St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DARUNAVIR 800 MG PO TABS

Facility

$86.33

Service Code	NDC 5967656630
Hospital Charge Code	5967656630
Hospital Revenue Code	250
Min. Negotiated Rate	$30.21
Max. Negotiated Rate	$69.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.16
Rate for Payer: Aetna Government	$43.16
Rate for Payer: Brighton Health Commercial	$64.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$69.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.70
Rate for Payer: EmblemHealth Commercial	$43.16
Rate for Payer: Group Health Inc Commercial	$43.16
Rate for Payer: Group Health Inc Medicare	$30.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.16
Rate for Payer: Hamaspik Choice Inc Medicare	$43.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$56.11

DARUNAVIR 800 MG PO TABS

Facility

$75.43

Service Code	NDC 7220518530
Hospital Charge Code	7220518530
Hospital Revenue Code	250
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$60.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.72
Rate for Payer: Aetna Government	$37.72
Rate for Payer: Brighton Health Commercial	$56.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.29
Rate for Payer: EmblemHealth Commercial	$37.72
Rate for Payer: Group Health Inc Commercial	$37.72
Rate for Payer: Group Health Inc Medicare	$26.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.72
Rate for Payer: Hamaspik Choice Inc Medicare	$37.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.03

DARUNAVIR 800 MG PO TABS

Facility

$86.33

Service Code	NDC 5967656630
Hospital Charge Code	5967656630
Hospital Revenue Code	250
Min. Negotiated Rate	$43.16
Max. Negotiated Rate	$43.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.16

DARUNAVIR 800 MG PO TABS

Facility

$75.43

Service Code	NDC 5965108630
Hospital Charge Code	5965108630
Hospital Revenue Code	250
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$60.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.72
Rate for Payer: Aetna Government	$37.72
Rate for Payer: Brighton Health Commercial	$56.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.29
Rate for Payer: EmblemHealth Commercial	$37.72
Rate for Payer: Group Health Inc Commercial	$37.72
Rate for Payer: Group Health Inc Medicare	$26.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.72
Rate for Payer: Hamaspik Choice Inc Medicare	$37.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.03

DARUNAVIR 800 MG PO TABS

Facility

$75.43

Service Code	NDC 5965108630
Hospital Charge Code	5965108630
Hospital Revenue Code	250
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$37.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.72

DARUNAVIR 800 MG PO TABS

Facility

$75.43

Service Code	NDC 7220518530
Hospital Charge Code	7220518530
Hospital Revenue Code	250
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$37.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.72

DARUNAVIR 800 MG PO TABS

Facility

$7.54

Service Code	NDC 7257814806
Hospital Charge Code	7257814806
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$6.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.77
Rate for Payer: Aetna Government	$3.77
Rate for Payer: Brighton Health Commercial	$5.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.13
Rate for Payer: EmblemHealth Commercial	$3.77
Rate for Payer: Group Health Inc Commercial	$3.77
Rate for Payer: Group Health Inc Medicare	$2.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.77
Rate for Payer: Hamaspik Choice Inc Medicare	$3.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.90

DARUNAVIR-COBICISTAT 800-150 MG PO TABS

Facility

$98.67

Service Code	NDC 5967657530
Hospital Charge Code	5967657530
Hospital Revenue Code	250
Min. Negotiated Rate	$34.53
Max. Negotiated Rate	$78.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$49.33
Rate for Payer: Aetna Government	$49.33
Rate for Payer: Brighton Health Commercial	$74.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.09
Rate for Payer: EmblemHealth Commercial	$49.33
Rate for Payer: Group Health Inc Commercial	$49.33
Rate for Payer: Group Health Inc Medicare	$34.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.33
Rate for Payer: Hamaspik Choice Inc Medicare	$49.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$64.13

DARUNAVIR-COBICISTAT 800-150 MG PO TABS

Facility

$98.67

Service Code	NDC 5967657530
Hospital Charge Code	5967657530
Hospital Revenue Code	250
Min. Negotiated Rate	$49.33
Max. Negotiated Rate	$49.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.33

