St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DAPSONE 100 MG PO TABS

Facility

$3.36

Service Code	NDC 4993810130
Hospital Charge Code	4993810130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68

DAPSONE 25 MG PO TABS

Facility

$2.20

Service Code	NDC 7095413520
Hospital Charge Code	7095413520
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$1.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.10
Rate for Payer: Aetna Government	$1.10
Rate for Payer: Brighton Health Commercial	$1.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.50
Rate for Payer: EmblemHealth Commercial	$1.10
Rate for Payer: Group Health Inc Commercial	$1.10
Rate for Payer: Group Health Inc Medicare	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.43

DAPSONE 25 MG PO TABS

Facility

$2.74

Service Code	NDC 4993810230
Hospital Charge Code	4993810230
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37

DAPSONE 25 MG PO TABS

Facility

$2.20

Service Code	NDC 7095413520
Hospital Charge Code	7095413520
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.10

DAPSONE 25 MG PO TABS

Facility

$2.74

Service Code	NDC 4993810230
Hospital Charge Code	4993810230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.37
Rate for Payer: Aetna Government	$1.37
Rate for Payer: Brighton Health Commercial	$2.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.86
Rate for Payer: EmblemHealth Commercial	$1.37
Rate for Payer: Group Health Inc Commercial	$1.37
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.78

DAPTOMYCIN 350 MG IV SOLR

Facility

$30.00

Service Code	HCPCS J0878
Hospital Charge Code	7128801715
Hospital Revenue Code	258
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00

DAPTOMYCIN 350 MG IV SOLR

Facility

$30.00

Service Code	HCPCS J0878
Hospital Charge Code	7128801715
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$24.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.40
Rate for Payer: EmblemHealth Commercial	$15.00
Rate for Payer: Group Health Inc Commercial	$15.00
Rate for Payer: Group Health Inc Medicare	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.50

DAPTOMYCIN 350 MG IV SOLR

Facility

$48.00

Service Code	HCPCS J0878
Hospital Charge Code	7059405301
Hospital Revenue Code	258
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.00

DAPTOMYCIN 350 MG IV SOLR

Facility

$48.00

Service Code	HCPCS J0878
Hospital Charge Code	7059405301
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$38.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.64
Rate for Payer: EmblemHealth Commercial	$24.00
Rate for Payer: Group Health Inc Commercial	$24.00
Rate for Payer: Group Health Inc Medicare	$16.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.00
Rate for Payer: Hamaspik Choice Inc Medicare	$24.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.20

DAPTOMYCIN 500 MG IV SOLR

Facility

$72.00

Service Code	HCPCS J0878
Hospital Charge Code	5515034401
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$57.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$54.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.96
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Group Health Inc Commercial	$36.00
Rate for Payer: Group Health Inc Medicare	$25.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.00
Rate for Payer: Hamaspik Choice Inc Medicare	$36.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.80

DAPTOMYCIN 500 MG IV SOLR

Facility

$72.00

Service Code	HCPCS J0878
Hospital Charge Code	7059403401
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$57.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$54.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.96
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Group Health Inc Commercial	$36.00
Rate for Payer: Group Health Inc Medicare	$25.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.00
Rate for Payer: Hamaspik Choice Inc Medicare	$36.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.80

DAPTOMYCIN 500 MG IV SOLR

Facility

$23.04

Service Code	HCPCS J0878
Hospital Charge Code	7059403402
Hospital Revenue Code	258
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$11.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.52

DAPTOMYCIN 500 MG IV SOLR

Facility

$126.00

Service Code	HCPCS J0878
Hospital Charge Code	0703012501
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$100.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$94.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$100.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.68
Rate for Payer: EmblemHealth Commercial	$63.00
Rate for Payer: Group Health Inc Commercial	$63.00
Rate for Payer: Group Health Inc Medicare	$44.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.00
Rate for Payer: Hamaspik Choice Inc Medicare	$63.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.90

DAPTOMYCIN 500 MG IV SOLR

Facility

$126.00

Service Code	HCPCS J0878
Hospital Charge Code	0703012501
Hospital Revenue Code	258
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$63.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.00

