St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RILPIVIRINE HCL 25 MG PO TABS

Facility

$58.11

Service Code	NDC 5967627801
Hospital Charge Code	5967627801
Hospital Revenue Code	250
Min. Negotiated Rate	$20.34
Max. Negotiated Rate	$46.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.06
Rate for Payer: Aetna Government	$29.06
Rate for Payer: Brighton Health Commercial	$43.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.52
Rate for Payer: EmblemHealth Commercial	$29.06
Rate for Payer: Group Health Inc Commercial	$29.06
Rate for Payer: Group Health Inc Medicare	$20.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.06
Rate for Payer: Hamaspik Choice Inc Medicare	$29.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37.77

RILPIVIRINE HCL 25 MG PO TABS

Facility

$58.11

Service Code	NDC 5967627801
Hospital Charge Code	5967627801
Hospital Revenue Code	250
Min. Negotiated Rate	$29.06
Max. Negotiated Rate	$29.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.06

RILUZOLE 50 MG PO TABS

Facility

$36.94

Service Code	NDC 6787728660
Hospital Charge Code	6787728660
Hospital Revenue Code	250
Min. Negotiated Rate	$18.47
Max. Negotiated Rate	$18.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.47

RILUZOLE 50 MG PO TABS

Facility

$36.94

Service Code	NDC 6787728660
Hospital Charge Code	6787728660
Hospital Revenue Code	250
Min. Negotiated Rate	$12.93
Max. Negotiated Rate	$29.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.47
Rate for Payer: Aetna Government	$18.47
Rate for Payer: Brighton Health Commercial	$27.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.12
Rate for Payer: EmblemHealth Commercial	$18.47
Rate for Payer: Group Health Inc Commercial	$18.47
Rate for Payer: Group Health Inc Medicare	$12.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.47
Rate for Payer: Hamaspik Choice Inc Medicare	$18.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.01

RIMANTADINE HCL 100 MG PO TABS

Facility

$3.25

Service Code	NDC 0115191101
Hospital Charge Code	0115191101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.62
Rate for Payer: Aetna Government	$1.62
Rate for Payer: Brighton Health Commercial	$2.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.21
Rate for Payer: EmblemHealth Commercial	$1.62
Rate for Payer: Group Health Inc Commercial	$1.62
Rate for Payer: Group Health Inc Medicare	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.11

RIMANTADINE HCL 100 MG PO TABS

Facility

$3.25

Service Code	NDC 0115191101
Hospital Charge Code	0115191101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.62

RISPERIDONE 0.25 MG PO TABS

Facility

$0.29

Service Code	NDC 0904736061
Hospital Charge Code	0904736061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14

RISPERIDONE 0.25 MG PO TABS

Facility

$0.29

Service Code	NDC 0904736061
Hospital Charge Code	0904736061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: EmblemHealth Commercial	$0.14
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

RISPERIDONE 0.25 MG PO TABS

Facility

$3.90

Service Code	NDC 6838211214
Hospital Charge Code	6838211214
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$3.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.95
Rate for Payer: Aetna Government	$1.95
Rate for Payer: Brighton Health Commercial	$2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.65
Rate for Payer: EmblemHealth Commercial	$1.95
Rate for Payer: Group Health Inc Commercial	$1.95
Rate for Payer: Group Health Inc Medicare	$1.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95
Rate for Payer: Hamaspik Choice Inc Medicare	$1.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.54

RISPERIDONE 0.25 MG PO TABS

Facility

$3.90

Service Code	NDC 6838211214
Hospital Charge Code	6838211214
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95

RISPERIDONE 0.25 MG PO TABS

Facility

$3.90

Service Code	NDC 4354733906
Hospital Charge Code	4354733906
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$3.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.95
Rate for Payer: Aetna Government	$1.95
Rate for Payer: Brighton Health Commercial	$2.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.65
Rate for Payer: EmblemHealth Commercial	$1.95
Rate for Payer: Group Health Inc Commercial	$1.95
Rate for Payer: Group Health Inc Medicare	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95
Rate for Payer: Hamaspik Choice Inc Medicare	$1.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.54

RISPERIDONE 0.25 MG PO TABS

Facility

$3.90

Service Code	NDC 4354733906
Hospital Charge Code	4354733906
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95