DARUN-COBIC-EMTRICIT-TENOFAF 800-150-200-10 MG PO TABS

Facility

$188.68

Service Code	NDC 5967680030
Hospital Charge Code	5967680030
Hospital Revenue Code	250
Min. Negotiated Rate	$94.34
Max. Negotiated Rate	$94.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.34

DARUN-COBIC-EMTRICIT-TENOFAF 800-150-200-10 MG PO TABS

Facility

$188.68

Service Code	NDC 5967680030
Hospital Charge Code	5967680030
Hospital Revenue Code	250
Min. Negotiated Rate	$66.04
Max. Negotiated Rate	$150.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$94.34
Rate for Payer: Aetna Government	$94.34
Rate for Payer: Brighton Health Commercial	$141.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.30
Rate for Payer: EmblemHealth Commercial	$94.34
Rate for Payer: Group Health Inc Commercial	$94.34
Rate for Payer: Group Health Inc Medicare	$66.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.34
Rate for Payer: Hamaspik Choice Inc Medicare	$94.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$122.64

DAY REHABILITATION, FULL DAY

Facility

$209.88

Service Code	EAPG 00329
Min. Negotiated Rate	$192.09
Max. Negotiated Rate	$209.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$192.09
Rate for Payer: Healthfirst Commercial	$209.88

DAY REHABILITATION, HALF DAY

Facility

$157.39

Service Code	EAPG 00328
Min. Negotiated Rate	$143.49
Max. Negotiated Rate	$157.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$143.49
Rate for Payer: Healthfirst Commercial	$157.39

D&C, aspiration curettage or hysterotomy for obstetric diagnoses

Facility

$40,456.89

Service Code	APR-DRG 5441
Min. Negotiated Rate	$5,600.00
Max. Negotiated Rate	$40,456.89
Rate for Payer: Affinity Essential Plan 1&2	$40,456.89
Rate for Payer: Affinity Essential Plan 3&4	$40,456.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,980.84
Rate for Payer: Amida Care Medicaid	$17,980.84
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,456.89
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,980.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,980.84
Rate for Payer: Fidelis Qualified Health Plan	$21,577.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,980.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,980.84
Rate for Payer: Healthfirst Commercial	$9,922.00
Rate for Payer: Healthfirst Essential Plan	$40,456.89
Rate for Payer: Healthfirst QHP	$5,600.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,980.84
Rate for Payer: SOMOS Essential	$40,456.89
Rate for Payer: United Healthcare Essential Plan 1&2	$40,456.89
Rate for Payer: United Healthcare Essential Plan 3&4	$40,456.89
Rate for Payer: United Healthcare Medicaid	$17,980.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,980.84

D&C, aspiration curettage or hysterotomy for obstetric diagnoses

Facility

$51,352.33

Service Code	APR-DRG 5443
Min. Negotiated Rate	$11,067.00
Max. Negotiated Rate	$51,352.33
Rate for Payer: Affinity Essential Plan 1&2	$51,352.33
Rate for Payer: Affinity Essential Plan 3&4	$51,352.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,823.26
Rate for Payer: Amida Care Medicaid	$22,823.26
Rate for Payer: EmblemHealth Essential Plan 1&2	$51,352.33
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,823.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,823.26
Rate for Payer: Fidelis Qualified Health Plan	$27,387.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,823.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,823.26
Rate for Payer: Healthfirst Commercial	$20,413.00
Rate for Payer: Healthfirst Essential Plan	$51,352.33
Rate for Payer: Healthfirst QHP	$11,067.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,823.26
Rate for Payer: SOMOS Essential	$51,352.33
Rate for Payer: United Healthcare Essential Plan 1&2	$51,352.33
Rate for Payer: United Healthcare Essential Plan 3&4	$51,352.33
Rate for Payer: United Healthcare Medicaid	$22,823.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,823.26