DAPTOMYCIN 500 MG IV SOLR

Facility

$72.00

Service Code	HCPCS J0878
Hospital Charge Code	5515034401
Hospital Revenue Code	258
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.00

DAPTOMYCIN 500 MG IV SOLR

Facility

$72.00

Service Code	HCPCS J0878
Hospital Charge Code	7059403401
Hospital Revenue Code	258
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.00

DAPTOMYCIN 500 MG IV SOLR

Facility

$23.04

Service Code	HCPCS J0878
Hospital Charge Code	7059403402
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$18.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$17.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.67
Rate for Payer: EmblemHealth Commercial	$11.52
Rate for Payer: Group Health Inc Commercial	$11.52
Rate for Payer: Group Health Inc Medicare	$8.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.52
Rate for Payer: Hamaspik Choice Inc Medicare	$11.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.98

DARATUMUMAB 100 MG/5ML IV SOLN

Facility

$170.68

Service Code	HCPCS J9145
Hospital Charge Code	5789450205
Hospital Revenue Code	258
Min. Negotiated Rate	$85.34
Max. Negotiated Rate	$85.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.34

DARATUMUMAB 100 MG/5ML IV SOLN

Facility

$170.68

Service Code	HCPCS J9145
Hospital Charge Code	5789450205
Hospital Revenue Code	258
Min. Negotiated Rate	$49.96
Max. Negotiated Rate	$136.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$71.37
Rate for Payer: Aetna Government	$71.37
Rate for Payer: Affinity Essential Plan 1&2	$49.96
Rate for Payer: Affinity Essential Plan 3&4	$49.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$49.96
Rate for Payer: Brighton Health Commercial	$128.01
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$71.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$136.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$116.06
Rate for Payer: Elderplan Medicare Advantage	$71.37
Rate for Payer: EmblemHealth Commercial	$71.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$64.23
Rate for Payer: Fidelis Essential Plan Aliesa	$60.66
Rate for Payer: Fidelis Essential Plan QHP	$63.52
Rate for Payer: Fidelis Medicare Advantage	$71.37
Rate for Payer: Fidelis Qualified Health Plan	$63.52
Rate for Payer: Group Health Inc Commercial	$71.37
Rate for Payer: Group Health Inc Medicare	$71.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.37
Rate for Payer: Hamaspik Choice Inc Medicare	$71.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$71.37
Rate for Payer: Healthfirst Medicare Advantage	$60.66
Rate for Payer: Healthfirst QHP	$71.37
Rate for Payer: Humana Medicare	$72.80
Rate for Payer: Senior Whole Health Medicare Advantage	$71.37
Rate for Payer: United Healthcare Medicare Advantage	$71.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$110.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$67.80
Rate for Payer: Wellcare Medicare	$67.80

DARATUMUMAB-HYALURONIDASE-FIHJ 1800-30000 MG-UT/15ML SC SOLN

Facility

$775.45

Service Code	HCPCS J9144
Hospital Charge Code	5789450301
Hospital Revenue Code	250
Min. Negotiated Rate	$387.72
Max. Negotiated Rate	$387.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$387.72

