St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TRASTUZUMAB-QYYP 150 MG IV SOLR

Facility

$1.00

Service Code	HCPCS Q5116
Hospital Charge Code	0069030801
Hospital Revenue Code	258
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$28.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.99
Rate for Payer: Aetna Government	$27.99
Rate for Payer: Affinity Essential Plan 1&2	$19.59
Rate for Payer: Affinity Essential Plan 3&4	$19.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$19.59
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$27.99
Rate for Payer: EmblemHealth Commercial	$27.99
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25.19
Rate for Payer: Fidelis Essential Plan Aliesa	$23.79
Rate for Payer: Fidelis Essential Plan QHP	$24.91
Rate for Payer: Fidelis Medicare Advantage	$27.99
Rate for Payer: Fidelis Qualified Health Plan	$24.91
Rate for Payer: Group Health Inc Commercial	$27.99
Rate for Payer: Group Health Inc Medicare	$27.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.99
Rate for Payer: Hamaspik Choice Inc Medicare	$27.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.99
Rate for Payer: Healthfirst Medicare Advantage	$23.79
Rate for Payer: Healthfirst QHP	$27.99
Rate for Payer: Humana Medicare	$28.55
Rate for Payer: Senior Whole Health Medicare Advantage	$27.99
Rate for Payer: United Healthcare Medicare Advantage	$27.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26.59
Rate for Payer: Wellcare Medicare	$26.59

TRASTUZUMAB-QYYP 150 MG IV SOLR

Facility

$1.00

Service Code	HCPCS Q5116
Hospital Charge Code	0069030801
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

TRASTUZUMAB-QYYP 420 MG IV SOLR

Facility

$4.00

Service Code	HCPCS Q5116
Hospital Charge Code	0069030501
Hospital Revenue Code	258
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00

TRASTUZUMAB-QYYP 420 MG IV SOLR

Facility

$4.00

Service Code	HCPCS Q5116
Hospital Charge Code	0069030501
Hospital Revenue Code	258
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$28.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.99
Rate for Payer: Aetna Government	$27.99
Rate for Payer: Affinity Essential Plan 1&2	$19.59
Rate for Payer: Affinity Essential Plan 3&4	$19.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$19.59
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Elderplan Medicare Advantage	$27.99
Rate for Payer: EmblemHealth Commercial	$27.99
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25.19
Rate for Payer: Fidelis Essential Plan Aliesa	$23.79
Rate for Payer: Fidelis Essential Plan QHP	$24.91
Rate for Payer: Fidelis Medicare Advantage	$27.99
Rate for Payer: Fidelis Qualified Health Plan	$24.91
Rate for Payer: Group Health Inc Commercial	$27.99
Rate for Payer: Group Health Inc Medicare	$27.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.99
Rate for Payer: Hamaspik Choice Inc Medicare	$27.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.99
Rate for Payer: Healthfirst Medicare Advantage	$23.79
Rate for Payer: Healthfirst QHP	$27.99
Rate for Payer: Humana Medicare	$28.55
Rate for Payer: Senior Whole Health Medicare Advantage	$27.99
Rate for Payer: United Healthcare Medicare Advantage	$27.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26.59
Rate for Payer: Wellcare Medicare	$26.59

TRASTUZUMAB-QYYP 420 MG IV SOLR

Facility

$4.00

Service Code	HCPCS Q5116
Hospital Charge Code	0069030601
Hospital Revenue Code	258
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00

TRASTUZUMAB-QYYP 420 MG IV SOLR

Facility

$4.00

Service Code	HCPCS Q5116
Hospital Charge Code	0069030601
Hospital Revenue Code	258
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$28.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.99
Rate for Payer: Aetna Government	$27.99
Rate for Payer: Affinity Essential Plan 1&2	$19.59
Rate for Payer: Affinity Essential Plan 3&4	$19.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$19.59
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Elderplan Medicare Advantage	$27.99
Rate for Payer: EmblemHealth Commercial	$27.99
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25.19
Rate for Payer: Fidelis Essential Plan Aliesa	$23.79
Rate for Payer: Fidelis Essential Plan QHP	$24.91
Rate for Payer: Fidelis Medicare Advantage	$27.99
Rate for Payer: Fidelis Qualified Health Plan	$24.91
Rate for Payer: Group Health Inc Commercial	$27.99
Rate for Payer: Group Health Inc Medicare	$27.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.99
Rate for Payer: Hamaspik Choice Inc Medicare	$27.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.99
Rate for Payer: Healthfirst Medicare Advantage	$23.79
Rate for Payer: Healthfirst QHP	$27.99
Rate for Payer: Humana Medicare	$28.55
Rate for Payer: Senior Whole Health Medicare Advantage	$27.99
Rate for Payer: United Healthcare Medicare Advantage	$27.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26.59
Rate for Payer: Wellcare Medicare	$26.59

