St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$95,818.70

Service Code	APR-DRG 1104
Min. Negotiated Rate	$32,763.00
Max. Negotiated Rate	$95,818.70
Rate for Payer: Affinity Essential Plan 1&2	$95,818.70
Rate for Payer: Affinity Essential Plan 3&4	$95,818.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$42,586.09
Rate for Payer: Amida Care Medicaid	$42,586.09
Rate for Payer: EmblemHealth Essential Plan 1&2	$95,818.70
Rate for Payer: EmblemHealth Essential Plan 3&4	$42,586.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,586.09
Rate for Payer: Fidelis Qualified Health Plan	$51,103.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,586.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,586.09
Rate for Payer: Healthfirst Commercial	$54,791.00
Rate for Payer: Healthfirst Essential Plan	$95,818.70
Rate for Payer: Healthfirst QHP	$32,763.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,586.09
Rate for Payer: SOMOS Essential	$95,818.70
Rate for Payer: United Healthcare Essential Plan 1&2	$95,818.70
Rate for Payer: United Healthcare Essential Plan 3&4	$95,818.70
Rate for Payer: United Healthcare Medicaid	$42,586.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,586.09

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

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

Facility

$47,889.36

Service Code	APR-DRG 1102
Min. Negotiated Rate	$9,645.00
Max. Negotiated Rate	$47,889.36
Rate for Payer: Affinity Essential Plan 1&2	$47,889.36
Rate for Payer: Affinity Essential Plan 3&4	$47,889.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,284.16
Rate for Payer: Amida Care Medicaid	$21,284.16
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,889.36
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,284.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,284.16
Rate for Payer: Fidelis Qualified Health Plan	$25,540.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,284.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,284.16
Rate for Payer: Healthfirst Commercial	$18,019.00
Rate for Payer: Healthfirst Essential Plan	$47,889.36
Rate for Payer: Healthfirst QHP	$9,645.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,284.16
Rate for Payer: SOMOS Essential	$47,889.36
Rate for Payer: United Healthcare Essential Plan 1&2	$47,889.36
Rate for Payer: United Healthcare Essential Plan 3&4	$47,889.36
Rate for Payer: United Healthcare Medicaid	$21,284.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,284.16

Eating disorders

Facility

$15,447.00

Service Code	APR-DRG 7592
Min. Negotiated Rate	$3,259.83
Max. Negotiated Rate	$15,447.00
Rate for Payer: Affinity Essential Plan 1&2	$3,259.83
Rate for Payer: Affinity Essential Plan 3&4	$3,259.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,259.83
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,259.83
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,334.62
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,259.83
Rate for Payer: Fidelis Qualified Health Plan	$3,911.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,259.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,259.83
Rate for Payer: Healthfirst Commercial	$15,447.00
Rate for Payer: Healthfirst Essential Plan	$7,334.62
Rate for Payer: Healthfirst QHP	$5,932.89
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,259.83
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,334.62
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,334.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,259.83
Rate for Payer: SOMOS Essential	$7,334.62
Rate for Payer: United Healthcare Essential Plan 1&2	$7,334.62
Rate for Payer: United Healthcare Essential Plan 3&4	$7,334.62
Rate for Payer: United Healthcare Medicaid	$3,259.83

Eating disorders

Facility

$15,447.00

Service Code	APR-DRG 7591
Min. Negotiated Rate	$3,191.80
Max. Negotiated Rate	$15,447.00
Rate for Payer: Affinity Essential Plan 1&2	$3,191.80
Rate for Payer: Affinity Essential Plan 3&4	$3,191.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,191.80
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,191.80
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,181.55
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,191.80
Rate for Payer: Fidelis Qualified Health Plan	$3,830.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,191.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,191.80
Rate for Payer: Healthfirst Commercial	$15,447.00
Rate for Payer: Healthfirst Essential Plan	$7,181.55
Rate for Payer: Healthfirst QHP	$5,809.08
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,191.80
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,181.55
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,181.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,191.80
Rate for Payer: SOMOS Essential	$7,181.55
Rate for Payer: United Healthcare Essential Plan 1&2	$7,181.55
Rate for Payer: United Healthcare Essential Plan 3&4	$7,181.55
Rate for Payer: United Healthcare Medicaid	$3,191.80

