St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Sinus & mastoid procedures

Facility

$73,665.54

Service Code	APR-DRG 0933
Min. Negotiated Rate	$21,120.00
Max. Negotiated Rate	$73,665.54
Rate for Payer: Affinity Essential Plan 1&2	$73,665.54
Rate for Payer: Affinity Essential Plan 3&4	$73,665.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,740.24
Rate for Payer: Amida Care Medicaid	$32,740.24
Rate for Payer: EmblemHealth Essential Plan 1&2	$73,665.54
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,740.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,740.24
Rate for Payer: Fidelis Qualified Health Plan	$39,288.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,740.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,740.24
Rate for Payer: Healthfirst Commercial	$37,309.00
Rate for Payer: Healthfirst Essential Plan	$73,665.54
Rate for Payer: Healthfirst QHP	$21,120.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,740.24
Rate for Payer: SOMOS Essential	$73,665.54
Rate for Payer: United Healthcare Essential Plan 1&2	$73,665.54
Rate for Payer: United Healthcare Essential Plan 3&4	$73,665.54
Rate for Payer: United Healthcare Medicaid	$32,740.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,740.24

Sinus & mastoid procedures

Facility

$80,927.39

Service Code	APR-DRG 0934
Min. Negotiated Rate	$23,420.00
Max. Negotiated Rate	$80,927.39
Rate for Payer: Affinity Essential Plan 1&2	$80,927.39
Rate for Payer: Affinity Essential Plan 3&4	$80,927.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,967.73
Rate for Payer: Amida Care Medicaid	$35,967.73
Rate for Payer: EmblemHealth Essential Plan 1&2	$80,927.39
Rate for Payer: EmblemHealth Essential Plan 3&4	$35,967.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,967.73
Rate for Payer: Fidelis Qualified Health Plan	$43,161.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,967.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,967.73
Rate for Payer: Healthfirst Commercial	$38,420.00
Rate for Payer: Healthfirst Essential Plan	$80,927.39
Rate for Payer: Healthfirst QHP	$23,420.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,967.73
Rate for Payer: SOMOS Essential	$80,927.39
Rate for Payer: United Healthcare Essential Plan 1&2	$80,927.39
Rate for Payer: United Healthcare Essential Plan 3&4	$80,927.39
Rate for Payer: United Healthcare Medicaid	$35,967.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,967.73

SITAGLIPTIN 100 MG PO TABS

Facility

$19.60

Service Code	NDC 7071019013
Hospital Charge Code	7071019013
Hospital Revenue Code	250
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$15.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.80
Rate for Payer: Aetna Government	$9.80
Rate for Payer: Brighton Health Commercial	$14.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.33
Rate for Payer: EmblemHealth Commercial	$9.80
Rate for Payer: Group Health Inc Commercial	$9.80
Rate for Payer: Group Health Inc Medicare	$6.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.80
Rate for Payer: Hamaspik Choice Inc Medicare	$9.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.74

SITAGLIPTIN 100 MG PO TABS

Facility

$19.60

Service Code	NDC 7071019013
Hospital Charge Code	7071019013
Hospital Revenue Code	250
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.80

SITAGLIPTIN 25 MG PO TABS

Facility

$1.97

Service Code	NDC 7071018993
Hospital Charge Code	7071018993
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.99
Rate for Payer: Aetna Government	$0.99
Rate for Payer: Brighton Health Commercial	$1.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.34
Rate for Payer: EmblemHealth Commercial	$0.99
Rate for Payer: Group Health Inc Commercial	$0.99
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.99
Rate for Payer: Hamaspik Choice Inc Medicare	$0.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.28

SITAGLIPTIN 25 MG PO TABS

Facility

$19.60

Service Code	NDC 7071018999
Hospital Charge Code	7071018999
Hospital Revenue Code	250
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.80

SITAGLIPTIN 25 MG PO TABS

Facility

$1.97

Service Code	NDC 7071018993
Hospital Charge Code	7071018993
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.99

