St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR

Facility

$8.83

Service Code	NDC 6787757290
Hospital Charge Code	6787757290
Hospital Revenue Code	250
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$7.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.42
Rate for Payer: Aetna Government	$4.42
Rate for Payer: Brighton Health Commercial	$6.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.01
Rate for Payer: EmblemHealth Commercial	$4.42
Rate for Payer: Group Health Inc Commercial	$4.42
Rate for Payer: Group Health Inc Medicare	$3.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.42
Rate for Payer: Hamaspik Choice Inc Medicare	$4.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.74

ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR

Facility

$9.02

Service Code	NDC 6838244206
Hospital Charge Code	6838244206
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$7.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.51
Rate for Payer: Aetna Government	$4.51
Rate for Payer: Brighton Health Commercial	$6.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.14
Rate for Payer: EmblemHealth Commercial	$4.51
Rate for Payer: Group Health Inc Commercial	$4.51
Rate for Payer: Group Health Inc Medicare	$3.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.51
Rate for Payer: Hamaspik Choice Inc Medicare	$4.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.87

ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR

Facility

$8.52

Service Code	NDC 0093645198
Hospital Charge Code	0093645198
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$6.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.26
Rate for Payer: Aetna Government	$4.26
Rate for Payer: Brighton Health Commercial	$6.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.79
Rate for Payer: EmblemHealth Commercial	$4.26
Rate for Payer: Group Health Inc Commercial	$4.26
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.26
Rate for Payer: Hamaspik Choice Inc Medicare	$4.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.54

ESOPHAGITIS AND OTHER ESOPHAGEAL DIAGNOSES

Facility

$215.42

Service Code	EAPG 00623
Min. Negotiated Rate	$157.37
Max. Negotiated Rate	$215.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$157.37
Rate for Payer: Healthfirst Commercial	$215.42

ESOPHAGOGASTRIC RESTRICTIVE PROCEDURES AND GASTRIC FUNDOPLICATION

Facility

$3,189.11

Service Code	EAPG 00129
Min. Negotiated Rate	$3,189.11
Max. Negotiated Rate	$3,189.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,189.11

ESRD CASE MANAGEMENT

Facility

$25.46

Service Code	EAPG 00261
Min. Negotiated Rate	$25.46
Max. Negotiated Rate	$25.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.46

ESTROGENS CONJUGATED 0.625 MG/GM VA CREA

Facility

$18.00

Service Code	NDC 0046087221
Hospital Charge Code	0046087221
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00

ESTROGENS CONJUGATED 0.625 MG/GM VA CREA

Facility

$18.00

Service Code	NDC 0046087221
Hospital Charge Code	0046087221
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$14.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.00
Rate for Payer: Aetna Government	$9.00
Rate for Payer: Brighton Health Commercial	$13.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.24
Rate for Payer: EmblemHealth Commercial	$9.00
Rate for Payer: Group Health Inc Commercial	$9.00
Rate for Payer: Group Health Inc Medicare	$6.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.70

ESTROGENS CONJUGATED 1.25 MG PO TABS

Facility

$8.29

Service Code	NDC 0046110481
Hospital Charge Code	0046110481
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$6.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.14
Rate for Payer: Aetna Government	$4.14
Rate for Payer: Brighton Health Commercial	$6.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.64
Rate for Payer: EmblemHealth Commercial	$4.14
Rate for Payer: Group Health Inc Commercial	$4.14
Rate for Payer: Group Health Inc Medicare	$2.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.14
Rate for Payer: Hamaspik Choice Inc Medicare	$4.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.39

ESTROGENS CONJUGATED 1.25 MG PO TABS

Facility

$8.29

Service Code	NDC 0046110481
Hospital Charge Code	0046110481
Hospital Revenue Code	250
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$4.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.14

ESTROGENS CONJUGATED 25 MG IJ SOLR

Facility

$441.66

Service Code	HCPCS J1410
Hospital Charge Code	0046074905
Hospital Revenue Code	250
Min. Negotiated Rate	$242.91
Max. Negotiated Rate	$399.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$392.06
Rate for Payer: Aetna Government	$392.06
Rate for Payer: Affinity Essential Plan 1&2	$274.44
Rate for Payer: Affinity Essential Plan 3&4	$274.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$274.44
Rate for Payer: Brighton Health Commercial	$331.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$392.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$353.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$300.33
Rate for Payer: Elderplan Medicare Advantage	$392.06
Rate for Payer: EmblemHealth Commercial	$392.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$352.85
Rate for Payer: Fidelis Essential Plan Aliesa	$333.25
Rate for Payer: Fidelis Essential Plan QHP	$348.93
Rate for Payer: Fidelis Medicare Advantage	$392.06
Rate for Payer: Fidelis Qualified Health Plan	$348.93
Rate for Payer: Group Health Inc Commercial	$392.06
Rate for Payer: Group Health Inc Medicare	$392.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.06
Rate for Payer: Hamaspik Choice Inc Medicare	$392.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$392.06
Rate for Payer: Healthfirst Medicare Advantage	$333.25
Rate for Payer: Healthfirst QHP	$392.06
Rate for Payer: Humana Medicare	$399.90
Rate for Payer: Senior Whole Health Medicare Advantage	$392.06
Rate for Payer: United Healthcare Medicare Advantage	$392.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$287.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$372.46
Rate for Payer: Wellcare Medicare	$372.46

