St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

EFAVIRENZ 600 MG PO TABS

Facility

$35.77

Service Code	NDC 6909730102
Hospital Charge Code	6909730102
Hospital Revenue Code	250
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.89

EFAVIRENZ 600 MG PO TABS

Facility

$37.26

Service Code	NDC 6438088904
Hospital Charge Code	6438088904
Hospital Revenue Code	250
Min. Negotiated Rate	$18.63
Max. Negotiated Rate	$18.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.63

EFAVIRENZ 600 MG PO TABS

Facility

$37.26

Service Code	NDC 6438088904
Hospital Charge Code	6438088904
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-EMTRICITAB-TENOFO DF 600-200-300 MG PO TABS

Facility

$113.80

Service Code	NDC 6909721002
Hospital Charge Code	6909721002
Hospital Revenue Code	250
Min. Negotiated Rate	$39.83
Max. Negotiated Rate	$91.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.90
Rate for Payer: Aetna Government	$56.90
Rate for Payer: Brighton Health Commercial	$85.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$91.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.38
Rate for Payer: EmblemHealth Commercial	$56.90
Rate for Payer: Group Health Inc Commercial	$56.90
Rate for Payer: Group Health Inc Medicare	$39.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.90
Rate for Payer: Hamaspik Choice Inc Medicare	$56.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.97

EFAVIRENZ-EMTRICITAB-TENOFO DF 600-200-300 MG PO TABS

Facility

$113.80

Service Code	NDC 0093523456
Hospital Charge Code	0093523456
Hospital Revenue Code	250
Min. Negotiated Rate	$39.83
Max. Negotiated Rate	$91.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.90
Rate for Payer: Aetna Government	$56.90
Rate for Payer: Brighton Health Commercial	$85.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$91.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.38
Rate for Payer: EmblemHealth Commercial	$56.90
Rate for Payer: Group Health Inc Commercial	$56.90
Rate for Payer: Group Health Inc Medicare	$39.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.90
Rate for Payer: Hamaspik Choice Inc Medicare	$56.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.97

EFAVIRENZ-EMTRICITAB-TENOFO DF 600-200-300 MG PO TABS

Facility

$113.80

Service Code	NDC 6909721002
Hospital Charge Code	6909721002
Hospital Revenue Code	250
Min. Negotiated Rate	$56.90
Max. Negotiated Rate	$56.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.90

EFAVIRENZ-EMTRICITAB-TENOFO DF 600-200-300 MG PO TABS

Facility

$113.80

Service Code	NDC 6586249730
Hospital Charge Code	6586249730
Hospital Revenue Code	250
Min. Negotiated Rate	$39.83
Max. Negotiated Rate	$91.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.90
Rate for Payer: Aetna Government	$56.90
Rate for Payer: Brighton Health Commercial	$85.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$91.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.38
Rate for Payer: EmblemHealth Commercial	$56.90
Rate for Payer: Group Health Inc Commercial	$56.90
Rate for Payer: Group Health Inc Medicare	$39.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.90
Rate for Payer: Hamaspik Choice Inc Medicare	$56.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.97

EFAVIRENZ-EMTRICITAB-TENOFO DF 600-200-300 MG PO TABS

Facility

$113.80

Service Code	NDC 3172273630
Hospital Charge Code	3172273630
Hospital Revenue Code	250
Min. Negotiated Rate	$56.90
Max. Negotiated Rate	$56.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.90

EFAVIRENZ-EMTRICITAB-TENOFO DF 600-200-300 MG PO TABS

Facility

$113.80

Service Code	NDC 6586249730
Hospital Charge Code	6586249730
Hospital Revenue Code	250
Min. Negotiated Rate	$56.90
Max. Negotiated Rate	$56.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.90

EFAVIRENZ-EMTRICITAB-TENOFO DF 600-200-300 MG PO TABS

Facility

$113.80

Service Code	NDC 3172273630
Hospital Charge Code	3172273630
Hospital Revenue Code	250
Min. Negotiated Rate	$39.83
Max. Negotiated Rate	$91.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.90
Rate for Payer: Aetna Government	$56.90
Rate for Payer: Brighton Health Commercial	$85.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$91.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.38
Rate for Payer: EmblemHealth Commercial	$56.90
Rate for Payer: Group Health Inc Commercial	$56.90
Rate for Payer: Group Health Inc Medicare	$39.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.90
Rate for Payer: Hamaspik Choice Inc Medicare	$56.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.97

