St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SEIZURE

Facility

$248.72

Service Code	EAPG 00529
Min. Negotiated Rate	$180.52
Max. Negotiated Rate	$248.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$180.52
Rate for Payer: Healthfirst Commercial	$248.72

SELEGILINE HCL 5 MG PO CAPS

Facility

$2.30

Service Code	NDC 6050500551
Hospital Charge Code	6050500551
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.15

SELEGILINE HCL 5 MG PO CAPS

Facility

$2.30

Service Code	NDC 6050500551
Hospital Charge Code	6050500551
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.15
Rate for Payer: Aetna Government	$1.15
Rate for Payer: Brighton Health Commercial	$1.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.57
Rate for Payer: EmblemHealth Commercial	$1.15
Rate for Payer: Group Health Inc Commercial	$1.15
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.15
Rate for Payer: Hamaspik Choice Inc Medicare	$1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.50

SELEGILINE HCL 5 MG PO TABS

Facility

$2.10

Service Code	NDC 5009029180
Hospital Charge Code	5009029180
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.05

SELEGILINE HCL 5 MG PO TABS

Facility

$2.10

Service Code	NDC 5009029180
Hospital Charge Code	5009029180
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$1.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.43
Rate for Payer: EmblemHealth Commercial	$1.05
Rate for Payer: Group Health Inc Commercial	$1.05
Rate for Payer: Group Health Inc Medicare	$0.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.05
Rate for Payer: Hamaspik Choice Inc Medicare	$1.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.37

SELENIUM SULFIDE 2.5 % EX LOTN

Facility

$0.17

Service Code	NDC 4580204064
Hospital Charge Code	4580204064
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

SELENIUM SULFIDE 2.5 % EX LOTN

Facility

$0.17

Service Code	NDC 4580204064
Hospital Charge Code	4580204064
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

SEMAGLUTIDE(0.25 OR 0.5MG/DOS) 2 MG/3ML SC SOPN

Facility

$387.41

Service Code	NDC 0169418113
Hospital Charge Code	0169418113
Hospital Revenue Code	250
Min. Negotiated Rate	$193.70
Max. Negotiated Rate	$193.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$193.70

SEMAGLUTIDE(0.25 OR 0.5MG/DOS) 2 MG/3ML SC SOPN

Facility

$387.41

Service Code	NDC 0169418113
Hospital Charge Code	0169418113
Hospital Revenue Code	250
Min. Negotiated Rate	$135.59
Max. Negotiated Rate	$309.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$213.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$193.70
Rate for Payer: Aetna Government	$193.70
Rate for Payer: Brighton Health Commercial	$290.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$309.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$263.44
Rate for Payer: EmblemHealth Commercial	$193.70
Rate for Payer: Group Health Inc Commercial	$193.70
Rate for Payer: Group Health Inc Medicare	$135.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$193.70
Rate for Payer: Hamaspik Choice Inc Medicare	$193.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$251.81

SEMAGLUTIDE-WEIGHT MANAGEMENT 0.5 MG/0.5ML SC SOAJ

Facility

$809.41

Service Code	NDC 0169450514
Hospital Charge Code	0169450514
Hospital Revenue Code	250
Min. Negotiated Rate	$404.70
Max. Negotiated Rate	$404.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$404.70

SEMAGLUTIDE-WEIGHT MANAGEMENT 0.5 MG/0.5ML SC SOAJ

Facility

$809.41

Service Code	NDC 0169450514
Hospital Charge Code	0169450514
Hospital Revenue Code	250
Min. Negotiated Rate	$283.29
Max. Negotiated Rate	$647.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$445.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$404.70
Rate for Payer: Aetna Government	$404.70
Rate for Payer: Brighton Health Commercial	$607.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$647.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$550.40
Rate for Payer: EmblemHealth Commercial	$404.70
Rate for Payer: Group Health Inc Commercial	$404.70
Rate for Payer: Group Health Inc Medicare	$283.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$404.70
Rate for Payer: Hamaspik Choice Inc Medicare	$404.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$526.12

SENNOSIDES 8.6 MG PO TABS

Facility

$0.02

Service Code	NDC 4948308010
Hospital Charge Code	4948308010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

SENNOSIDES 8.6 MG PO TABS

Facility

$0.02

Service Code	NDC 4948308010
Hospital Charge Code	4948308010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

SENNOSIDES 8.6 MG PO TABS

Facility

$0.05

Service Code	NDC 0904725261
Hospital Charge Code	0904725261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

SENNOSIDES 8.6 MG PO TABS

Facility

$0.05

Service Code	NDC 0904725261
Hospital Charge Code	0904725261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$294.17

Service Code	EAPG 00805
Min. Negotiated Rate	$212.92
Max. Negotiated Rate	$294.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$212.92
Rate for Payer: Healthfirst Commercial	$294.17

Septicemia & disseminated infections

Facility

$42,646.52

Service Code	APR-DRG 7201
Min. Negotiated Rate	$7,406.00
Max. Negotiated Rate	$42,646.52
Rate for Payer: Affinity Essential Plan 1&2	$42,646.52
Rate for Payer: Affinity Essential Plan 3&4	$42,646.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,954.01
Rate for Payer: Amida Care Medicaid	$18,954.01
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,646.52
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,954.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,954.01
Rate for Payer: Fidelis Qualified Health Plan	$22,744.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,954.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,954.01
Rate for Payer: Healthfirst Commercial	$12,017.00
Rate for Payer: Healthfirst Essential Plan	$42,646.52
Rate for Payer: Healthfirst QHP	$7,406.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,954.01
Rate for Payer: SOMOS Essential	$42,646.52
Rate for Payer: United Healthcare Essential Plan 1&2	$42,646.52
Rate for Payer: United Healthcare Essential Plan 3&4	$42,646.52
Rate for Payer: United Healthcare Medicaid	$18,954.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,954.01

