St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY

Facility

$90.62

Service Code	HCPCS J2790
Hospital Charge Code	1353363110
Hospital Revenue Code	250
Min. Negotiated Rate	$31.72
Max. Negotiated Rate	$82.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.54
Rate for Payer: Aetna Government	$75.54
Rate for Payer: Brighton Health Commercial	$67.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$72.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.62
Rate for Payer: EmblemHealth Commercial	$45.31
Rate for Payer: Group Health Inc Commercial	$45.31
Rate for Payer: Group Health Inc Medicare	$31.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.31
Rate for Payer: Hamaspik Choice Inc Medicare	$45.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$82.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$58.91

RHO D IMMUNE GLOBULIN 2500 UNIT/2.2ML IJ SOLN

Facility

$493.81

Service Code	HCPCS J2792
Hospital Charge Code	7025735002
Hospital Revenue Code	250
Min. Negotiated Rate	$17.82
Max. Negotiated Rate	$395.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$271.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.46
Rate for Payer: Aetna Government	$25.46
Rate for Payer: Affinity Essential Plan 1&2	$17.82
Rate for Payer: Affinity Essential Plan 3&4	$17.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$17.82
Rate for Payer: Brighton Health Commercial	$370.36
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$25.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$395.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$335.79
Rate for Payer: Elderplan Medicare Advantage	$25.46
Rate for Payer: EmblemHealth Commercial	$25.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22.91
Rate for Payer: Fidelis Essential Plan Aliesa	$21.64
Rate for Payer: Fidelis Essential Plan QHP	$22.66
Rate for Payer: Fidelis Medicare Advantage	$25.46
Rate for Payer: Fidelis Qualified Health Plan	$22.66
Rate for Payer: Group Health Inc Commercial	$25.46
Rate for Payer: Group Health Inc Medicare	$25.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.46
Rate for Payer: Hamaspik Choice Inc Medicare	$25.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.46
Rate for Payer: Healthfirst Medicare Advantage	$21.64
Rate for Payer: Healthfirst QHP	$25.46
Rate for Payer: Humana Medicare	$25.97
Rate for Payer: Senior Whole Health Medicare Advantage	$25.46
Rate for Payer: United Healthcare Medicare Advantage	$25.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$320.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.19
Rate for Payer: Wellcare Medicare	$24.19

RHO D IMMUNE GLOBULIN 2500 UNIT/2.2ML IJ SOLN

Facility

$493.81

Service Code	HCPCS J2792
Hospital Charge Code	7025735002
Hospital Revenue Code	250
Min. Negotiated Rate	$246.90
Max. Negotiated Rate	$246.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$246.90

RIBAVIRIN 200 MG PO TABS

Facility

$8.27

Service Code	NDC 6586220768
Hospital Charge Code	6586220768
Hospital Revenue Code	250
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$4.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.14

RIBAVIRIN 200 MG PO TABS

Facility

$8.27

Service Code	NDC 6586220768
Hospital Charge Code	6586220768
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$6.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.14
Rate for Payer: Aetna Government	$4.14
Rate for Payer: Brighton Health Commercial	$6.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.63
Rate for Payer: EmblemHealth Commercial	$4.14
Rate for Payer: Group Health Inc Commercial	$4.14
Rate for Payer: Group Health Inc Medicare	$2.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.14
Rate for Payer: Hamaspik Choice Inc Medicare	$4.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.38

RIFABUTIN 150 MG PO CAPS

Facility

$17.49

Service Code	NDC 5976213501
Hospital Charge Code	5976213501
Hospital Revenue Code	250
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$8.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.75

RIFABUTIN 150 MG PO CAPS

Facility

$17.49

Service Code	NDC 5976213501
Hospital Charge Code	5976213501
Hospital Revenue Code	250
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$14.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.75
Rate for Payer: Aetna Government	$8.75
Rate for Payer: Brighton Health Commercial	$13.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.90
Rate for Payer: EmblemHealth Commercial	$8.75
Rate for Payer: Group Health Inc Commercial	$8.75
Rate for Payer: Group Health Inc Medicare	$6.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.75
Rate for Payer: Hamaspik Choice Inc Medicare	$8.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.37

RIFAMPIN 300 MG PO CAPS

Facility

$5.85

Service Code	NDC 4280679960
Hospital Charge Code	4280679960
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$4.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.92
Rate for Payer: Aetna Government	$2.92
Rate for Payer: Brighton Health Commercial	$4.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.98
Rate for Payer: EmblemHealth Commercial	$2.92
Rate for Payer: Group Health Inc Commercial	$2.92
Rate for Payer: Group Health Inc Medicare	$2.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.92
Rate for Payer: Hamaspik Choice Inc Medicare	$2.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.80

RIFAMPIN 300 MG PO CAPS

Facility

$4.59

Service Code	NDC 6818065907
Hospital Charge Code	6818065907
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$2.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.30

RIFAMPIN 300 MG PO CAPS

Facility

$1.24

Service Code	NDC 0904731561
Hospital Charge Code	0904731561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.62
Rate for Payer: Aetna Government	$0.62
Rate for Payer: Brighton Health Commercial	$0.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.84
Rate for Payer: EmblemHealth Commercial	$0.62
Rate for Payer: Group Health Inc Commercial	$0.62
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.81

RIFAMPIN 300 MG PO CAPS

Facility

$1.24

Service Code	NDC 0904731561
Hospital Charge Code	0904731561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62

RIFAMPIN 300 MG PO CAPS

Facility

$2.23

Service Code	NDC 6068758611
Hospital Charge Code	6068758611
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.11