SITAGLIPTIN 25 MG PO TABS

Facility

$19.60

Service Code	NDC 7071018999
Hospital Charge Code	7071018999
Hospital Revenue Code	250
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$15.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.80
Rate for Payer: Aetna Government	$9.80
Rate for Payer: Brighton Health Commercial	$14.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.33
Rate for Payer: EmblemHealth Commercial	$9.80
Rate for Payer: Group Health Inc Commercial	$9.80
Rate for Payer: Group Health Inc Medicare	$6.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.80
Rate for Payer: Hamaspik Choice Inc Medicare	$9.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.74

SITAGLIPTIN 50 MG PO TABS

Facility

$1.97

Service Code	NDC 7071019003
Hospital Charge Code	7071019003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.99

SITAGLIPTIN 50 MG PO TABS

Facility

$1.97

Service Code	NDC 7071019003
Hospital Charge Code	7071019003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.99
Rate for Payer: Aetna Government	$0.99
Rate for Payer: Brighton Health Commercial	$1.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.34
Rate for Payer: EmblemHealth Commercial	$0.99
Rate for Payer: Group Health Inc Commercial	$0.99
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.99
Rate for Payer: Hamaspik Choice Inc Medicare	$0.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.28

SITAGLIPTIN PHOSPHATE 100 MG PO TABS

Facility

$22.92

Service Code	NDC 0006027728
Hospital Charge Code	0006027728
Hospital Revenue Code	250
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$18.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.46
Rate for Payer: Aetna Government	$11.46
Rate for Payer: Brighton Health Commercial	$17.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.59
Rate for Payer: EmblemHealth Commercial	$11.46
Rate for Payer: Group Health Inc Commercial	$11.46
Rate for Payer: Group Health Inc Medicare	$8.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46
Rate for Payer: Hamaspik Choice Inc Medicare	$11.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.90

SITAGLIPTIN PHOSPHATE 100 MG PO TABS

Facility

$22.92

Service Code	NDC 0006027731
Hospital Charge Code	0006027731
Hospital Revenue Code	250
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$11.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46

SITAGLIPTIN PHOSPHATE 100 MG PO TABS

Facility

$22.92

Service Code	NDC 0006027731
Hospital Charge Code	0006027731
Hospital Revenue Code	250
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$18.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.46
Rate for Payer: Aetna Government	$11.46
Rate for Payer: Brighton Health Commercial	$17.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.59
Rate for Payer: EmblemHealth Commercial	$11.46
Rate for Payer: Group Health Inc Commercial	$11.46
Rate for Payer: Group Health Inc Medicare	$8.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46
Rate for Payer: Hamaspik Choice Inc Medicare	$11.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.90

SITAGLIPTIN PHOSPHATE 100 MG PO TABS

Facility

$22.92

Service Code	NDC 0006027728
Hospital Charge Code	0006027728
Hospital Revenue Code	250
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$11.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46

SITAGLIPTIN PHOSPHATE 100 MG PO TABS

Facility

$22.92

Service Code	NDC 0006027701
Hospital Charge Code	0006027701
Hospital Revenue Code	250
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$18.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.46
Rate for Payer: Aetna Government	$11.46
Rate for Payer: Brighton Health Commercial	$17.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.59
Rate for Payer: EmblemHealth Commercial	$11.46
Rate for Payer: Group Health Inc Commercial	$11.46
Rate for Payer: Group Health Inc Medicare	$8.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46
Rate for Payer: Hamaspik Choice Inc Medicare	$11.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.90

SITAGLIPTIN PHOSPHATE 100 MG PO TABS

Facility

$22.92

Service Code	NDC 0006027701
Hospital Charge Code	0006027701
Hospital Revenue Code	250
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$11.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46

