St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CLOTRIMAZOLE 1 % VA CREA

Facility

$0.18

Service Code	NDC 5167220036
Hospital Charge Code	5167220036
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

CLOZAPINE 100 MG PO TABS

Facility

$3.42

Service Code	NDC 1672914201
Hospital Charge Code	1672914201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.71
Rate for Payer: Aetna Government	$1.71
Rate for Payer: Brighton Health Commercial	$2.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.32
Rate for Payer: EmblemHealth Commercial	$1.71
Rate for Payer: Group Health Inc Commercial	$1.71
Rate for Payer: Group Health Inc Medicare	$1.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.71
Rate for Payer: Hamaspik Choice Inc Medicare	$1.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.22

CLOZAPINE 100 MG PO TABS

Facility

$3.43

Service Code	NDC 6586284601
Hospital Charge Code	6586284601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$1.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.71

CLOZAPINE 100 MG PO TABS

Facility

$3.42

Service Code	NDC 1672914201
Hospital Charge Code	1672914201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$1.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.71

CLOZAPINE 100 MG PO TABS

Facility

$1.12

Service Code	NDC 0904708761
Hospital Charge Code	0904708761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56

CLOZAPINE 100 MG PO TABS

Facility

$3.46

Service Code	NDC 6068741511
Hospital Charge Code	6068741511
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$2.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.73
Rate for Payer: Aetna Government	$1.73
Rate for Payer: Brighton Health Commercial	$2.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.35
Rate for Payer: EmblemHealth Commercial	$1.73
Rate for Payer: Group Health Inc Commercial	$1.73
Rate for Payer: Group Health Inc Medicare	$1.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.73
Rate for Payer: Hamaspik Choice Inc Medicare	$1.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.25

CLOZAPINE 100 MG PO TABS

Facility

$3.46

Service Code	NDC 6068741511
Hospital Charge Code	6068741511
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$1.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.73

CLOZAPINE 100 MG PO TABS

Facility

$3.43

Service Code	NDC 6586284601
Hospital Charge Code	6586284601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.71
Rate for Payer: Aetna Government	$1.71
Rate for Payer: Brighton Health Commercial	$2.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.33
Rate for Payer: EmblemHealth Commercial	$1.71
Rate for Payer: Group Health Inc Commercial	$1.71
Rate for Payer: Group Health Inc Medicare	$1.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.71
Rate for Payer: Hamaspik Choice Inc Medicare	$1.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.23

CLOZAPINE 100 MG PO TABS

Facility

$3.46

Service Code	NDC 6068741501
Hospital Charge Code	6068741501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$2.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.73
Rate for Payer: Aetna Government	$1.73
Rate for Payer: Brighton Health Commercial	$2.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.35
Rate for Payer: EmblemHealth Commercial	$1.73
Rate for Payer: Group Health Inc Commercial	$1.73
Rate for Payer: Group Health Inc Medicare	$1.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.73
Rate for Payer: Hamaspik Choice Inc Medicare	$1.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.25

CLOZAPINE 100 MG PO TABS

Facility

$1.12

Service Code	NDC 0904708761
Hospital Charge Code	0904708761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.56
Rate for Payer: Aetna Government	$0.56
Rate for Payer: Brighton Health Commercial	$0.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.76
Rate for Payer: EmblemHealth Commercial	$0.56
Rate for Payer: Group Health Inc Commercial	$0.56
Rate for Payer: Group Health Inc Medicare	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56
Rate for Payer: Hamaspik Choice Inc Medicare	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.73

CLOZAPINE 100 MG PO TABS

Facility

$3.46

Service Code	NDC 6068741501
Hospital Charge Code	6068741501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$1.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.73

CLOZAPINE 25 MG PO TABS

Facility

$1.33

Service Code	NDC 6068740401
Hospital Charge Code	6068740401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67

CLOZAPINE 25 MG PO TABS

Facility

$7.32

Service Code	NDC 6980901265
Hospital Charge Code	6980901265
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$5.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.66
Rate for Payer: Aetna Government	$3.66
Rate for Payer: Brighton Health Commercial	$5.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.98
Rate for Payer: EmblemHealth Commercial	$3.66
Rate for Payer: Group Health Inc Commercial	$3.66
Rate for Payer: Group Health Inc Medicare	$2.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.66
Rate for Payer: Hamaspik Choice Inc Medicare	$3.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.76