D&C, aspiration curettage or hysterotomy for obstetric diagnoses

Facility

$82,503.25

Service Code	APR-DRG 5444
Min. Negotiated Rate	$30,618.00
Max. Negotiated Rate	$82,503.25
Rate for Payer: Affinity Essential Plan 1&2	$82,503.25
Rate for Payer: Affinity Essential Plan 3&4	$82,503.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$36,668.11
Rate for Payer: Amida Care Medicaid	$36,668.11
Rate for Payer: EmblemHealth Essential Plan 1&2	$82,503.25
Rate for Payer: EmblemHealth Essential Plan 3&4	$36,668.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,668.11
Rate for Payer: Fidelis Qualified Health Plan	$44,001.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,668.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,668.11
Rate for Payer: Healthfirst Commercial	$56,980.00
Rate for Payer: Healthfirst Essential Plan	$82,503.25
Rate for Payer: Healthfirst QHP	$30,618.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,668.11
Rate for Payer: SOMOS Essential	$82,503.25
Rate for Payer: United Healthcare Essential Plan 1&2	$82,503.25
Rate for Payer: United Healthcare Essential Plan 3&4	$82,503.25
Rate for Payer: United Healthcare Medicaid	$36,668.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,668.11

D&C, aspiration curettage or hysterotomy for obstetric diagnoses

Facility

$42,901.54

Service Code	APR-DRG 5442
Min. Negotiated Rate	$6,774.00
Max. Negotiated Rate	$42,901.54
Rate for Payer: Affinity Essential Plan 1&2	$42,901.54
Rate for Payer: Affinity Essential Plan 3&4	$42,901.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,067.35
Rate for Payer: Amida Care Medicaid	$19,067.35
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,901.54
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,067.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,067.35
Rate for Payer: Fidelis Qualified Health Plan	$22,880.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,067.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,067.35
Rate for Payer: Healthfirst Commercial	$12,259.00
Rate for Payer: Healthfirst Essential Plan	$42,901.54
Rate for Payer: Healthfirst QHP	$6,774.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,067.35
Rate for Payer: SOMOS Essential	$42,901.54
Rate for Payer: United Healthcare Essential Plan 1&2	$42,901.54
Rate for Payer: United Healthcare Essential Plan 3&4	$42,901.54
Rate for Payer: United Healthcare Medicaid	$19,067.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,067.35

DECITABINE 50 MG IV SOLR

Facility

$1.00

Service Code	HCPCS J0894
Hospital Charge Code	1672922405
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

DECITABINE 50 MG IV SOLR

Facility

$120.00

Service Code	HCPCS J0894
Hospital Charge Code	7128811920
Hospital Revenue Code	258
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00

DECITABINE 50 MG IV SOLR

Facility

$120.00

Service Code	HCPCS J0894
Hospital Charge Code	0143938501
Hospital Revenue Code	258
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$96.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.43
Rate for Payer: Aetna Government	$3.43
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.60
Rate for Payer: EmblemHealth Commercial	$60.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

DECITABINE 50 MG IV SOLR

Facility

$120.00

Service Code	HCPCS J0894
Hospital Charge Code	7128811920
Hospital Revenue Code	258
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$96.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.43
Rate for Payer: Aetna Government	$3.43
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.60
Rate for Payer: EmblemHealth Commercial	$60.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

DECITABINE 50 MG IV SOLR

Facility

$120.00

Service Code	HCPCS J0894
Hospital Charge Code	0143938501
Hospital Revenue Code	258
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00

DECITABINE 50 MG IV SOLR

Facility

$1.00

Service Code	HCPCS J0894
Hospital Charge Code	1672922405
Hospital Revenue Code	258
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$3.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.43
Rate for Payer: Aetna Government	$3.43
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: EmblemHealth Commercial	$0.50
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

DECITABINE 50 MG SUBCUTANEOUS SOLUTION

Facility

$120.00

Service Code	HCPCS J0894
Hospital Charge Code	0143938501
Hospital Revenue Code	250
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$96.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.43
Rate for Payer: Aetna Government	$3.43
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.60
Rate for Payer: EmblemHealth Commercial	$60.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

DECITABINE 50 MG SUBCUTANEOUS SOLUTION

Facility

$120.00

Service Code	HCPCS J0894
Hospital Charge Code	0143938501
Hospital Revenue Code	250
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00

Know your out-of-pocket cost for care.

All Charges