Eating disorders

Facility

$15,447.00

Service Code	APR-DRG 7594
Min. Negotiated Rate	$3,259.83
Max. Negotiated Rate	$15,447.00
Rate for Payer: Affinity Essential Plan 1&2	$3,259.83
Rate for Payer: Affinity Essential Plan 3&4	$3,259.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,259.83
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,259.83
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,334.62
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,259.83
Rate for Payer: Fidelis Qualified Health Plan	$3,911.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,259.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,259.83
Rate for Payer: Healthfirst Commercial	$15,447.00
Rate for Payer: Healthfirst Essential Plan	$7,334.62
Rate for Payer: Healthfirst QHP	$5,932.89
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,259.83
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,334.62
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,334.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,259.83
Rate for Payer: SOMOS Essential	$7,334.62
Rate for Payer: United Healthcare Essential Plan 1&2	$7,334.62
Rate for Payer: United Healthcare Essential Plan 3&4	$7,334.62
Rate for Payer: United Healthcare Medicaid	$3,259.83

Eating disorders

Facility

$15,447.00

Service Code	APR-DRG 7593
Min. Negotiated Rate	$3,259.83
Max. Negotiated Rate	$15,447.00
Rate for Payer: Affinity Essential Plan 1&2	$3,259.83
Rate for Payer: Affinity Essential Plan 3&4	$3,259.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,259.83
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,259.83
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,334.62
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,259.83
Rate for Payer: Fidelis Qualified Health Plan	$3,911.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,259.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,259.83
Rate for Payer: Healthfirst Commercial	$15,447.00
Rate for Payer: Healthfirst Essential Plan	$7,334.62
Rate for Payer: Healthfirst QHP	$5,932.89
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,259.83
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,334.62
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,334.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,259.83
Rate for Payer: SOMOS Essential	$7,334.62
Rate for Payer: United Healthcare Essential Plan 1&2	$7,334.62
Rate for Payer: United Healthcare Essential Plan 3&4	$7,334.62
Rate for Payer: United Healthcare Medicaid	$3,259.83

EATING DISORDERS

Facility

$211.05

Service Code	EAPG 00830
Min. Negotiated Rate	$152.74
Max. Negotiated Rate	$211.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.74
Rate for Payer: Healthfirst Commercial	$211.05

ECHOCARDIOGRAPHY

Facility

$563.88

Service Code	EAPG 00081
Min. Negotiated Rate	$409.63
Max. Negotiated Rate	$563.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$409.63
Rate for Payer: Healthfirst Commercial	$563.88

Ectopic pregnancy procedure

Facility

$44,241.71

Service Code	APR-DRG 5451
Min. Negotiated Rate	$7,970.00
Max. Negotiated Rate	$44,241.71
Rate for Payer: Affinity Essential Plan 1&2	$44,241.71
Rate for Payer: Affinity Essential Plan 3&4	$44,241.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,662.98
Rate for Payer: Amida Care Medicaid	$19,662.98
Rate for Payer: EmblemHealth Essential Plan 1&2	$44,241.71
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,662.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,662.98
Rate for Payer: Fidelis Qualified Health Plan	$23,595.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,662.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,662.98
Rate for Payer: Healthfirst Commercial	$13,541.00
Rate for Payer: Healthfirst Essential Plan	$44,241.71
Rate for Payer: Healthfirst QHP	$7,970.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,662.98
Rate for Payer: SOMOS Essential	$44,241.71
Rate for Payer: United Healthcare Essential Plan 1&2	$44,241.71
Rate for Payer: United Healthcare Essential Plan 3&4	$44,241.71
Rate for Payer: United Healthcare Medicaid	$19,662.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,662.98