CLOZAPINE 25 MG PO TABS

Facility

$0.43

Service Code	NDC 0904708961
Hospital Charge Code	0904708961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: EmblemHealth Commercial	$0.22
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

CLOZAPINE 25 MG PO TABS

Facility

$0.43

Service Code	NDC 0904708961
Hospital Charge Code	0904708961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22

CLOZAPINE 25 MG PO TABS

Facility

$7.32

Service Code	NDC 6980901265
Hospital Charge Code	6980901265
Hospital Revenue Code	250
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$3.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.66

CLOZAPINE 25 MG PO TABS

Facility

$1.33

Service Code	NDC 6068740401
Hospital Charge Code	6068740401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.67
Rate for Payer: Aetna Government	$0.67
Rate for Payer: Brighton Health Commercial	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: EmblemHealth Commercial	$0.67
Rate for Payer: Group Health Inc Commercial	$0.67
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67
Rate for Payer: Hamaspik Choice Inc Medicare	$0.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.86

CMMI ASYNTELEHEALTH 10-20MIN

Professional

Both

$134.02

Service Code	HCPCS G9869
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$82.94
Rate for Payer: Cash Price	$37.31
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$36.86
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33.17
Rate for Payer: Fidelis Essential Plan Aliesa	$33.17
Rate for Payer: Fidelis Essential Plan QHP	$35.02
Rate for Payer: Fidelis Medicare Advantage	$36.86
Rate for Payer: Fidelis Qualified Health Plan	$35.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.86
Rate for Payer: Hamaspik Choice Inc Medicare	$36.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.64
Rate for Payer: Healthfirst Commercial	$36.86
Rate for Payer: Healthfirst Essential Plan	$82.94
Rate for Payer: Healthfirst Medicare Advantage	$35.02
Rate for Payer: Healthfirst QHP	$36.86
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$25.80
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$36.86
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$31.33
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$25.80
Rate for Payer: Senior Whole Health Medicare Advantage	$36.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.64
Rate for Payer: SOMOS Essential	$27.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.86

CMMI ASYNTELEHEALTH <10MIN

Professional

Both

$100.21

Service Code	HCPCS G9868
Min. Negotiated Rate	$19.29
Max. Negotiated Rate	$62.01
Rate for Payer: Cash Price	$27.90
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24.80
Rate for Payer: Fidelis Essential Plan Aliesa	$24.80
Rate for Payer: Fidelis Essential Plan QHP	$26.18
Rate for Payer: Fidelis Medicare Advantage	$27.56
Rate for Payer: Fidelis Qualified Health Plan	$26.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.56
Rate for Payer: Hamaspik Choice Inc Medicare	$27.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.67
Rate for Payer: Healthfirst Commercial	$27.56
Rate for Payer: Healthfirst Essential Plan	$62.01
Rate for Payer: Healthfirst Medicare Advantage	$26.18
Rate for Payer: Healthfirst QHP	$27.56
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$19.29
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$27.56
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$23.43
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$19.29
Rate for Payer: Senior Whole Health Medicare Advantage	$27.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20.67
Rate for Payer: SOMOS Essential	$20.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.56

CMMI ASYNTELEHEALTH >20MIN

Professional

Both

$167.83

Service Code	HCPCS G9870
Min. Negotiated Rate	$32.31
Max. Negotiated Rate	$103.86
Rate for Payer: Cash Price	$46.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$46.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41.54
Rate for Payer: Fidelis Essential Plan Aliesa	$41.54
Rate for Payer: Fidelis Essential Plan QHP	$43.85
Rate for Payer: Fidelis Medicare Advantage	$46.16
Rate for Payer: Fidelis Qualified Health Plan	$43.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.16
Rate for Payer: Hamaspik Choice Inc Medicare	$46.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34.62
Rate for Payer: Healthfirst Commercial	$46.16
Rate for Payer: Healthfirst Essential Plan	$103.86
Rate for Payer: Healthfirst Medicare Advantage	$43.85
Rate for Payer: Healthfirst QHP	$46.16
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$32.31
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$46.16
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$39.24
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$32.31
Rate for Payer: Senior Whole Health Medicare Advantage	$46.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34.62
Rate for Payer: SOMOS Essential	$34.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.16

