St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SULFASALAZINE 500 MG PO TABS

Facility

$0.23

Service Code	NDC 5976250006
Hospital Charge Code	5976250006
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12

SULFASALAZINE 500 MG PO TABS

Facility

$0.23

Service Code	NDC 5976250005
Hospital Charge Code	5976250005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: EmblemHealth Commercial	$0.12
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

SULFASALAZINE 500 MG PO TABS

Facility

$0.23

Service Code	NDC 5976250005
Hospital Charge Code	5976250005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12

SULFASALAZINE 500 MG PO TBEC

Facility

$0.34

Service Code	NDC 5976201045
Hospital Charge Code	5976201045
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.23
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

SULFASALAZINE 500 MG PO TBEC

Facility

$0.34

Service Code	NDC 5976201045
Hospital Charge Code	5976201045
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

SULINDAC 150 MG PO TABS

Facility

$0.98

Service Code	NDC 4280601801
Hospital Charge Code	4280601801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49

SULINDAC 150 MG PO TABS

Facility

$0.98

Service Code	NDC 4280601801
Hospital Charge Code	4280601801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.67
Rate for Payer: EmblemHealth Commercial	$0.49
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.64

SULINDAC 200 MG PO TABS

Facility

$1.21

Service Code	NDC 5348947901
Hospital Charge Code	5348947901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60

SULINDAC 200 MG PO TABS

Facility

$1.21

Service Code	NDC 5348947901
Hospital Charge Code	5348947901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.60
Rate for Payer: Aetna Government	$0.60
Rate for Payer: Brighton Health Commercial	$0.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.82
Rate for Payer: EmblemHealth Commercial	$0.60
Rate for Payer: Group Health Inc Commercial	$0.60
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60
Rate for Payer: Hamaspik Choice Inc Medicare	$0.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.78

SUMATRIPTAN SUCCINATE 100 MG PO TABS

Facility

$25.14

Service Code	NDC 6945234672
Hospital Charge Code	6945234672
Hospital Revenue Code	250
Min. Negotiated Rate	$12.57
Max. Negotiated Rate	$12.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.57

SUMATRIPTAN SUCCINATE 100 MG PO TABS

Facility

$25.14

Service Code	NDC 6945234672
Hospital Charge Code	6945234672
Hospital Revenue Code	250
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$20.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.57
Rate for Payer: Aetna Government	$12.57
Rate for Payer: Brighton Health Commercial	$18.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.10
Rate for Payer: EmblemHealth Commercial	$12.57
Rate for Payer: Group Health Inc Commercial	$12.57
Rate for Payer: Group Health Inc Medicare	$8.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.57
Rate for Payer: Hamaspik Choice Inc Medicare	$12.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.34

SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN

Facility

$122.50

Service Code	NDC 6332327301
Hospital Charge Code	6332327301
Hospital Revenue Code	250
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$98.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.25
Rate for Payer: Aetna Government	$61.25
Rate for Payer: Brighton Health Commercial	$91.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$98.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.30
Rate for Payer: EmblemHealth Commercial	$61.25
Rate for Payer: Group Health Inc Commercial	$61.25
Rate for Payer: Group Health Inc Medicare	$42.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.25
Rate for Payer: Hamaspik Choice Inc Medicare	$61.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$79.62

SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN

Facility

$122.50

Service Code	NDC 6332327301
Hospital Charge Code	6332327301
Hospital Revenue Code	250
Min. Negotiated Rate	$61.25
Max. Negotiated Rate	$61.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.25

SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN

Facility

$26.40

Service Code	NDC 5515017301
Hospital Charge Code	5515017301
Hospital Revenue Code	250
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.20

SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN

Facility

$26.40

Service Code	NDC 5515017301
Hospital Charge Code	5515017301
Hospital Revenue Code	250
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$21.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.20
Rate for Payer: Aetna Government	$13.20
Rate for Payer: Brighton Health Commercial	$19.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.95
Rate for Payer: EmblemHealth Commercial	$13.20
Rate for Payer: Group Health Inc Commercial	$13.20
Rate for Payer: Group Health Inc Medicare	$9.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.20
Rate for Payer: Hamaspik Choice Inc Medicare	$13.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.16

SUPERFICIAL INJURY TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$210.60

Service Code	EAPG 00777
Min. Negotiated Rate	$210.60
Max. Negotiated Rate	$210.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$210.60

SUPERFICIAL NEEDLE BIOPSY AND ASPIRATION

Facility

$881.08

Service Code	EAPG 00002
Min. Negotiated Rate	$638.75
Max. Negotiated Rate	$881.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$638.75
Rate for Payer: Healthfirst Commercial	$881.08

SYNCOPE AND COLLAPSE

Facility

$262.10

Service Code	EAPG 00605
Min. Negotiated Rate	$189.77
Max. Negotiated Rate	$262.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$189.77
Rate for Payer: Healthfirst Commercial	$262.10