Ectopic pregnancy procedure

Facility

$45,822.82

Service Code	APR-DRG 5452
Min. Negotiated Rate	$9,267.00
Max. Negotiated Rate	$45,822.82
Rate for Payer: Affinity Essential Plan 1&2	$45,822.82
Rate for Payer: Affinity Essential Plan 3&4	$45,822.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,365.70
Rate for Payer: Amida Care Medicaid	$20,365.70
Rate for Payer: EmblemHealth Essential Plan 1&2	$45,822.82
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,365.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,365.70
Rate for Payer: Fidelis Qualified Health Plan	$24,438.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,365.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,365.70
Rate for Payer: Healthfirst Commercial	$15,310.00
Rate for Payer: Healthfirst Essential Plan	$45,822.82
Rate for Payer: Healthfirst QHP	$9,267.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,365.70
Rate for Payer: SOMOS Essential	$45,822.82
Rate for Payer: United Healthcare Essential Plan 1&2	$45,822.82
Rate for Payer: United Healthcare Essential Plan 3&4	$45,822.82
Rate for Payer: United Healthcare Medicaid	$20,365.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,365.70

Ectopic pregnancy procedure

Facility

$51,385.75

Service Code	APR-DRG 5453
Min. Negotiated Rate	$11,653.00
Max. Negotiated Rate	$51,385.75
Rate for Payer: Affinity Essential Plan 1&2	$51,385.75
Rate for Payer: Affinity Essential Plan 3&4	$51,385.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,838.11
Rate for Payer: Amida Care Medicaid	$22,838.11
Rate for Payer: EmblemHealth Essential Plan 1&2	$51,385.75
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,838.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,838.11
Rate for Payer: Fidelis Qualified Health Plan	$27,405.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,838.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,838.11
Rate for Payer: Healthfirst Commercial	$20,863.00
Rate for Payer: Healthfirst Essential Plan	$51,385.75
Rate for Payer: Healthfirst QHP	$11,653.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,838.11
Rate for Payer: SOMOS Essential	$51,385.75
Rate for Payer: United Healthcare Essential Plan 1&2	$51,385.75
Rate for Payer: United Healthcare Essential Plan 3&4	$51,385.75
Rate for Payer: United Healthcare Medicaid	$22,838.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,838.11

Ectopic pregnancy procedure

Facility

$52,683.71

Service Code	APR-DRG 5454
Min. Negotiated Rate	$12,982.00
Max. Negotiated Rate	$52,683.71
Rate for Payer: Affinity Essential Plan 1&2	$52,683.71
Rate for Payer: Affinity Essential Plan 3&4	$52,683.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,414.98
Rate for Payer: Amida Care Medicaid	$23,414.98
Rate for Payer: EmblemHealth Essential Plan 1&2	$52,683.71
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,414.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,414.98
Rate for Payer: Fidelis Qualified Health Plan	$28,097.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,414.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,414.98
Rate for Payer: Healthfirst Commercial	$22,878.00
Rate for Payer: Healthfirst Essential Plan	$52,683.71
Rate for Payer: Healthfirst QHP	$12,982.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,414.98
Rate for Payer: SOMOS Essential	$52,683.71
Rate for Payer: United Healthcare Essential Plan 1&2	$52,683.71
Rate for Payer: United Healthcare Essential Plan 3&4	$52,683.71
Rate for Payer: United Healthcare Medicaid	$23,414.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,414.98

ECTOPIC PREGNANCY PROCEDURES

Facility

$2,034.27

Service Code	EAPG 00179
Min. Negotiated Rate	$2,034.27
Max. Negotiated Rate	$2,034.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,034.27

ECULIZUMAB 300 MG/30ML IV SOLN

Facility

$260.92

Service Code	HCPCS J1300
Hospital Charge Code	2568200101
Hospital Revenue Code	258
Min. Negotiated Rate	$91.32
Max. Negotiated Rate	$229.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$143.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$229.23
Rate for Payer: Aetna Government	$229.23
Rate for Payer: Brighton Health Commercial	$195.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$177.43
Rate for Payer: EmblemHealth Commercial	$130.46
Rate for Payer: Group Health Inc Commercial	$130.46
Rate for Payer: Group Health Inc Medicare	$91.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.46
Rate for Payer: Hamaspik Choice Inc Medicare	$130.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$169.60

