St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

$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

ELOTUZUMAB 400 MG IV SOLR

Facility

$3.00

Service Code	HCPCS J9176
Hospital Charge Code	0003452211
Hospital Revenue Code	258
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50

ELOTUZUMAB 400 MG IV SOLR

Facility

$3.00

Service Code	HCPCS J9176
Hospital Charge Code	0003452211
Hospital Revenue Code	258
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$8.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.89
Rate for Payer: Aetna Government	$7.89
Rate for Payer: Affinity Essential Plan 1&2	$5.52
Rate for Payer: Affinity Essential Plan 3&4	$5.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.52
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Elderplan Medicare Advantage	$7.89
Rate for Payer: EmblemHealth Commercial	$7.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.10
Rate for Payer: Fidelis Essential Plan Aliesa	$6.71
Rate for Payer: Fidelis Essential Plan QHP	$7.02
Rate for Payer: Fidelis Medicare Advantage	$7.89
Rate for Payer: Fidelis Qualified Health Plan	$7.02
Rate for Payer: Group Health Inc Commercial	$7.89
Rate for Payer: Group Health Inc Medicare	$7.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.89
Rate for Payer: Hamaspik Choice Inc Medicare	$7.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.89
Rate for Payer: Healthfirst Medicare Advantage	$6.71
Rate for Payer: Healthfirst QHP	$7.89
Rate for Payer: Humana Medicare	$8.05
Rate for Payer: Senior Whole Health Medicare Advantage	$7.89
Rate for Payer: United Healthcare Medicare Advantage	$7.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7.50
Rate for Payer: Wellcare Medicare	$7.50

ELVITEG-COBIC-EMTRICIT-TENOFAF 150-150-200-10 MG PO TABS

Facility

$159.25

Service Code	NDC 6195819011
Hospital Charge Code	6195819011
Hospital Revenue Code	250
Min. Negotiated Rate	$55.74
Max. Negotiated Rate	$127.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$79.62
Rate for Payer: Aetna Government	$79.62
Rate for Payer: Brighton Health Commercial	$119.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$127.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.29
Rate for Payer: EmblemHealth Commercial	$79.62
Rate for Payer: Group Health Inc Commercial	$79.62
Rate for Payer: Group Health Inc Medicare	$55.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.62
Rate for Payer: Hamaspik Choice Inc Medicare	$79.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.51

ELVITEG-COBIC-EMTRICIT-TENOFAF 150-150-200-10 MG PO TABS

Facility

$159.25

Service Code	NDC 6195819011
Hospital Charge Code	6195819011
Hospital Revenue Code	250
Min. Negotiated Rate	$79.62
Max. Negotiated Rate	$79.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.62

ELVITEG-COBIC-EMTRICIT-TENOFDF 150-150-200-300 MG PO TABS

Facility

$167.05

Service Code	NDC 6195812011
Hospital Charge Code	6195812011
Hospital Revenue Code	250
Min. Negotiated Rate	$58.47
Max. Negotiated Rate	$133.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$83.53
Rate for Payer: Aetna Government	$83.53
Rate for Payer: Brighton Health Commercial	$125.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.60
Rate for Payer: EmblemHealth Commercial	$83.53
Rate for Payer: Group Health Inc Commercial	$83.53
Rate for Payer: Group Health Inc Medicare	$58.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.53
Rate for Payer: Hamaspik Choice Inc Medicare	$83.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$108.58

ELVITEG-COBIC-EMTRICIT-TENOFDF 150-150-200-300 MG PO TABS

Facility

$167.05

Service Code	NDC 6195812011
Hospital Charge Code	6195812011
Hospital Revenue Code	250
Min. Negotiated Rate	$83.53
Max. Negotiated Rate	$83.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.53

EMERGING TECHNOLOGY PROCEDURES

Facility

$104.14

Service Code	EAPG 04001
Min. Negotiated Rate	$104.14
Max. Negotiated Rate	$104.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$104.14

EMPTY STERILIZED MISC

Facility

$1.36

Service Code	NDC 6332300110
Hospital Charge Code	6332300110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.68
Rate for Payer: Aetna Government	$0.68
Rate for Payer: Brighton Health Commercial	$1.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.92
Rate for Payer: EmblemHealth Commercial	$0.68
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.88

EMPTY STERILIZED MISC

Facility

$1.36

Service Code	NDC 6332300110
Hospital Charge Code	6332300110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68

EMTRICITABINE 200 MG PO CAPS

Facility

$19.31

Service Code	NDC 6909764202
Hospital Charge Code	6909764202
Hospital Revenue Code	250
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$9.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.66

EMTRICITABINE 200 MG PO CAPS

Facility

$19.31

Service Code	NDC 6909764202
Hospital Charge Code	6909764202
Hospital Revenue Code	250
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$15.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.66
Rate for Payer: Aetna Government	$9.66
Rate for Payer: Brighton Health Commercial	$14.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.13
Rate for Payer: EmblemHealth Commercial	$9.66
Rate for Payer: Group Health Inc Commercial	$9.66
Rate for Payer: Group Health Inc Medicare	$6.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.66
Rate for Payer: Hamaspik Choice Inc Medicare	$9.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.55