RISPERIDONE 0.5 MG PO TABS

Facility

$4.27

Service Code	NDC 4354734006
Hospital Charge Code	4354734006
Hospital Revenue Code	250
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$3.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.13
Rate for Payer: Aetna Government	$2.13
Rate for Payer: Brighton Health Commercial	$3.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.90
Rate for Payer: EmblemHealth Commercial	$2.13
Rate for Payer: Group Health Inc Commercial	$2.13
Rate for Payer: Group Health Inc Medicare	$1.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.13
Rate for Payer: Hamaspik Choice Inc Medicare	$2.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.77

RISPERIDONE 0.5 MG PO TABS

Facility

$4.27

Service Code	NDC 4354734006
Hospital Charge Code	4354734006
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.13

RISPERIDONE 0.5 MG PO TABS

Facility

$4.28

Service Code	NDC 6838211314
Hospital Charge Code	6838211314
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.14

RISPERIDONE 0.5 MG PO TABS

Facility

$0.33

Service Code	NDC 0904736161
Hospital Charge Code	0904736161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16

RISPERIDONE 0.5 MG PO TABS

Facility

$0.33

Service Code	NDC 0904736161
Hospital Charge Code	0904736161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.22
Rate for Payer: EmblemHealth Commercial	$0.16
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.21

RISPERIDONE 0.5 MG PO TABS

Facility

$4.28

Service Code	NDC 6838211314
Hospital Charge Code	6838211314
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.14
Rate for Payer: Aetna Government	$2.14
Rate for Payer: Brighton Health Commercial	$3.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.91
Rate for Payer: EmblemHealth Commercial	$2.14
Rate for Payer: Group Health Inc Commercial	$2.14
Rate for Payer: Group Health Inc Medicare	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.78

RISPERIDONE 1 MG/ML PO SOLN

Facility

$5.59

Service Code	NDC 2780800201
Hospital Charge Code	2780800201
Hospital Revenue Code	250
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$2.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.79

RISPERIDONE 1 MG/ML PO SOLN

Facility

$5.59

Service Code	NDC 2780800201
Hospital Charge Code	2780800201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$4.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.79
Rate for Payer: Aetna Government	$2.79
Rate for Payer: Brighton Health Commercial	$4.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.80
Rate for Payer: EmblemHealth Commercial	$2.79
Rate for Payer: Group Health Inc Commercial	$2.79
Rate for Payer: Group Health Inc Medicare	$1.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.63

RISPERIDONE 1 MG/ML PO SOLN

Facility

$5.08

Service Code	NDC 6516267384
Hospital Charge Code	6516267384
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$2.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.54

RISPERIDONE 1 MG/ML PO SOLN

Facility

$4.87

Service Code	NDC 5045859601
Hospital Charge Code	5045859601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.44

RISPERIDONE 1 MG/ML PO SOLN

Facility

$4.87

Service Code	NDC 5045859601
Hospital Charge Code	5045859601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$3.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.44
Rate for Payer: Aetna Government	$2.44
Rate for Payer: Brighton Health Commercial	$3.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.31
Rate for Payer: EmblemHealth Commercial	$2.44
Rate for Payer: Group Health Inc Commercial	$2.44
Rate for Payer: Group Health Inc Medicare	$1.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.44
Rate for Payer: Hamaspik Choice Inc Medicare	$2.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.17

RISPERIDONE 1 MG/ML PO SOLN

Facility

$5.08

Service Code	NDC 6516267384
Hospital Charge Code	6516267384
Hospital Revenue Code	250
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$4.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.54
Rate for Payer: Aetna Government	$2.54
Rate for Payer: Brighton Health Commercial	$3.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.45
Rate for Payer: EmblemHealth Commercial	$2.54
Rate for Payer: Group Health Inc Commercial	$2.54
Rate for Payer: Group Health Inc Medicare	$1.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.54
Rate for Payer: Hamaspik Choice Inc Medicare	$2.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.30

RISPERIDONE 1 MG PO TABS

Facility

$4.54

Service Code	NDC 6808427211
Hospital Charge Code	6808427211
Hospital Revenue Code	250
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$2.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.27

Know your out-of-pocket cost for care.

All Charges