code	0781323294
Hospital Revenue Code	258
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$8.50

Service Code	NDC 5515020200
Hospital Charge Code	5515020200
Hospital Revenue Code	258
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$6.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.25
Rate for Payer: Aetna Government	$4.25
Rate for Payer: Brighton Health Commercial	$6.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.78
Rate for Payer: EmblemHealth Commercial	$4.25
Rate for Payer: Group Health Inc Commercial	$4.25
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.53

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$6.09

Service Code	NDC 0008092355
Hospital Charge Code	0008092355
Hospital Revenue Code	258
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.04

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$6.09

Service Code	NDC 0008092355
Hospital Charge Code	0008092355
Hospital Revenue Code	258
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.04
Rate for Payer: Aetna Government	$3.04
Rate for Payer: Brighton Health Commercial	$4.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: EmblemHealth Commercial	$3.04
Rate for Payer: Group Health Inc Commercial	$3.04
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.04
Rate for Payer: Hamaspik Choice Inc Medicare	$3.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$8.50

Service Code	NDC 5515020200
Hospital Charge Code	5515020200
Hospital Revenue Code	258
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$0.34

Service Code	NDC 6373956410
Hospital Charge Code	6373956410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
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

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$4.06

Service Code	NDC 6217561743
Hospital Charge Code	6217561743
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$3.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.03
Rate for Payer: Aetna Government	$2.03
Rate for Payer: Brighton Health Commercial	$3.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.76
Rate for Payer: EmblemHealth Commercial	$2.03
Rate for Payer: Group Health Inc Commercial	$2.03
Rate for Payer: Group Health Inc Medicare	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.03
Rate for Payer: Hamaspik Choice Inc Medicare	$2.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.64

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$4.06

Service Code	NDC 6217561743
Hospital Charge Code	6217561743
Hospital Revenue Code	250
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$2.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.03

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$4.03

Service Code	NDC 5026863911
Hospital Charge Code	5026863911
Hospital Revenue Code	250
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.01

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$4.03

Service Code	NDC 5026863915
Hospital Charge Code	5026863915
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$3.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.01
Rate for Payer: Aetna Government	$2.01
Rate for Payer: Brighton Health Commercial	$3.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.74
Rate for Payer: EmblemHealth Commercial	$2.01
Rate for Payer: Group Health Inc Commercial	$2.01
Rate for Payer: Group Health Inc Medicare	$1.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.01
Rate for Payer: Hamaspik Choice Inc Medicare	$2.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.62

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$0.26

Service Code	NDC 6068773665
Hospital Charge Code	6068773665
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$0.26

Service Code	NDC 6068773665
Hospital Charge Code	6068773665
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

PANTOPRAZOLE SODIUM 40 MG PO TBEC

Facility

$0.34

Service Code	NDC 6373956410
Hospital Charge Code	6373956410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

Know your out-of-pocket cost for care.

All Charges