ECULIZUMAB 300 MG/30ML IV SOLN

Facility

$260.92

Service Code	HCPCS J1300
Hospital Charge Code	2568200101
Hospital Revenue Code	258
Min. Negotiated Rate	$130.46
Max. Negotiated Rate	$130.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.46

EFAVIRENZ 200 MG PO CAPS

Facility

$11.77

Service Code	NDC 6498040709
Hospital Charge Code	6498040709
Hospital Revenue Code	250
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$9.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.88
Rate for Payer: Aetna Government	$5.88
Rate for Payer: Brighton Health Commercial	$8.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.00
Rate for Payer: EmblemHealth Commercial	$5.88
Rate for Payer: Group Health Inc Commercial	$5.88
Rate for Payer: Group Health Inc Medicare	$4.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.88
Rate for Payer: Hamaspik Choice Inc Medicare	$5.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.65

EFAVIRENZ 200 MG PO CAPS

Facility

$11.77

Service Code	NDC 6498040709
Hospital Charge Code	6498040709
Hospital Revenue Code	250
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$5.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.88

EFAVIRENZ 50 MG PO CAPS

Facility

$3.27

Service Code	NDC 0056047030
Hospital Charge Code	0056047030
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.64
Rate for Payer: Aetna Government	$1.64
Rate for Payer: Brighton Health Commercial	$2.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.22
Rate for Payer: EmblemHealth Commercial	$1.64
Rate for Payer: Group Health Inc Commercial	$1.64
Rate for Payer: Group Health Inc Medicare	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.64
Rate for Payer: Hamaspik Choice Inc Medicare	$1.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.13

EFAVIRENZ 50 MG PO CAPS

Facility

$2.94

Service Code	NDC 6498040603
Hospital Charge Code	6498040603
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.47
Rate for Payer: Aetna Government	$1.47
Rate for Payer: Brighton Health Commercial	$2.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.00
Rate for Payer: EmblemHealth Commercial	$1.47
Rate for Payer: Group Health Inc Commercial	$1.47
Rate for Payer: Group Health Inc Medicare	$1.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.47
Rate for Payer: Hamaspik Choice Inc Medicare	$1.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.91

EFAVIRENZ 50 MG PO CAPS

Facility

$2.94

Service Code	NDC 6498040603
Hospital Charge Code	6498040603
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.47

EFAVIRENZ 50 MG PO CAPS

Facility

$3.27

Service Code	NDC 0056047030
Hospital Charge Code	0056047030
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.64

EFAVIRENZ 600 MG PO TABS

Facility

$35.77

Service Code	NDC 6909730102
Hospital Charge Code	6909730102
Hospital Revenue Code	250
Min. Negotiated Rate	$12.52
Max. Negotiated Rate	$28.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.89
Rate for Payer: Aetna Government	$17.89
Rate for Payer: Brighton Health Commercial	$26.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.33
Rate for Payer: EmblemHealth Commercial	$17.89
Rate for Payer: Group Health Inc Commercial	$17.89
Rate for Payer: Group Health Inc Medicare	$12.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.89
Rate for Payer: Hamaspik Choice Inc Medicare	$17.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.25

EFAVIRENZ 600 MG PO TABS

Facility

$37.26

Service Code	NDC 3172250430
Hospital Charge Code	3172250430
Hospital Revenue Code	250
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$29.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.63
Rate for Payer: Aetna Government	$18.63
Rate for Payer: Brighton Health Commercial	$27.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.34
Rate for Payer: EmblemHealth Commercial	$18.63
Rate for Payer: Group Health Inc Commercial	$18.63
Rate for Payer: Group Health Inc Medicare	$13.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.63
Rate for Payer: Hamaspik Choice Inc Medicare	$18.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.22

EFAVIRENZ 600 MG PO TABS

Facility

$37.26

Service Code	NDC 3172250430
Hospital Charge Code	3172250430
Hospital Revenue Code	250
Min. Negotiated Rate	$18.63
Max. Negotiated Rate	$18.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.63

Know your out-of-pocket cost for care.

All Charges