EFAVIRENZ-EMTRICITAB-TENOFO DF 600-200-300 MG PO TABS

Facility

$113.80

Service Code	NDC 0093523456
Hospital Charge Code	0093523456
Hospital Revenue Code	250
Min. Negotiated Rate	$56.90
Max. Negotiated Rate	$56.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.90

ELECTROCONVULSIVE THERAPY

Facility

$669.12

Service Code	EAPG 00212
Min. Negotiated Rate	$486.00
Max. Negotiated Rate	$669.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$486.00
Rate for Payer: Healthfirst Commercial	$669.12

ELECTROENCEPHALOGRAM

Facility

$309.70

Service Code	EAPG 00211
Min. Negotiated Rate	$224.49
Max. Negotiated Rate	$309.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$224.49
Rate for Payer: Healthfirst Commercial	$309.70

ELECTROLYTE DISORDERS

Facility

$234.07

Service Code	EAPG 00694
Min. Negotiated Rate	$168.94
Max. Negotiated Rate	$234.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$168.94
Rate for Payer: Healthfirst Commercial	$234.07

Electrolyte disorders except hypovolemia related

Facility

$49,575.98

Service Code	APR-DRG 4253
Min. Negotiated Rate	$9,743.00
Max. Negotiated Rate	$49,575.98
Rate for Payer: Affinity Essential Plan 1&2	$49,575.98
Rate for Payer: Affinity Essential Plan 3&4	$49,575.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,033.77
Rate for Payer: Amida Care Medicaid	$22,033.77
Rate for Payer: EmblemHealth Essential Plan 1&2	$49,575.98
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,033.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,033.77
Rate for Payer: Fidelis Qualified Health Plan	$26,440.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,033.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,033.77
Rate for Payer: Healthfirst Commercial	$18,182.00
Rate for Payer: Healthfirst Essential Plan	$49,575.98
Rate for Payer: Healthfirst QHP	$9,743.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,033.77
Rate for Payer: SOMOS Essential	$49,575.98
Rate for Payer: United Healthcare Essential Plan 1&2	$49,575.98
Rate for Payer: United Healthcare Essential Plan 3&4	$49,575.98
Rate for Payer: United Healthcare Medicaid	$22,033.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,033.77

Electrolyte disorders except hypovolemia related

Facility

$75,827.05

Service Code	APR-DRG 4254
Min. Negotiated Rate	$20,800.00
Max. Negotiated Rate	$75,827.05
Rate for Payer: Affinity Essential Plan 1&2	$75,827.05
Rate for Payer: Affinity Essential Plan 3&4	$75,827.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,700.91
Rate for Payer: Amida Care Medicaid	$33,700.91
Rate for Payer: EmblemHealth Essential Plan 1&2	$75,827.05
Rate for Payer: EmblemHealth Essential Plan 3&4	$33,700.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,700.91
Rate for Payer: Fidelis Qualified Health Plan	$40,441.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,700.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,700.91
Rate for Payer: Healthfirst Commercial	$42,893.00
Rate for Payer: Healthfirst Essential Plan	$75,827.05
Rate for Payer: Healthfirst QHP	$20,800.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,700.91
Rate for Payer: SOMOS Essential	$75,827.05
Rate for Payer: United Healthcare Essential Plan 1&2	$75,827.05
Rate for Payer: United Healthcare Essential Plan 3&4	$75,827.05
Rate for Payer: United Healthcare Medicaid	$33,700.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,700.91

Electrolyte disorders except hypovolemia related

Facility

$39,593.34

Service Code	APR-DRG 4251
Min. Negotiated Rate	$5,231.00
Max. Negotiated Rate	$39,593.34
Rate for Payer: Affinity Essential Plan 1&2	$39,593.34
Rate for Payer: Affinity Essential Plan 3&4	$39,593.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,597.04
Rate for Payer: Amida Care Medicaid	$17,597.04
Rate for Payer: EmblemHealth Essential Plan 1&2	$39,593.34
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,597.04
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,597.04
Rate for Payer: Fidelis Qualified Health Plan	$21,116.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,597.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,597.04
Rate for Payer: Healthfirst Commercial	$9,119.00
Rate for Payer: Healthfirst Essential Plan	$39,593.34
Rate for Payer: Healthfirst QHP	$5,231.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,597.04
Rate for Payer: SOMOS Essential	$39,593.34
Rate for Payer: United Healthcare Essential Plan 1&2	$39,593.34
Rate for Payer: United Healthcare Essential Plan 3&4	$39,593.34
Rate for Payer: United Healthcare Medicaid	$17,597.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,597.04