Septicemia & disseminated infections

Facility

$46,679.33

Service Code	APR-DRG 7202
Min. Negotiated Rate	$9,799.00
Max. Negotiated Rate	$46,679.33
Rate for Payer: Affinity Essential Plan 1&2	$46,679.33
Rate for Payer: Affinity Essential Plan 3&4	$46,679.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,746.37
Rate for Payer: Amida Care Medicaid	$20,746.37
Rate for Payer: EmblemHealth Essential Plan 1&2	$46,679.33
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,746.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,746.37
Rate for Payer: Fidelis Qualified Health Plan	$24,895.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,746.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,746.37
Rate for Payer: Healthfirst Commercial	$16,121.00
Rate for Payer: Healthfirst Essential Plan	$46,679.33
Rate for Payer: Healthfirst QHP	$9,799.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,746.37
Rate for Payer: SOMOS Essential	$46,679.33
Rate for Payer: United Healthcare Essential Plan 1&2	$46,679.33
Rate for Payer: United Healthcare Essential Plan 3&4	$46,679.33
Rate for Payer: United Healthcare Medicaid	$20,746.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,746.37

Septicemia & disseminated infections

Facility

$88,301.81

Service Code	APR-DRG 7204
Min. Negotiated Rate	$29,823.00
Max. Negotiated Rate	$88,301.81
Rate for Payer: Affinity Essential Plan 1&2	$88,301.81
Rate for Payer: Affinity Essential Plan 3&4	$88,301.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$39,245.25
Rate for Payer: Amida Care Medicaid	$39,245.25
Rate for Payer: EmblemHealth Essential Plan 1&2	$88,301.81
Rate for Payer: EmblemHealth Essential Plan 3&4	$39,245.25
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,245.25
Rate for Payer: Fidelis Qualified Health Plan	$47,094.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,245.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,245.25
Rate for Payer: Healthfirst Commercial	$51,609.00
Rate for Payer: Healthfirst Essential Plan	$88,301.81
Rate for Payer: Healthfirst QHP	$29,823.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,245.25
Rate for Payer: SOMOS Essential	$88,301.81
Rate for Payer: United Healthcare Essential Plan 1&2	$88,301.81
Rate for Payer: United Healthcare Essential Plan 3&4	$88,301.81
Rate for Payer: United Healthcare Medicaid	$39,245.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,245.25

Septicemia & disseminated infections

Facility

$58,186.82

Service Code	APR-DRG 7203
Min. Negotiated Rate	$15,024.00
Max. Negotiated Rate	$58,186.82
Rate for Payer: Affinity Essential Plan 1&2	$58,186.82
Rate for Payer: Affinity Essential Plan 3&4	$58,186.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,860.81
Rate for Payer: Amida Care Medicaid	$25,860.81
Rate for Payer: EmblemHealth Essential Plan 1&2	$58,186.82
Rate for Payer: EmblemHealth Essential Plan 3&4	$25,860.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,860.81
Rate for Payer: Fidelis Qualified Health Plan	$31,032.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,860.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,860.81
Rate for Payer: Healthfirst Commercial	$25,794.00
Rate for Payer: Healthfirst Essential Plan	$58,186.82
Rate for Payer: Healthfirst QHP	$15,024.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,860.81
Rate for Payer: SOMOS Essential	$58,186.82
Rate for Payer: United Healthcare Essential Plan 1&2	$58,186.82
Rate for Payer: United Healthcare Essential Plan 3&4	$58,186.82
Rate for Payer: United Healthcare Medicaid	$25,860.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,860.81

SERTRALINE HCL 100 MG PO TABS

Facility

$2.85

Service Code	NDC 6818035309
Hospital Charge Code	6818035309
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43

SERTRALINE HCL 100 MG PO TABS

Facility

$2.85

Service Code	NDC 6818035309
Hospital Charge Code	6818035309
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$2.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.94
Rate for Payer: EmblemHealth Commercial	$1.43
Rate for Payer: Group Health Inc Commercial	$1.43
Rate for Payer: Group Health Inc Medicare	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43
Rate for Payer: Hamaspik Choice Inc Medicare	$1.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.85

SERTRALINE HCL 100 MG PO TABS

Facility

$2.85

Service Code	NDC 6586201301
Hospital Charge Code	6586201301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42

SERTRALINE HCL 100 MG PO TABS

Facility

$2.85

Service Code	NDC 6586201301
Hospital Charge Code	6586201301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.42
Rate for Payer: Aetna Government	$1.42
Rate for Payer: Brighton Health Commercial	$2.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.94
Rate for Payer: EmblemHealth Commercial	$1.42
Rate for Payer: Group Health Inc Commercial	$1.42
Rate for Payer: Group Health Inc Medicare	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.85

SERTRALINE HCL 100 MG PO TABS

Facility

$2.85

Service Code	NDC 6586201330
Hospital Charge Code	6586201330
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42

Know your out-of-pocket cost for care.

All Charges