TRAUMATIC INJURIES

Facility

$189.77

Service Code	EAPG 00568
Min. Negotiated Rate	$189.77
Max. Negotiated Rate	$189.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$189.77

TRAZODONE HCL 100 MG PO TABS

Facility

$1.10

Service Code	NDC 1672930017
Hospital Charge Code	1672930017
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.75
Rate for Payer: EmblemHealth Commercial	$0.55
Rate for Payer: Group Health Inc Commercial	$0.55
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55
Rate for Payer: Hamaspik Choice Inc Medicare	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

TRAZODONE HCL 100 MG PO TABS

Facility

$1.39

Service Code	NDC 5011156101
Hospital Charge Code	5011156101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.70

TRAZODONE HCL 100 MG PO TABS

Facility

$1.10

Service Code	NDC 1672930017
Hospital Charge Code	1672930017
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55

TRAZODONE HCL 100 MG PO TABS

Facility

$0.21

Service Code	NDC 0904686961
Hospital Charge Code	0904686961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

TRAZODONE HCL 100 MG PO TABS

Facility

$0.21

Service Code	NDC 0904686961
Hospital Charge Code	0904686961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: EmblemHealth Commercial	$0.11
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

TRAZODONE HCL 100 MG PO TABS

Facility

$1.39

Service Code	NDC 5011156101
Hospital Charge Code	5011156101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$1.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.70
Rate for Payer: Aetna Government	$0.70
Rate for Payer: Brighton Health Commercial	$1.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.95
Rate for Payer: EmblemHealth Commercial	$0.70
Rate for Payer: Group Health Inc Commercial	$0.70
Rate for Payer: Group Health Inc Medicare	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.70
Rate for Payer: Hamaspik Choice Inc Medicare	$0.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.90

TRAZODONE HCL 100 MG PO TABS

Facility

$0.22

Service Code	NDC 6068745411
Hospital Charge Code	6068745411
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: EmblemHealth Commercial	$0.11
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

TRAZODONE HCL 100 MG PO TABS

Facility

$0.22

Service Code	NDC 6068745411
Hospital Charge Code	6068745411
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

TRAZODONE HCL 100 MG PO TABS

Facility

$0.22

Service Code	NDC 6068745401
Hospital Charge Code	6068745401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: EmblemHealth Commercial	$0.11
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

TRAZODONE HCL 100 MG PO TABS

Facility

$0.22

Service Code	NDC 6068745401
Hospital Charge Code	6068745401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

TRAZODONE HCL 50 MG PO TABS

Facility

$0.79

Service Code	NDC 1672929917
Hospital Charge Code	1672929917
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39

TRAZODONE HCL 50 MG PO TABS

Facility

$0.79

Service Code	NDC 1672929917
Hospital Charge Code	1672929917
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: EmblemHealth Commercial	$0.39
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.51

TRAZODONE HCL 50 MG PO TABS

Facility

$1.07

Service Code	NDC 5011156001
Hospital Charge Code	5011156001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.54
Rate for Payer: Aetna Government	$0.54
Rate for Payer: Brighton Health Commercial	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.73
Rate for Payer: EmblemHealth Commercial	$0.54
Rate for Payer: Group Health Inc Commercial	$0.54
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54
Rate for Payer: Hamaspik Choice Inc Medicare	$0.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.70

TRAZODONE HCL 50 MG PO TABS

Facility

$0.16

Service Code	NDC 6068744301
Hospital Charge Code	6068744301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

TRAZODONE HCL 50 MG PO TABS

Facility

$0.15

Service Code	NDC 0904686861
Hospital Charge Code	0904686861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

TRAZODONE HCL 50 MG PO TABS

Facility

$0.16

Service Code	NDC 6068744301
Hospital Charge Code	6068744301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.12
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	$0.12
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	$0.05
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	$0.10

TRAZODONE HCL 50 MG PO TABS

Facility

$1.07

Service Code	NDC 5011156001
Hospital Charge Code	5011156001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54

TRAZODONE HCL 50 MG PO TABS

Facility

$0.15

Service Code	NDC 0904686861
Hospital Charge Code	0904686861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

Know your out-of-pocket cost for care.

All Charges