RIFAMPIN 300 MG PO CAPS

Facility

$2.23

Service Code	NDC 6068758611
Hospital Charge Code	6068758611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.11
Rate for Payer: Aetna Government	$1.11
Rate for Payer: Brighton Health Commercial	$1.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.52
Rate for Payer: EmblemHealth Commercial	$1.11
Rate for Payer: Group Health Inc Commercial	$1.11
Rate for Payer: Group Health Inc Medicare	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.11
Rate for Payer: Hamaspik Choice Inc Medicare	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.45

RIFAMPIN 300 MG PO CAPS

Facility

$4.59

Service Code	NDC 6818065907
Hospital Charge Code	6818065907
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$3.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.30
Rate for Payer: Aetna Government	$2.30
Rate for Payer: Brighton Health Commercial	$3.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.12
Rate for Payer: EmblemHealth Commercial	$2.30
Rate for Payer: Group Health Inc Commercial	$2.30
Rate for Payer: Group Health Inc Medicare	$1.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.30
Rate for Payer: Hamaspik Choice Inc Medicare	$2.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.98

RIFAMPIN 300 MG PO CAPS

Facility

$5.85

Service Code	NDC 4280679960
Hospital Charge Code	4280679960
Hospital Revenue Code	250
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$2.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.92

RIFAMPIN 600 MG IV SOLR

Facility

$192.63

Service Code	NDC 6745744560
Hospital Charge Code	6745744560
Hospital Revenue Code	258
Min. Negotiated Rate	$67.42
Max. Negotiated Rate	$154.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$105.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.31
Rate for Payer: Aetna Government	$96.31
Rate for Payer: Brighton Health Commercial	$144.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$154.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$130.99
Rate for Payer: EmblemHealth Commercial	$96.31
Rate for Payer: Group Health Inc Commercial	$96.31
Rate for Payer: Group Health Inc Medicare	$67.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.31
Rate for Payer: Hamaspik Choice Inc Medicare	$96.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$125.21

RIFAMPIN 600 MG IV SOLR

Facility

$214.27

Service Code	NDC 0068059701
Hospital Charge Code	0068059701
Hospital Revenue Code	258
Min. Negotiated Rate	$107.14
Max. Negotiated Rate	$107.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.14

RIFAMPIN 600 MG IV SOLR

Facility

$192.63

Service Code	NDC 6745744560
Hospital Charge Code	6745744560
Hospital Revenue Code	258
Min. Negotiated Rate	$96.31
Max. Negotiated Rate	$96.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.31

RIFAMPIN 600 MG IV SOLR

Facility

$214.27

Service Code	NDC 0068059701
Hospital Charge Code	0068059701
Hospital Revenue Code	258
Min. Negotiated Rate	$74.99
Max. Negotiated Rate	$171.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$117.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$107.14
Rate for Payer: Aetna Government	$107.14
Rate for Payer: Brighton Health Commercial	$160.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$171.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$145.70
Rate for Payer: EmblemHealth Commercial	$107.14
Rate for Payer: Group Health Inc Commercial	$107.14
Rate for Payer: Group Health Inc Medicare	$74.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.14
Rate for Payer: Hamaspik Choice Inc Medicare	$107.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$139.28

RIFAMPIN 600 MG IV SOLR

Facility

$183.60

Service Code	NDC 6332335120
Hospital Charge Code	6332335120
Hospital Revenue Code	258
Min. Negotiated Rate	$64.26
Max. Negotiated Rate	$146.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$91.80
Rate for Payer: Aetna Government	$91.80
Rate for Payer: Brighton Health Commercial	$137.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.85
Rate for Payer: EmblemHealth Commercial	$91.80
Rate for Payer: Group Health Inc Commercial	$91.80
Rate for Payer: Group Health Inc Medicare	$64.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.80
Rate for Payer: Hamaspik Choice Inc Medicare	$91.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$119.34

RIFAMPIN 600 MG IV SOLR

Facility

$183.60

Service Code	NDC 6332335120
Hospital Charge Code	6332335120
Hospital Revenue Code	258
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$91.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.80

RIFAXIMIN 550 MG PO TABS

Facility

$65.35

Service Code	NDC 6564930303
Hospital Charge Code	6564930303
Hospital Revenue Code	250
Min. Negotiated Rate	$22.87
Max. Negotiated Rate	$52.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.67
Rate for Payer: Aetna Government	$32.67
Rate for Payer: Brighton Health Commercial	$49.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.43
Rate for Payer: EmblemHealth Commercial	$32.67
Rate for Payer: Group Health Inc Commercial	$32.67
Rate for Payer: Group Health Inc Medicare	$22.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.67
Rate for Payer: Hamaspik Choice Inc Medicare	$32.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.47

RIFAXIMIN 550 MG PO TABS

Facility

$65.35

Service Code	NDC 6564930303
Hospital Charge Code	6564930303
Hospital Revenue Code	250
Min. Negotiated Rate	$32.67
Max. Negotiated Rate	$32.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.67

RIFAXIMIN 550 MG PO TABS

Facility

$65.35

Service Code	NDC 6564930302
Hospital Charge Code	6564930302
Hospital Revenue Code	250
Min. Negotiated Rate	$22.87
Max. Negotiated Rate	$52.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.67
Rate for Payer: Aetna Government	$32.67
Rate for Payer: Brighton Health Commercial	$49.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.43
Rate for Payer: EmblemHealth Commercial	$32.67
Rate for Payer: Group Health Inc Commercial	$32.67
Rate for Payer: Group Health Inc Medicare	$22.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.67
Rate for Payer: Hamaspik Choice Inc Medicare	$32.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.47

RIFAXIMIN 550 MG PO TABS

Facility

$65.35

Service Code	NDC 6564930302
Hospital Charge Code	6564930302
Hospital Revenue Code	250
Min. Negotiated Rate	$32.67
Max. Negotiated Rate	$32.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.67

Know your out-of-pocket cost for care.

All Charges