St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ABACAVIR-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS

Facility

$149.90

Service Code	NDC 4970223113
Hospital Charge Code	4970223113
Hospital Revenue Code	250
Min. Negotiated Rate	$74.95
Max. Negotiated Rate	$74.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.95

ABACAVIR-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS

Facility

$149.90

Service Code	NDC 4970223113
Hospital Charge Code	4970223113
Hospital Revenue Code	250
Min. Negotiated Rate	$52.47
Max. Negotiated Rate	$119.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.95
Rate for Payer: Aetna Government	$74.95
Rate for Payer: Brighton Health Commercial	$112.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$101.93
Rate for Payer: EmblemHealth Commercial	$74.95
Rate for Payer: Group Health Inc Commercial	$74.95
Rate for Payer: Group Health Inc Medicare	$52.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.95
Rate for Payer: Hamaspik Choice Inc Medicare	$74.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.44

ABACAVIR-LAMIVUDINE-ZIDOVUDINE 300-150-300 MG PO TABS

Facility

$32.19

Service Code	NDC 4970221718
Hospital Charge Code	4970221718
Hospital Revenue Code	250
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$16.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.10

ABACAVIR-LAMIVUDINE-ZIDOVUDINE 300-150-300 MG PO TABS

Facility

$32.19

Service Code	NDC 4970221718
Hospital Charge Code	4970221718
Hospital Revenue Code	250
Min. Negotiated Rate	$11.27
Max. Negotiated Rate	$25.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.10
Rate for Payer: Aetna Government	$16.10
Rate for Payer: Brighton Health Commercial	$24.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.89
Rate for Payer: EmblemHealth Commercial	$16.10
Rate for Payer: Group Health Inc Commercial	$16.10
Rate for Payer: Group Health Inc Medicare	$11.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.10
Rate for Payer: Hamaspik Choice Inc Medicare	$16.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.93

ABACAVIR SULFATE 20 MG/ML PO SOLN

Facility

$0.73

Service Code	NDC 4970222248
Hospital Charge Code	4970222248
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.37
Rate for Payer: Aetna Government	$0.37
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.50
Rate for Payer: EmblemHealth Commercial	$0.37
Rate for Payer: Group Health Inc Commercial	$0.37
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37
Rate for Payer: Hamaspik Choice Inc Medicare	$0.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.48

ABACAVIR SULFATE 20 MG/ML PO SOLN

Facility

$0.65

Service Code	NDC 6498040524
Hospital Charge Code	6498040524
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
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	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
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

ABACAVIR SULFATE 20 MG/ML PO SOLN

Facility

$0.73

Service Code	NDC 4970222248
Hospital Charge Code	4970222248
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37

ABACAVIR SULFATE 20 MG/ML PO SOLN

Facility

$0.65

Service Code	NDC 3172256224
Hospital Charge Code	3172256224
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
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	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
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

ABACAVIR SULFATE 20 MG/ML PO SOLN

Facility

$0.65

Service Code	NDC 3172256224
Hospital Charge Code	3172256224
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

ABACAVIR SULFATE 20 MG/ML PO SOLN

Facility

$0.65

Service Code	NDC 6498040524
Hospital Charge Code	6498040524
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

ABACAVIR SULFATE 300 MG PO TABS

Facility

$10.04

Service Code	NDC 6808402111
Hospital Charge Code	6808402111
Hospital Revenue Code	250
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$8.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.02
Rate for Payer: Aetna Government	$5.02
Rate for Payer: Brighton Health Commercial	$7.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.83
Rate for Payer: EmblemHealth Commercial	$5.02
Rate for Payer: Group Health Inc Commercial	$5.02
Rate for Payer: Group Health Inc Medicare	$3.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.02
Rate for Payer: Hamaspik Choice Inc Medicare	$5.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.53

ABACAVIR SULFATE 300 MG PO TABS

Facility

$10.04

Service Code	NDC 5026804912
Hospital Charge Code	5026804912
Hospital Revenue Code	250
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$8.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.02
Rate for Payer: Aetna Government	$5.02
Rate for Payer: Brighton Health Commercial	$7.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.83
Rate for Payer: EmblemHealth Commercial	$5.02
Rate for Payer: Group Health Inc Commercial	$5.02
Rate for Payer: Group Health Inc Medicare	$3.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.02
Rate for Payer: Hamaspik Choice Inc Medicare	$5.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.53

