St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

TACROLIMUS 0.5 MG PO CAPS

Facility

$2.23

Service Code	HCPCS J7507
Hospital Charge Code	7037701411
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$1.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
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: Healthfirst CHP/FHP/Medicaid	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.45

TACROLIMUS 0.5 MG PO CAPS

Facility

$2.23

Service Code	HCPCS J7507
Hospital Charge Code	6945215320
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.11

TACROLIMUS 1 MG PO CAPS

Facility

$4.46

Service Code	HCPCS J7507
Hospital Charge Code	6787727901
Hospital Revenue Code	250
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$2.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.23

TACROLIMUS 1 MG PO CAPS

Facility

$4.46

Service Code	HCPCS J7507
Hospital Charge Code	6787727901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$3.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.03
Rate for Payer: EmblemHealth Commercial	$2.23
Rate for Payer: Group Health Inc Commercial	$2.23
Rate for Payer: Group Health Inc Medicare	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.23
Rate for Payer: Hamaspik Choice Inc Medicare	$2.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.90

TACROLIMUS 1 MG PO CAPS

Facility

$1.64

Service Code	HCPCS J7507
Hospital Charge Code	0904709761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82

TACROLIMUS 1 MG PO CAPS

Facility

$1.64

Service Code	HCPCS J7507
Hospital Charge Code	0904709761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$1.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$1.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.12
Rate for Payer: EmblemHealth Commercial	$0.82
Rate for Payer: Group Health Inc Commercial	$0.82
Rate for Payer: Group Health Inc Medicare	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82
Rate for Payer: Hamaspik Choice Inc Medicare	$0.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.07

TACROLIMUS 5 MG PO CAPS

Facility

$22.30

Service Code	HCPCS J7507
Hospital Charge Code	1672904301
Hospital Revenue Code	250
Min. Negotiated Rate	$11.15
Max. Negotiated Rate	$11.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.15

TACROLIMUS 5 MG PO CAPS

Facility

$22.30

Service Code	HCPCS J7507
Hospital Charge Code	1672904301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$17.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$16.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.16
Rate for Payer: EmblemHealth Commercial	$11.15
Rate for Payer: Group Health Inc Commercial	$11.15
Rate for Payer: Group Health Inc Medicare	$7.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.15
Rate for Payer: Hamaspik Choice Inc Medicare	$11.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.49

TACROLIMUS 5 MG PO CAPS

Facility

$10.80

Service Code	HCPCS J7507
Hospital Charge Code	0904662461
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.40

TACROLIMUS 5 MG PO CAPS

Facility

$10.80

Service Code	HCPCS J7507
Hospital Charge Code	0904662461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$8.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$8.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.34
Rate for Payer: EmblemHealth Commercial	$5.40
Rate for Payer: Group Health Inc Commercial	$5.40
Rate for Payer: Group Health Inc Medicare	$3.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.40
Rate for Payer: Hamaspik Choice Inc Medicare	$5.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.02

TACROLIMUS 5 MG PO CAPS

Facility

$22.30

Service Code	HCPCS J7507
Hospital Charge Code	7037701611
Hospital Revenue Code	250
Min. Negotiated Rate	$11.15
Max. Negotiated Rate	$11.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.15

TACROLIMUS 5 MG PO CAPS

Facility

$22.30

Service Code	HCPCS J7507
Hospital Charge Code	7037701611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$17.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$16.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.16
Rate for Payer: EmblemHealth Commercial	$11.15
Rate for Payer: Group Health Inc Commercial	$11.15
Rate for Payer: Group Health Inc Medicare	$7.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.15
Rate for Payer: Hamaspik Choice Inc Medicare	$11.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.49

TALC 4 G PL AERP

Facility

$4.20

Service Code	NDC 6325610030
Hospital Charge Code	6325610030
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.10
Rate for Payer: Aetna Government	$2.10
Rate for Payer: Brighton Health Commercial	$3.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.86
Rate for Payer: EmblemHealth Commercial	$2.10
Rate for Payer: Group Health Inc Commercial	$2.10
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.73

TALC 4 G PL AERP

Facility

$4.20

Service Code	NDC 6325610030
Hospital Charge Code	6325610030
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10

TALC 4 G PL POWD

Facility

$204.00

Service Code	NDC 6232744404
Hospital Charge Code	6232744404
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$163.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$112.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$102.00
Rate for Payer: Aetna Government	$102.00
Rate for Payer: Brighton Health Commercial	$153.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$163.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$138.72
Rate for Payer: EmblemHealth Commercial	$102.00
Rate for Payer: Group Health Inc Commercial	$102.00
Rate for Payer: Group Health Inc Medicare	$71.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.00
Rate for Payer: Hamaspik Choice Inc Medicare	$102.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$132.60

TALC 4 G PL POWD

Facility

$204.00

Service Code	NDC 6232744404
Hospital Charge Code	6232744404
Hospital Revenue Code	250
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$102.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.00

TAMOXIFEN CITRATE 10 MG PO TABS

Facility

$1.89

Service Code	NDC 0591247260
Hospital Charge Code	0591247260
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$1.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.29
Rate for Payer: EmblemHealth Commercial	$0.95
Rate for Payer: Group Health Inc Commercial	$0.95
Rate for Payer: Group Health Inc Medicare	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.95
Rate for Payer: Hamaspik Choice Inc Medicare	$0.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.23

TAMOXIFEN CITRATE 10 MG PO TABS

Facility

$0.57

Service Code	NDC 6373914310
Hospital Charge Code	6373914310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.29
Rate for Payer: Aetna Government	$0.29
Rate for Payer: Brighton Health Commercial	$0.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.39
Rate for Payer: EmblemHealth Commercial	$0.29
Rate for Payer: Group Health Inc Commercial	$0.29
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.29
Rate for Payer: Hamaspik Choice Inc Medicare	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.37

TAMOXIFEN CITRATE 10 MG PO TABS

Facility

$0.57

Service Code	NDC 6373914310
Hospital Charge Code	6373914310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.29

TAMOXIFEN CITRATE 10 MG PO TABS

Facility

$1.89

Service Code	NDC 0591247260
Hospital Charge Code	0591247260
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.95

TAMSULOSIN HCL 0.4 MG PO CAPS

Facility

$0.48

Service Code	NDC 5026874011
Hospital Charge Code	5026874011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24

TAMSULOSIN HCL 0.4 MG PO CAPS

Facility

$0.48

Service Code	NDC 5026874015
Hospital Charge Code	5026874015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24

TAMSULOSIN HCL 0.4 MG PO CAPS

Facility

$4.21

Service Code	NDC 6275616013
Hospital Charge Code	6275616013
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.10
Rate for Payer: Aetna Government	$2.10
Rate for Payer: Brighton Health Commercial	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.86
Rate for Payer: EmblemHealth Commercial	$2.10
Rate for Payer: Group Health Inc Commercial	$2.10
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.74

TAMSULOSIN HCL 0.4 MG PO CAPS

Facility

$4.21

Service Code	NDC 6275616013
Hospital Charge Code	6275616013
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10

Know your out-of-pocket cost for care.

All Charges