St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TREMELIMUMAB-ACTL 25 MG/1.25ML IV SOLN

Facility

$3.00

Service Code	HCPCS J9347
Hospital Charge Code	0310450525
Hospital Revenue Code	258
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50

TREMELIMUMAB-ACTL 25 MG/1.25ML IV SOLN

Facility

$3.00

Service Code	HCPCS J9347
Hospital Charge Code	0310450525
Hospital Revenue Code	258
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$143.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.90
Rate for Payer: Aetna Government	$140.90
Rate for Payer: Affinity Essential Plan 1&2	$98.63
Rate for Payer: Affinity Essential Plan 3&4	$98.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$98.63
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$140.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Elderplan Medicare Advantage	$140.90
Rate for Payer: EmblemHealth Commercial	$140.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$126.81
Rate for Payer: Fidelis Essential Plan Aliesa	$119.77
Rate for Payer: Fidelis Essential Plan QHP	$125.40
Rate for Payer: Fidelis Medicare Advantage	$140.90
Rate for Payer: Fidelis Qualified Health Plan	$125.40
Rate for Payer: Group Health Inc Commercial	$140.90
Rate for Payer: Group Health Inc Medicare	$140.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.90
Rate for Payer: Hamaspik Choice Inc Medicare	$140.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$140.90
Rate for Payer: Healthfirst Medicare Advantage	$119.77
Rate for Payer: Healthfirst QHP	$140.90
Rate for Payer: Humana Medicare	$143.72
Rate for Payer: Senior Whole Health Medicare Advantage	$140.90
Rate for Payer: United Healthcare Medicare Advantage	$140.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$133.85
Rate for Payer: Wellcare Medicare	$133.85

TREMELIMUMAB-ACTL 300 MG/15ML IV SOLN

Facility

$3.00

Service Code	HCPCS J9347
Hospital Charge Code	0310453530
Hospital Revenue Code	258
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$143.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.90
Rate for Payer: Aetna Government	$140.90
Rate for Payer: Affinity Essential Plan 1&2	$98.63
Rate for Payer: Affinity Essential Plan 3&4	$98.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$98.63
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$140.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Elderplan Medicare Advantage	$140.90
Rate for Payer: EmblemHealth Commercial	$140.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$126.81
Rate for Payer: Fidelis Essential Plan Aliesa	$119.77
Rate for Payer: Fidelis Essential Plan QHP	$125.40
Rate for Payer: Fidelis Medicare Advantage	$140.90
Rate for Payer: Fidelis Qualified Health Plan	$125.40
Rate for Payer: Group Health Inc Commercial	$140.90
Rate for Payer: Group Health Inc Medicare	$140.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.90
Rate for Payer: Hamaspik Choice Inc Medicare	$140.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$140.90
Rate for Payer: Healthfirst Medicare Advantage	$119.77
Rate for Payer: Healthfirst QHP	$140.90
Rate for Payer: Humana Medicare	$143.72
Rate for Payer: Senior Whole Health Medicare Advantage	$140.90
Rate for Payer: United Healthcare Medicare Advantage	$140.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$133.85
Rate for Payer: Wellcare Medicare	$133.85

TREMELIMUMAB-ACTL 300 MG/15ML IV SOLN

Facility

$3.00

Service Code	HCPCS J9347
Hospital Charge Code	0310453530
Hospital Revenue Code	258
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50

TRIAMCINOLONE ACETONIDE 0.025 % EX CREA

Facility

$0.14

Service Code	NDC 0168000380
Hospital Charge Code	0168000380
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

TRIAMCINOLONE ACETONIDE 0.025 % EX CREA

Facility

$0.30

Service Code	NDC 0168000315
Hospital Charge Code	0168000315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: EmblemHealth Commercial	$0.15
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

TRIAMCINOLONE ACETONIDE 0.025 % EX CREA

Facility

$0.30

Service Code	NDC 6787731715
Hospital Charge Code	6787731715
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: EmblemHealth Commercial	$0.15
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

TRIAMCINOLONE ACETONIDE 0.025 % EX CREA

Facility

$0.30

Service Code	NDC 0168000315
Hospital Charge Code	0168000315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15

TRIAMCINOLONE ACETONIDE 0.025 % EX CREA

Facility

$0.14

Service Code	NDC 0168000380
Hospital Charge Code	0168000380
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
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	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
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	$0.09

TRIAMCINOLONE ACETONIDE 0.025 % EX CREA

Facility

$0.30

Service Code	NDC 6787731715
Hospital Charge Code	6787731715
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15

TRIAMCINOLONE ACETONIDE 0.025 % EX OINT

Facility

$0.41

Service Code	NDC 4580205435
Hospital Charge Code	4580205435
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.28
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

TRIAMCINOLONE ACETONIDE 0.025 % EX OINT

Facility

$0.41

Service Code	NDC 4580205435
Hospital Charge Code	4580205435
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

TRIAMCINOLONE ACETONIDE 0.025 % EX OINT

Facility

$0.14

Service Code	NDC 0168000580
Hospital Charge Code	0168000580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

TRIAMCINOLONE ACETONIDE 0.025 % EX OINT

Facility

$0.14

Service Code	NDC 0168000580
Hospital Charge Code	0168000580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
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	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
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	$0.09

TRIAMCINOLONE ACETONIDE 0.1 % EX CREA

Facility

$0.16

Service Code	NDC 0713022580
Hospital Charge Code	0713022580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

TRIAMCINOLONE ACETONIDE 0.1 % EX CREA

Facility

$0.16

Service Code	NDC 0713022580
Hospital Charge Code	0713022580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
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	$0.05
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

TRIAMCINOLONE ACETONIDE 0.1 % EX CREA

Facility

$0.24

Service Code	NDC 0168000415
Hospital Charge Code	0168000415
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12

TRIAMCINOLONE ACETONIDE 0.1 % EX CREA

Facility

$0.24

Service Code	NDC 0168000415
Hospital Charge Code	0168000415
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	$0.18
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	$0.16

TRIAMCINOLONE ACETONIDE 0.1 % EX CREA

Facility

$0.39

Service Code	NDC 2192206204
Hospital Charge Code	2192206204
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.26
Rate for Payer: EmblemHealth Commercial	$0.19
Rate for Payer: Group Health Inc Commercial	$0.19
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19
Rate for Payer: Hamaspik Choice Inc Medicare	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

TRIAMCINOLONE ACETONIDE 0.1 % EX CREA

Facility

$0.39

Service Code	NDC 2192206204
Hospital Charge Code	2192206204
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19

TRIAMCINOLONE ACETONIDE 0.1 % EX CREA

Facility

$0.07

Service Code	NDC 6787725145
Hospital Charge Code	6787725145
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

TRIAMCINOLONE ACETONIDE 0.1 % EX CREA

Facility

$0.16

Service Code	NDC 5167212828
Hospital Charge Code	5167212828
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

TRIAMCINOLONE ACETONIDE 0.1 % EX CREA

Facility

$0.16

Service Code	NDC 5167212828
Hospital Charge Code	5167212828
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
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	$0.05
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

TRIAMCINOLONE ACETONIDE 0.1 % EX CREA

Facility

$0.12

Service Code	NDC 4580206436
Hospital Charge Code	4580206436
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: EmblemHealth Commercial	$0.06
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

TRIAMCINOLONE ACETONIDE 0.1 % EX CREA

Facility

$0.12

Service Code	NDC 4580206436
Hospital Charge Code	4580206436
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

Know your out-of-pocket cost for care.

All Charges