ABACAVIR SULFATE 300 MG PO TABS

Facility

$10.04

Service Code	NDC 6808402121
Hospital Charge Code	6808402121
Hospital Revenue Code	250
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$8.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.02
Rate for Payer: Aetna Government	$5.02
Rate for Payer: Brighton Health Commercial	$7.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.83
Rate for Payer: EmblemHealth Commercial	$5.02
Rate for Payer: Group Health Inc Commercial	$5.02
Rate for Payer: Group Health Inc Medicare	$3.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.02
Rate for Payer: Hamaspik Choice Inc Medicare	$5.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.53

ABACAVIR SULFATE 300 MG PO TABS

Facility

$10.04

Service Code	NDC 6808402121
Hospital Charge Code	6808402121
Hospital Revenue Code	250
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$5.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.02

ABACAVIR SULFATE 300 MG PO TABS

Facility

$10.05

Service Code	NDC 3172255760
Hospital Charge Code	3172255760
Hospital Revenue Code	250
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$5.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.02

ABACAVIR SULFATE 300 MG PO TABS

Facility

$10.04

Service Code	NDC 0378410591
Hospital Charge Code	0378410591
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$8.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.02
Rate for Payer: Aetna Government	$5.02
Rate for Payer: Brighton Health Commercial	$7.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.83
Rate for Payer: EmblemHealth Commercial	$5.02
Rate for Payer: Group Health Inc Commercial	$5.02
Rate for Payer: Group Health Inc Medicare	$3.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.02
Rate for Payer: Hamaspik Choice Inc Medicare	$5.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.53

ABACAVIR SULFATE 300 MG PO TABS

Facility

$10.04

Service Code	NDC 0378410591
Hospital Charge Code	0378410591
Hospital Revenue Code	250
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$5.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.02

ABACAVIR SULFATE 300 MG PO TABS

Facility

$10.04

Service Code	NDC 5026804912
Hospital Charge Code	5026804912
Hospital Revenue Code	250
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$5.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.02

ABACAVIR SULFATE 300 MG PO TABS

Facility

$10.04

Service Code	NDC 6808402111
Hospital Charge Code	6808402111
Hospital Revenue Code	250
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$5.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.02

ABACAVIR SULFATE 300 MG PO TABS

Facility

$10.05

Service Code	NDC 3172255760
Hospital Charge Code	3172255760
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$8.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.02
Rate for Payer: Aetna Government	$5.02
Rate for Payer: Brighton Health Commercial	$7.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.83
Rate for Payer: EmblemHealth Commercial	$5.02
Rate for Payer: Group Health Inc Commercial	$5.02
Rate for Payer: Group Health Inc Medicare	$3.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.02
Rate for Payer: Hamaspik Choice Inc Medicare	$5.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.53

ABACAVIR SULFATE 300 MG PO TABS

Facility

$10.40

Service Code	NDC 0904687404
Hospital Charge Code	0904687404
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$8.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.20
Rate for Payer: Aetna Government	$5.20
Rate for Payer: Brighton Health Commercial	$7.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.07
Rate for Payer: EmblemHealth Commercial	$5.20
Rate for Payer: Group Health Inc Commercial	$5.20
Rate for Payer: Group Health Inc Medicare	$3.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.20
Rate for Payer: Hamaspik Choice Inc Medicare	$5.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.76

ABACAVIR SULFATE 300 MG PO TABS

Facility

$10.40

Service Code	NDC 0904687404
Hospital Charge Code	0904687404
Hospital Revenue Code	250
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$5.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.20

ABACAVIR SULFATE-LAMIVUDINE 600-300 MG PO TABS

Facility

$46.50

Service Code	NDC 6909736202
Hospital Charge Code	6909736202
Hospital Revenue Code	250
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$23.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.25

ABACAVIR SULFATE-LAMIVUDINE 600-300 MG PO TABS

Facility

$46.50

Service Code	NDC 6909736202
Hospital Charge Code	6909736202
Hospital Revenue Code	250
Min. Negotiated Rate	$16.28
Max. Negotiated Rate	$37.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.25
Rate for Payer: Aetna Government	$23.25
Rate for Payer: Brighton Health Commercial	$34.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.62
Rate for Payer: EmblemHealth Commercial	$23.25
Rate for Payer: Group Health Inc Commercial	$23.25
Rate for Payer: Group Health Inc Medicare	$16.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.25
Rate for Payer: Hamaspik Choice Inc Medicare	$23.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.23

ABACAVIR SULFATE-LAMIVUDINE 600-300 MG PO TABS

Facility

$46.50

Service Code	NDC 6818028806
Hospital Charge Code	6818028806
Hospital Revenue Code	250
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$23.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.25

Know your out-of-pocket cost for care.

All Charges