St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DULOXETINE HCL 30 MG PO CPEP

Facility

$7.85

Service Code	NDC 6818029509
Hospital Charge Code	6818029509
Hospital Revenue Code	250
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$3.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93

DULOXETINE HCL 30 MG PO CPEP

Facility

$1.72

Service Code	NDC 0904704461
Hospital Charge Code	0904704461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.86
Rate for Payer: Aetna Government	$0.86
Rate for Payer: Brighton Health Commercial	$1.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.17
Rate for Payer: EmblemHealth Commercial	$0.86
Rate for Payer: Group Health Inc Commercial	$0.86
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.12

DULOXETINE HCL 30 MG PO CPEP

Facility

$7.84

Service Code	NDC 4354738003
Hospital Charge Code	4354738003
Hospital Revenue Code	250
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$3.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.92

DULOXETINE HCL 60 MG PO CPEP

Facility

$7.85

Service Code	NDC 5723701930
Hospital Charge Code	5723701930
Hospital Revenue Code	250
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$3.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93

DULOXETINE HCL 60 MG PO CPEP

Facility

$7.70

Service Code	NDC 6808469201
Hospital Charge Code	6808469201
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$6.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.85
Rate for Payer: Aetna Government	$3.85
Rate for Payer: Brighton Health Commercial	$5.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.24
Rate for Payer: EmblemHealth Commercial	$3.85
Rate for Payer: Group Health Inc Commercial	$3.85
Rate for Payer: Group Health Inc Medicare	$2.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.85
Rate for Payer: Hamaspik Choice Inc Medicare	$3.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.00

DULOXETINE HCL 60 MG PO CPEP

Facility

$7.70

Service Code	NDC 6808469201
Hospital Charge Code	6808469201
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.85

DULOXETINE HCL 60 MG PO CPEP

Facility

$7.85

Service Code	NDC 6818029606
Hospital Charge Code	6818029606
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$6.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.93
Rate for Payer: Aetna Government	$3.93
Rate for Payer: Brighton Health Commercial	$5.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.34
Rate for Payer: EmblemHealth Commercial	$3.93
Rate for Payer: Group Health Inc Commercial	$3.93
Rate for Payer: Group Health Inc Medicare	$2.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93
Rate for Payer: Hamaspik Choice Inc Medicare	$3.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.10

DULOXETINE HCL 60 MG PO CPEP

Facility

$7.85

Service Code	NDC 6818029606
Hospital Charge Code	6818029606
Hospital Revenue Code	250
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$3.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93

DULOXETINE HCL 60 MG PO CPEP

Facility

$7.84

Service Code	NDC 4354738103
Hospital Charge Code	4354738103
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$6.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.92
Rate for Payer: Aetna Government	$3.92
Rate for Payer: Brighton Health Commercial	$5.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.33
Rate for Payer: EmblemHealth Commercial	$3.92
Rate for Payer: Group Health Inc Commercial	$3.92
Rate for Payer: Group Health Inc Medicare	$2.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.92
Rate for Payer: Hamaspik Choice Inc Medicare	$3.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.10

DULOXETINE HCL 60 MG PO CPEP

Facility

$7.84

Service Code	NDC 4354738103
Hospital Charge Code	4354738103
Hospital Revenue Code	250
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$3.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.92

DULOXETINE HCL 60 MG PO CPEP

Facility

$7.85

Service Code	NDC 5723701930
Hospital Charge Code	5723701930
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$6.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.93
Rate for Payer: Aetna Government	$3.93
Rate for Payer: Brighton Health Commercial	$5.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.34
Rate for Payer: EmblemHealth Commercial	$3.93
Rate for Payer: Group Health Inc Commercial	$3.93
Rate for Payer: Group Health Inc Medicare	$2.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93
Rate for Payer: Hamaspik Choice Inc Medicare	$3.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.10

DUPILUMAB 200 MG/1.14ML SC SOAJ

Facility

$2.00

Service Code	NDC 0024591902
Hospital Charge Code	0024591902
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

DUPILUMAB 200 MG/1.14ML SC SOAJ

Facility

$2.00

Service Code	NDC 0024591902
Hospital Charge Code	0024591902
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: EmblemHealth Commercial	$1.00
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

DUPILUMAB 200 MG/1.14ML SC SOSY

Facility

$2.00

Service Code	NDC 0024591801
Hospital Charge Code	0024591801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: EmblemHealth Commercial	$1.00
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

DUPILUMAB 200 MG/1.14ML SC SOSY

Facility

$2.00

Service Code	NDC 0024591801
Hospital Charge Code	0024591801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

DUPILUMAB 300 MG/2ML SC SOAJ

Facility

$0.01

Service Code	NDC 0024591502
Hospital Charge Code	0024591502
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

DUPILUMAB 300 MG/2ML SC SOAJ

Facility

$0.01

Service Code	NDC 0024591502
Hospital Charge Code	0024591502
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

DUPILUMAB 300 MG/2ML SC SOSY

Facility

$0.01

Service Code	NDC 0024591401
Hospital Charge Code	0024591401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

DUPILUMAB 300 MG/2ML SC SOSY

Facility

$0.01

Service Code	NDC 0024591401
Hospital Charge Code	0024591401
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