COAGULATION AND PLATELET DISORDERS AND CONGENITAL FACTOR DEFICIENCIES

Facility

$216.04

Service Code	EAPG 00781
Min. Negotiated Rate	$157.37
Max. Negotiated Rate	$216.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$157.37
Rate for Payer: Healthfirst Commercial	$216.04

COAGULATION FACTOR VIIA RECOMB 1 MG IV SOLR

Facility

$3.22

Service Code	HCPCS J7189
Hospital Charge Code	0169720101
Hospital Revenue Code	258
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$2.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.66
Rate for Payer: Aetna Government	$2.66
Rate for Payer: Affinity Essential Plan 1&2	$1.86
Rate for Payer: Affinity Essential Plan 3&4	$1.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.86
Rate for Payer: Brighton Health Commercial	$2.42
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.19
Rate for Payer: Elderplan Medicare Advantage	$2.66
Rate for Payer: EmblemHealth Commercial	$2.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.39
Rate for Payer: Fidelis Essential Plan Aliesa	$2.26
Rate for Payer: Fidelis Essential Plan QHP	$2.37
Rate for Payer: Fidelis Medicare Advantage	$2.66
Rate for Payer: Fidelis Qualified Health Plan	$2.37
Rate for Payer: Group Health Inc Commercial	$2.66
Rate for Payer: Group Health Inc Medicare	$2.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.66
Rate for Payer: Hamaspik Choice Inc Medicare	$2.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.66
Rate for Payer: Healthfirst Medicare Advantage	$2.26
Rate for Payer: Healthfirst QHP	$2.66
Rate for Payer: Humana Medicare	$2.71
Rate for Payer: Senior Whole Health Medicare Advantage	$2.66
Rate for Payer: United Healthcare Medicare Advantage	$2.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.53
Rate for Payer: Wellcare Medicare	$2.53

COAGULATION FACTOR VIIA RECOMB 1 MG IV SOLR

Facility

$3.22

Service Code	HCPCS J7189
Hospital Charge Code	0169720101
Hospital Revenue Code	258
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.61

COAGULATION FACTOR VIIA RECOMB 5 MG IV SOLR

Facility

$3.22

Service Code	HCPCS J7189
Hospital Charge Code	0169720501
Hospital Revenue Code	258
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$2.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.66
Rate for Payer: Aetna Government	$2.66
Rate for Payer: Affinity Essential Plan 1&2	$1.86
Rate for Payer: Affinity Essential Plan 3&4	$1.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.86
Rate for Payer: Brighton Health Commercial	$2.42
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.19
Rate for Payer: Elderplan Medicare Advantage	$2.66
Rate for Payer: EmblemHealth Commercial	$2.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.39
Rate for Payer: Fidelis Essential Plan Aliesa	$2.26
Rate for Payer: Fidelis Essential Plan QHP	$2.37
Rate for Payer: Fidelis Medicare Advantage	$2.66
Rate for Payer: Fidelis Qualified Health Plan	$2.37
Rate for Payer: Group Health Inc Commercial	$2.66
Rate for Payer: Group Health Inc Medicare	$2.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.66
Rate for Payer: Hamaspik Choice Inc Medicare	$2.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.66
Rate for Payer: Healthfirst Medicare Advantage	$2.26
Rate for Payer: Healthfirst QHP	$2.66
Rate for Payer: Humana Medicare	$2.71
Rate for Payer: Senior Whole Health Medicare Advantage	$2.66
Rate for Payer: United Healthcare Medicare Advantage	$2.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.53
Rate for Payer: Wellcare Medicare	$2.53

COAGULATION FACTOR VIIA RECOMB 5 MG IV SOLR

Facility

$3.22

Service Code	HCPCS J7189
Hospital Charge Code	0169720501
Hospital Revenue Code	258
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.61

Know your out-of-pocket cost for care.

All Charges