SITAGLIPTIN PHOSPHATE 25 MG PO TABS

Facility

$22.92

Service Code	NDC 0006022101
Hospital Charge Code	0006022101
Hospital Revenue Code	250
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$11.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46

SITAGLIPTIN PHOSPHATE 25 MG PO TABS

Facility

$22.92

Service Code	NDC 0006022131
Hospital Charge Code	0006022131
Hospital Revenue Code	250
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$11.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46

SITAGLIPTIN PHOSPHATE 25 MG PO TABS

Facility

$22.92

Service Code	NDC 0006022131
Hospital Charge Code	0006022131
Hospital Revenue Code	250
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$18.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.46
Rate for Payer: Aetna Government	$11.46
Rate for Payer: Brighton Health Commercial	$17.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.59
Rate for Payer: EmblemHealth Commercial	$11.46
Rate for Payer: Group Health Inc Commercial	$11.46
Rate for Payer: Group Health Inc Medicare	$8.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46
Rate for Payer: Hamaspik Choice Inc Medicare	$11.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.90

SITAGLIPTIN PHOSPHATE 25 MG PO TABS

Facility

$22.92

Service Code	NDC 0006022128
Hospital Charge Code	0006022128
Hospital Revenue Code	250
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$11.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46

SITAGLIPTIN PHOSPHATE 25 MG PO TABS

Facility

$22.92

Service Code	NDC 0006022128
Hospital Charge Code	0006022128
Hospital Revenue Code	250
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$18.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.46
Rate for Payer: Aetna Government	$11.46
Rate for Payer: Brighton Health Commercial	$17.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.59
Rate for Payer: EmblemHealth Commercial	$11.46
Rate for Payer: Group Health Inc Commercial	$11.46
Rate for Payer: Group Health Inc Medicare	$8.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46
Rate for Payer: Hamaspik Choice Inc Medicare	$11.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.90

SITAGLIPTIN PHOSPHATE 25 MG PO TABS

Facility

$22.92

Service Code	NDC 0006022101
Hospital Charge Code	0006022101
Hospital Revenue Code	250
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$18.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.46
Rate for Payer: Aetna Government	$11.46
Rate for Payer: Brighton Health Commercial	$17.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.59
Rate for Payer: EmblemHealth Commercial	$11.46
Rate for Payer: Group Health Inc Commercial	$11.46
Rate for Payer: Group Health Inc Medicare	$8.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46
Rate for Payer: Hamaspik Choice Inc Medicare	$11.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.90

SITAGLIPTIN PHOSPHATE 50 MG PO TABS

Facility

$22.92

Service Code	NDC 0006011231
Hospital Charge Code	0006011231
Hospital Revenue Code	250
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$18.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.46
Rate for Payer: Aetna Government	$11.46
Rate for Payer: Brighton Health Commercial	$17.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.59
Rate for Payer: EmblemHealth Commercial	$11.46
Rate for Payer: Group Health Inc Commercial	$11.46
Rate for Payer: Group Health Inc Medicare	$8.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46
Rate for Payer: Hamaspik Choice Inc Medicare	$11.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.90

SITAGLIPTIN PHOSPHATE 50 MG PO TABS

Facility

$22.92

Service Code	NDC 0006011231
Hospital Charge Code	0006011231
Hospital Revenue Code	250
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$11.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46

SITAGLIPTIN PHOSPHATE 50 MG PO TABS

Facility

$22.92

Service Code	NDC 0006011201
Hospital Charge Code	0006011201
Hospital Revenue Code	250
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$18.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.46
Rate for Payer: Aetna Government	$11.46
Rate for Payer: Brighton Health Commercial	$17.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.59
Rate for Payer: EmblemHealth Commercial	$11.46
Rate for Payer: Group Health Inc Commercial	$11.46
Rate for Payer: Group Health Inc Medicare	$8.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.46
Rate for Payer: Hamaspik Choice Inc Medicare	$11.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.90

Know your out-of-pocket cost for care.

All Charges