Electrolyte disorders except hypovolemia related

Facility

$42,583.21

Service Code	APR-DRG 4252
Min. Negotiated Rate	$6,776.00
Max. Negotiated Rate	$42,583.21
Rate for Payer: Affinity Essential Plan 1&2	$42,583.21
Rate for Payer: Affinity Essential Plan 3&4	$42,583.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,925.87
Rate for Payer: Amida Care Medicaid	$18,925.87
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,583.21
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,925.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,925.87
Rate for Payer: Fidelis Qualified Health Plan	$22,711.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,925.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,925.87
Rate for Payer: Healthfirst Commercial	$11,746.00
Rate for Payer: Healthfirst Essential Plan	$42,583.21
Rate for Payer: Healthfirst QHP	$6,776.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,925.87
Rate for Payer: SOMOS Essential	$42,583.21
Rate for Payer: United Healthcare Essential Plan 1&2	$42,583.21
Rate for Payer: United Healthcare Essential Plan 3&4	$42,583.21
Rate for Payer: United Healthcare Medicaid	$18,925.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,925.87

ELECTRONIC ANALYSIS FOR PACEMAKERS AND OTHER DEVICES

Facility

$144.87

Service Code	EAPG 00420
Min. Negotiated Rate	$104.14
Max. Negotiated Rate	$144.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$104.14
Rate for Payer: Healthfirst Commercial	$144.87

ELETRIPTAN HYDROBROMIDE 40 MG PO TABS

Facility

$61.46

Service Code	NDC 2724104011
Hospital Charge Code	2724104011
Hospital Revenue Code	250
Min. Negotiated Rate	$30.73
Max. Negotiated Rate	$30.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.73

ELETRIPTAN HYDROBROMIDE 40 MG PO TABS

Facility

$61.39

Service Code	NDC 0378428808
Hospital Charge Code	0378428808
Hospital Revenue Code	250
Min. Negotiated Rate	$30.70
Max. Negotiated Rate	$30.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.70

ELETRIPTAN HYDROBROMIDE 40 MG PO TABS

Facility

$96.92

Service Code	NDC 0049234045
Hospital Charge Code	0049234045
Hospital Revenue Code	250
Min. Negotiated Rate	$33.92
Max. Negotiated Rate	$77.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.46
Rate for Payer: Aetna Government	$48.46
Rate for Payer: Brighton Health Commercial	$72.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$77.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.91
Rate for Payer: EmblemHealth Commercial	$48.46
Rate for Payer: Group Health Inc Commercial	$48.46
Rate for Payer: Group Health Inc Medicare	$33.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.46
Rate for Payer: Hamaspik Choice Inc Medicare	$48.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.00

ELETRIPTAN HYDROBROMIDE 40 MG PO TABS

Facility

$61.39

Service Code	NDC 0378428885
Hospital Charge Code	0378428885
Hospital Revenue Code	250
Min. Negotiated Rate	$21.49
Max. Negotiated Rate	$49.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.70
Rate for Payer: Aetna Government	$30.70
Rate for Payer: Brighton Health Commercial	$46.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$41.75
Rate for Payer: EmblemHealth Commercial	$30.70
Rate for Payer: Group Health Inc Commercial	$30.70
Rate for Payer: Group Health Inc Medicare	$21.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.70
Rate for Payer: Hamaspik Choice Inc Medicare	$30.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.90

ELETRIPTAN HYDROBROMIDE 40 MG PO TABS

Facility

$96.92

Service Code	NDC 0049234045
Hospital Charge Code	0049234045
Hospital Revenue Code	250
Min. Negotiated Rate	$48.46
Max. Negotiated Rate	$48.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.46

ELETRIPTAN HYDROBROMIDE 40 MG PO TABS

Facility

$61.39

Service Code	NDC 0378428808
Hospital Charge Code	0378428808
Hospital Revenue Code	250
Min. Negotiated Rate	$21.49
Max. Negotiated Rate	$49.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.70
Rate for Payer: Aetna Government	$30.70
Rate for Payer: Brighton Health Commercial	$46.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$41.75
Rate for Payer: EmblemHealth Commercial	$30.70
Rate for Payer: Group Health Inc Commercial	$30.70
Rate for Payer: Group Health Inc Medicare	$21.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.70
Rate for Payer: Hamaspik Choice Inc Medicare	$30.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.90

Know your out-of-pocket cost for care.

All Charges