DURVALUMAB 120 MG/2.4ML IV SOLN

Facility

$483.27

Service Code	HCPCS J9173
Hospital Charge Code	0310450012
Hospital Revenue Code	258
Min. Negotiated Rate	$59.58
Max. Negotiated Rate	$386.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$265.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$85.12
Rate for Payer: Aetna Government	$85.12
Rate for Payer: Affinity Essential Plan 1&2	$59.58
Rate for Payer: Affinity Essential Plan 3&4	$59.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$59.58
Rate for Payer: Brighton Health Commercial	$362.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$85.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$386.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$328.62
Rate for Payer: Elderplan Medicare Advantage	$85.12
Rate for Payer: EmblemHealth Commercial	$85.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$76.61
Rate for Payer: Fidelis Essential Plan Aliesa	$72.35
Rate for Payer: Fidelis Essential Plan QHP	$75.76
Rate for Payer: Fidelis Medicare Advantage	$85.12
Rate for Payer: Fidelis Qualified Health Plan	$75.76
Rate for Payer: Group Health Inc Commercial	$85.12
Rate for Payer: Group Health Inc Medicare	$85.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.12
Rate for Payer: Hamaspik Choice Inc Medicare	$85.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$85.12
Rate for Payer: Healthfirst Medicare Advantage	$72.35
Rate for Payer: Healthfirst QHP	$85.12
Rate for Payer: Humana Medicare	$86.82
Rate for Payer: Senior Whole Health Medicare Advantage	$85.12
Rate for Payer: United Healthcare Medicare Advantage	$85.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$314.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$80.86
Rate for Payer: Wellcare Medicare	$80.86

DURVALUMAB 120 MG/2.4ML IV SOLN

Facility

$483.27

Service Code	HCPCS J9173
Hospital Charge Code	0310450012
Hospital Revenue Code	258
Min. Negotiated Rate	$241.63
Max. Negotiated Rate	$241.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$241.63

DURVALUMAB 500 MG/10ML IV SOLN

Facility

$483.27

Service Code	HCPCS J9173
Hospital Charge Code	0310461150
Hospital Revenue Code	258
Min. Negotiated Rate	$59.58
Max. Negotiated Rate	$386.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$265.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$85.12
Rate for Payer: Aetna Government	$85.12
Rate for Payer: Affinity Essential Plan 1&2	$59.58
Rate for Payer: Affinity Essential Plan 3&4	$59.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$59.58
Rate for Payer: Brighton Health Commercial	$362.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$85.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$386.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$328.62
Rate for Payer: Elderplan Medicare Advantage	$85.12
Rate for Payer: EmblemHealth Commercial	$85.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$76.61
Rate for Payer: Fidelis Essential Plan Aliesa	$72.35
Rate for Payer: Fidelis Essential Plan QHP	$75.76
Rate for Payer: Fidelis Medicare Advantage	$85.12
Rate for Payer: Fidelis Qualified Health Plan	$75.76
Rate for Payer: Group Health Inc Commercial	$85.12
Rate for Payer: Group Health Inc Medicare	$85.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.12
Rate for Payer: Hamaspik Choice Inc Medicare	$85.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$85.12
Rate for Payer: Healthfirst Medicare Advantage	$72.35
Rate for Payer: Healthfirst QHP	$85.12
Rate for Payer: Humana Medicare	$86.82
Rate for Payer: Senior Whole Health Medicare Advantage	$85.12
Rate for Payer: United Healthcare Medicare Advantage	$85.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$314.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$80.86
Rate for Payer: Wellcare Medicare	$80.86

DURVALUMAB 500 MG/10ML IV SOLN

Facility

$483.27

Service Code	HCPCS J9173
Hospital Charge Code	0310461150
Hospital Revenue Code	258
Min. Negotiated Rate	$241.63
Max. Negotiated Rate	$241.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$241.63

EAR, NOSE, MOUTH, THROAT, CRANIAL AND FACIAL MALIGNANCIES

Facility

$239.54

Service Code	EAPG 00560
Min. Negotiated Rate	$173.57
Max. Negotiated Rate	$239.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$173.57
Rate for Payer: Healthfirst Commercial	$239.54

Ear, nose, mouth, throat, cranial/facial malignancies

Facility

$44,630.39

Service Code	APR-DRG 1101
Min. Negotiated Rate	$6,768.00
Max. Negotiated Rate	$44,630.39
Rate for Payer: Affinity Essential Plan 1&2	$44,630.39
Rate for Payer: Affinity Essential Plan 3&4	$44,630.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,835.73
Rate for Payer: Amida Care Medicaid	$19,835.73
Rate for Payer: EmblemHealth Essential Plan 1&2	$44,630.39
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,835.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,835.73
Rate for Payer: Fidelis Qualified Health Plan	$23,802.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,835.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,835.73
Rate for Payer: Healthfirst Commercial	$13,306.00
Rate for Payer: Healthfirst Essential Plan	$44,630.39
Rate for Payer: Healthfirst QHP	$6,768.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,835.73
Rate for Payer: SOMOS Essential	$44,630.39
Rate for Payer: United Healthcare Essential Plan 1&2	$44,630.39
Rate for Payer: United Healthcare Essential Plan 3&4	$44,630.39
Rate for Payer: United Healthcare Medicaid	$19,835.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,835.73

Know your out-of-pocket cost for care.

All Charges