EMTRICITABINE-TENOFOVIR AF 200-25 MG PO TABS

Facility

$88.09

Service Code	NDC 6195820022
Hospital Charge Code	6195820022
Hospital Revenue Code	250
Min. Negotiated Rate	$44.05
Max. Negotiated Rate	$44.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.05

EMTRICITABINE-TENOFOVIR AF 200-25 MG PO TABS

Facility

$88.09

Service Code	NDC 6195820022
Hospital Charge Code	6195820022
Hospital Revenue Code	250
Min. Negotiated Rate	$30.83
Max. Negotiated Rate	$70.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.05
Rate for Payer: Aetna Government	$44.05
Rate for Payer: Brighton Health Commercial	$66.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.90
Rate for Payer: EmblemHealth Commercial	$44.05
Rate for Payer: Group Health Inc Commercial	$44.05
Rate for Payer: Group Health Inc Medicare	$30.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.05
Rate for Payer: Hamaspik Choice Inc Medicare	$44.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57.26

EMTRICITABINE-TENOFOVIR AF 200-25 MG PO TABS

Facility

$88.09

Service Code	NDC 6195820021
Hospital Charge Code	6195820021
Hospital Revenue Code	250
Min. Negotiated Rate	$44.05
Max. Negotiated Rate	$44.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.05

EMTRICITABINE-TENOFOVIR AF 200-25 MG PO TABS

Facility

$88.09

Service Code	NDC 6195820021
Hospital Charge Code	6195820021
Hospital Revenue Code	250
Min. Negotiated Rate	$30.83
Max. Negotiated Rate	$70.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.05
Rate for Payer: Aetna Government	$44.05
Rate for Payer: Brighton Health Commercial	$66.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.90
Rate for Payer: EmblemHealth Commercial	$44.05
Rate for Payer: Group Health Inc Commercial	$44.05
Rate for Payer: Group Health Inc Medicare	$30.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.05
Rate for Payer: Hamaspik Choice Inc Medicare	$44.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57.26

EMTRICITABINE-TENOFOVIR DF 100-150 MG PO TABS

Facility

$70.01

Service Code	NDC 6923820923
Hospital Charge Code	6923820923
Hospital Revenue Code	250
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$56.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.00
Rate for Payer: Aetna Government	$35.00
Rate for Payer: Brighton Health Commercial	$52.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.60
Rate for Payer: EmblemHealth Commercial	$35.00
Rate for Payer: Group Health Inc Commercial	$35.00
Rate for Payer: Group Health Inc Medicare	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00
Rate for Payer: Hamaspik Choice Inc Medicare	$35.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.50

EMTRICITABINE-TENOFOVIR DF 100-150 MG PO TABS

Facility

$70.01

Service Code	NDC 6923820923
Hospital Charge Code	6923820923
Hospital Revenue Code	250
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00

EMTRICITABINE-TENOFOVIR DF 100-150 MG PO TABS

Facility

$73.69

Service Code	NDC 6195807031
Hospital Charge Code	6195807031
Hospital Revenue Code	250
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$36.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.85

EMTRICITABINE-TENOFOVIR DF 100-150 MG PO TABS

Facility

$73.69

Service Code	NDC 6195807031
Hospital Charge Code	6195807031
Hospital Revenue Code	250
Min. Negotiated Rate	$25.79
Max. Negotiated Rate	$58.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.85
Rate for Payer: Aetna Government	$36.85
Rate for Payer: Brighton Health Commercial	$55.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.11
Rate for Payer: EmblemHealth Commercial	$36.85
Rate for Payer: Group Health Inc Commercial	$36.85
Rate for Payer: Group Health Inc Medicare	$25.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.85
Rate for Payer: Hamaspik Choice Inc Medicare	$36.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.90

EMTRICITABINE-TENOFOVIR DF 133-200 MG PO TABS

Facility

$70.01

Service Code	NDC 6923820933
Hospital Charge Code	6923820933
Hospital Revenue Code	250
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$56.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.00
Rate for Payer: Aetna Government	$35.00
Rate for Payer: Brighton Health Commercial	$52.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.60
Rate for Payer: EmblemHealth Commercial	$35.00
Rate for Payer: Group Health Inc Commercial	$35.00
Rate for Payer: Group Health Inc Medicare	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00
Rate for Payer: Hamaspik Choice Inc Medicare	$35.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.50

EMTRICITABINE-TENOFOVIR DF 133-200 MG PO TABS

Facility

$70.01

Service Code	NDC 6923820933
Hospital Charge Code	6923820933
Hospital Revenue Code	250
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00

EMTRICITABINE-TENOFOVIR DF 167-250 MG PO TABS

Facility

$70.01

Service Code	NDC 6923820943
Hospital Charge Code	6923820943
Hospital Revenue Code	250
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00

EMTRICITABINE-TENOFOVIR DF 167-250 MG PO TABS

Facility

$70.01

Service Code	NDC 6923820943
Hospital Charge Code	6923820943
Hospital Revenue Code	250
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$56.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.00
Rate for Payer: Aetna Government	$35.00
Rate for Payer: Brighton Health Commercial	$52.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.60
Rate for Payer: EmblemHealth Commercial	$35.00
Rate for Payer: Group Health Inc Commercial	$35.00
Rate for Payer: Group Health Inc Medicare	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00
Rate for Payer: Hamaspik Choice Inc Medicare	$35.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.50

Know your out-of-pocket cost for care.

All Charges