DARATUMUMAB-HYALURONIDASE-FIHJ 1800-30000 MG-UT/15ML SC SOLN

Facility

$775.45

Service Code	HCPCS J9144
Hospital Charge Code	5789450301
Hospital Revenue Code	250
Min. Negotiated Rate	$38.90
Max. Negotiated Rate	$620.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$426.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.57
Rate for Payer: Aetna Government	$55.57
Rate for Payer: Affinity Essential Plan 1&2	$38.90
Rate for Payer: Affinity Essential Plan 3&4	$38.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$38.90
Rate for Payer: Brighton Health Commercial	$581.58
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$55.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$620.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$527.30
Rate for Payer: Elderplan Medicare Advantage	$55.57
Rate for Payer: EmblemHealth Commercial	$55.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$50.01
Rate for Payer: Fidelis Essential Plan Aliesa	$47.23
Rate for Payer: Fidelis Essential Plan QHP	$49.46
Rate for Payer: Fidelis Medicare Advantage	$55.57
Rate for Payer: Fidelis Qualified Health Plan	$49.46
Rate for Payer: Group Health Inc Commercial	$55.57
Rate for Payer: Group Health Inc Medicare	$55.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.57
Rate for Payer: Hamaspik Choice Inc Medicare	$55.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$55.57
Rate for Payer: Healthfirst Medicare Advantage	$47.23
Rate for Payer: Healthfirst QHP	$55.57
Rate for Payer: Humana Medicare	$56.68
Rate for Payer: Senior Whole Health Medicare Advantage	$55.57
Rate for Payer: United Healthcare Medicare Advantage	$55.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$504.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$52.79
Rate for Payer: Wellcare Medicare	$52.79

DARBEPOETIN ALFA 100 MCG/0.5ML IJ SOSY

Facility

$1.00

Service Code	HCPCS J0881
Hospital Charge Code	5551302501
Hospital Revenue Code	634
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$3.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.93
Rate for Payer: Aetna Government	$2.93
Rate for Payer: Affinity Essential Plan 1&2	$2.05
Rate for Payer: Affinity Essential Plan 3&4	$2.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.05
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.93
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	$2.93
Rate for Payer: EmblemHealth Commercial	$2.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2.49
Rate for Payer: Fidelis Essential Plan QHP	$2.61
Rate for Payer: Fidelis Medicare Advantage	$2.93
Rate for Payer: Fidelis Qualified Health Plan	$3.08
Rate for Payer: Group Health Inc Commercial	$2.93
Rate for Payer: Group Health Inc Medicare	$2.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.93
Rate for Payer: Hamaspik Choice Inc Medicare	$2.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.93
Rate for Payer: Healthfirst Medicare Advantage	$2.49
Rate for Payer: Healthfirst QHP	$2.93
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Senior Whole Health Medicare Advantage	$2.93
Rate for Payer: United Healthcare Medicare Advantage	$2.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$2.78

DARBEPOETIN ALFA 100 MCG/0.5ML IJ SOSY

Facility

$1.00

Service Code	HCPCS J0881
Hospital Charge Code	5551302501
Hospital Revenue Code	634
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

DARBEPOETIN ALFA 100 MCG/ML IJ SOLN

Facility

$928.80

Service Code	HCPCS J0881
Hospital Charge Code	5551300504
Hospital Revenue Code	634
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$743.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$510.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.93
Rate for Payer: Aetna Government	$2.93
Rate for Payer: Affinity Essential Plan 1&2	$2.05
Rate for Payer: Affinity Essential Plan 3&4	$2.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.05
Rate for Payer: Brighton Health Commercial	$696.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$743.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$631.58
Rate for Payer: Elderplan Medicare Advantage	$2.93
Rate for Payer: EmblemHealth Commercial	$2.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2.49
Rate for Payer: Fidelis Essential Plan QHP	$2.61
Rate for Payer: Fidelis Medicare Advantage	$2.93
Rate for Payer: Fidelis Qualified Health Plan	$3.08
Rate for Payer: Group Health Inc Commercial	$2.93
Rate for Payer: Group Health Inc Medicare	$2.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.93
Rate for Payer: Hamaspik Choice Inc Medicare	$2.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.93
Rate for Payer: Healthfirst Medicare Advantage	$2.49
Rate for Payer: Healthfirst QHP	$2.93
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Senior Whole Health Medicare Advantage	$2.93
Rate for Payer: United Healthcare Medicare Advantage	$2.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$603.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$2.78

DARBEPOETIN ALFA 100 MCG/ML IJ SOLN

Facility

$928.80

Service Code	HCPCS J0881
Hospital Charge Code	5551300504
Hospital Revenue Code	634
Min. Negotiated Rate	$464.40
Max. Negotiated Rate	$464.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$464.40

Know your out-of-pocket cost for care.

All Charges