ESTROGENS CONJUGATED 25 MG IJ SOLR

Facility

$441.66

Service Code	HCPCS J1410
Hospital Charge Code	0046074905
Hospital Revenue Code	250
Min. Negotiated Rate	$220.83
Max. Negotiated Rate	$220.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.83

ETHACRYNATE SODIUM 50 MG IV SOLR

Facility

$4.00

Service Code	HCPCS J1807
Hospital Charge Code	4202315701
Hospital Revenue Code	258
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00

ETHACRYNATE SODIUM 50 MG IV SOLR

Facility

$4.00

Service Code	HCPCS J1807
Hospital Charge Code	4202315701
Hospital Revenue Code	258
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$21.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.97
Rate for Payer: Aetna Government	$20.97
Rate for Payer: Affinity Essential Plan 1&2	$14.68
Rate for Payer: Affinity Essential Plan 3&4	$14.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.68
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Elderplan Medicare Advantage	$20.97
Rate for Payer: EmblemHealth Commercial	$20.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.87
Rate for Payer: Fidelis Essential Plan Aliesa	$17.82
Rate for Payer: Fidelis Essential Plan QHP	$18.66
Rate for Payer: Fidelis Medicare Advantage	$20.97
Rate for Payer: Fidelis Qualified Health Plan	$18.66
Rate for Payer: Group Health Inc Commercial	$20.97
Rate for Payer: Group Health Inc Medicare	$20.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.97
Rate for Payer: Hamaspik Choice Inc Medicare	$20.97
Rate for Payer: Healthfirst Medicare Advantage	$17.82
Rate for Payer: Healthfirst QHP	$20.97
Rate for Payer: Humana Medicare	$21.39
Rate for Payer: Senior Whole Health Medicare Advantage	$20.97
Rate for Payer: United Healthcare Medicare Advantage	$20.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.92
Rate for Payer: Wellcare Medicare	$19.92

ETHACRYNIC ACID 25 MG PO TABS

Facility

$24.19

Service Code	NDC 6923811261
Hospital Charge Code	6923811261
Hospital Revenue Code	250
Min. Negotiated Rate	$8.47
Max. Negotiated Rate	$19.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.10
Rate for Payer: Aetna Government	$12.10
Rate for Payer: Brighton Health Commercial	$18.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.45
Rate for Payer: EmblemHealth Commercial	$12.10
Rate for Payer: Group Health Inc Commercial	$12.10
Rate for Payer: Group Health Inc Medicare	$8.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.10
Rate for Payer: Hamaspik Choice Inc Medicare	$12.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.72

ETHACRYNIC ACID 25 MG PO TABS

Facility

$24.19

Service Code	NDC 6923811261
Hospital Charge Code	6923811261
Hospital Revenue Code	250
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$12.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.10

ETHAMBUTOL HCL 100 MG PO TABS

Facility

$0.59

Service Code	NDC 6818028001
Hospital Charge Code	6818028001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Brighton Health Commercial	$0.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: EmblemHealth Commercial	$0.30
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.38

ETHAMBUTOL HCL 100 MG PO TABS

Facility

$0.59

Service Code	NDC 6818028001
Hospital Charge Code	6818028001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30

ETHAMBUTOL HCL 400 MG PO TABS

Facility

$0.72

Service Code	NDC 5487900201
Hospital Charge Code	5487900201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

ETHAMBUTOL HCL 400 MG PO TABS

Facility

$0.72

Service Code	NDC 5487900201
Hospital Charge Code	5487900201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

ETHAMBUTOL HCL 400 MG PO TABS

Facility

$1.63

Service Code	NDC 6808428011
Hospital Charge Code	6808428011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$1.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.10
Rate for Payer: EmblemHealth Commercial	$0.81
Rate for Payer: Group Health Inc Commercial	$0.81
Rate for Payer: Group Health Inc Medicare	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.81
Rate for Payer: Hamaspik Choice Inc Medicare	$0.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.06

ETHAMBUTOL HCL 400 MG PO TABS

Facility

$1.63

Service Code	NDC 6808428011
Hospital Charge Code	6808428011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.81

ETHOSUXIMIDE 250 MG/5ML PO SOLN

Facility

$0.50

Service Code	NDC 0121067016
Hospital Charge Code	0121067016
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25

ETHOSUXIMIDE 250 MG/5ML PO SOLN

Facility

$0.50

Service Code	NDC 0121067016
Hospital Charge Code	0121067016
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

ETHYL ALCOHOL 100 % SOLN

Facility

$0.00

Service Code	NDC 5048330005
Hospital Charge Code	5048330005
Hospital Revenue Code	250
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

Know your out-of-pocket cost for care.

All Charges