Syncope & collapse

Facility

$40,112.17

Service Code	APR-DRG 2041
Min. Negotiated Rate	$5,384.00
Max. Negotiated Rate	$40,112.17
Rate for Payer: Affinity Essential Plan 1&2	$40,112.17
Rate for Payer: Affinity Essential Plan 3&4	$40,112.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,827.63
Rate for Payer: Amida Care Medicaid	$17,827.63
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,112.17
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,827.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,827.63
Rate for Payer: Fidelis Qualified Health Plan	$21,393.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,827.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,827.63
Rate for Payer: Healthfirst Commercial	$9,282.00
Rate for Payer: Healthfirst Essential Plan	$40,112.17
Rate for Payer: Healthfirst QHP	$5,384.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,827.63
Rate for Payer: SOMOS Essential	$40,112.17
Rate for Payer: United Healthcare Essential Plan 1&2	$40,112.17
Rate for Payer: United Healthcare Essential Plan 3&4	$40,112.17
Rate for Payer: United Healthcare Medicaid	$17,827.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,827.63

Syncope & collapse

Facility

$42,129.45

Service Code	APR-DRG 2042
Min. Negotiated Rate	$6,476.00
Max. Negotiated Rate	$42,129.45
Rate for Payer: Affinity Essential Plan 1&2	$42,129.45
Rate for Payer: Affinity Essential Plan 3&4	$42,129.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,724.20
Rate for Payer: Amida Care Medicaid	$18,724.20
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,129.45
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,724.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,724.20
Rate for Payer: Fidelis Qualified Health Plan	$22,469.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,724.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,724.20
Rate for Payer: Healthfirst Commercial	$11,327.00
Rate for Payer: Healthfirst Essential Plan	$42,129.45
Rate for Payer: Healthfirst QHP	$6,476.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,724.20
Rate for Payer: SOMOS Essential	$42,129.45
Rate for Payer: United Healthcare Essential Plan 1&2	$42,129.45
Rate for Payer: United Healthcare Essential Plan 3&4	$42,129.45
Rate for Payer: United Healthcare Medicaid	$18,724.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,724.20

Syncope & collapse

Facility

$47,131.33

Service Code	APR-DRG 2043
Min. Negotiated Rate	$8,637.00
Max. Negotiated Rate	$47,131.33
Rate for Payer: Affinity Essential Plan 1&2	$47,131.33
Rate for Payer: Affinity Essential Plan 3&4	$47,131.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,947.26
Rate for Payer: Amida Care Medicaid	$20,947.26
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,131.33
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,947.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,947.26
Rate for Payer: Fidelis Qualified Health Plan	$25,136.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,947.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,947.26
Rate for Payer: Healthfirst Commercial	$16,471.00
Rate for Payer: Healthfirst Essential Plan	$47,131.33
Rate for Payer: Healthfirst QHP	$8,637.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,947.26
Rate for Payer: SOMOS Essential	$47,131.33
Rate for Payer: United Healthcare Essential Plan 1&2	$47,131.33
Rate for Payer: United Healthcare Essential Plan 3&4	$47,131.33
Rate for Payer: United Healthcare Medicaid	$20,947.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,947.26

Syncope & collapse

Facility

$69,314.40

Service Code	APR-DRG 2044
Min. Negotiated Rate	$17,278.00
Max. Negotiated Rate	$69,314.40
Rate for Payer: Affinity Essential Plan 1&2	$69,314.40
Rate for Payer: Affinity Essential Plan 3&4	$69,314.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,806.40
Rate for Payer: Amida Care Medicaid	$30,806.40
Rate for Payer: EmblemHealth Essential Plan 1&2	$69,314.40
Rate for Payer: EmblemHealth Essential Plan 3&4	$30,806.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,806.40
Rate for Payer: Fidelis Qualified Health Plan	$36,967.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,806.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,806.40
Rate for Payer: Healthfirst Commercial	$38,194.00
Rate for Payer: Healthfirst Essential Plan	$69,314.40
Rate for Payer: Healthfirst QHP	$17,278.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,806.40
Rate for Payer: SOMOS Essential	$69,314.40
Rate for Payer: United Healthcare Essential Plan 1&2	$69,314.40
Rate for Payer: United Healthcare Essential Plan 3&4	$69,314.40
Rate for Payer: United Healthcare Medicaid	$30,806.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,806.40

TACROLIMUS 0.5 MG PO CAPS

Facility

$1.26

Service Code	HCPCS J7507
Hospital Charge Code	0904662361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$1.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$0.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: EmblemHealth Commercial	$0.63
Rate for Payer: Group Health Inc Commercial	$0.63
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.82

TACROLIMUS 0.5 MG PO CAPS

Facility

$1.26

Service Code	HCPCS J7507
Hospital Charge Code	0904662361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63

TACROLIMUS 0.5 MG PO CAPS

Facility

$2.23

Service Code	HCPCS J7507
Hospital Charge Code	7037701411
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.11

Know your out-of-pocket cost for care.

All Charges