St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ASPIRIN 81 MG PO TBEC

Facility

$0.01

Service Code	NDC 0904675180
Hospital Charge Code	0904675180
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
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	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ASPIRIN 81 MG PO TBEC

Facility

$0.06

Service Code	NDC 6373921202
Hospital Charge Code	6373921202
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

ASPIRIN 81 MG PO TBEC

Facility

$0.03

Service Code	NDC 0536123441
Hospital Charge Code	0536123441
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
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	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
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	$0.02

ASPIRIN 81 MG PO TBEC

Facility

$0.01

Service Code	NDC 6961806610
Hospital Charge Code	6961806610
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
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	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ASPIRIN 81 MG PO TBEC

Facility

$0.01

Service Code	NDC 0904675180
Hospital Charge Code	0904675180
Hospital Revenue Code	250
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

ASPIRIN 81 MG PO TBEC

Facility

$0.06

Service Code	NDC 6373921202
Hospital Charge Code	6373921202
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

ASPIRIN 81 MG PO TBEC

Facility

$0.01

Service Code	NDC 4948348110
Hospital Charge Code	4948348110
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
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	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ASPIRIN 81 MG PO TBEC

Facility

$0.02

Service Code	NDC 5789698101
Hospital Charge Code	5789698101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

ASPIRIN 81 MG PO TBEC

Facility

$0.01

Service Code	NDC 1610335611
Hospital Charge Code	1610335611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

ASPIRIN 81 MG PO TBEC

Facility

$0.03

Service Code	NDC 0536123441
Hospital Charge Code	0536123441
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

ASPIRIN 81 MG PO TBEC

Facility

$1.43

Service Code	NDC 7733303125
Hospital Charge Code	7733303125
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72

ASPIRIN 81 MG PO TBEC

Facility

$0.01

Service Code	NDC 6961806602
Hospital Charge Code	6961806602
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

ASPIRIN 81 MG PO TBEC

Facility

$0.01

Service Code	NDC 6961806610
Hospital Charge Code	6961806610
Hospital Revenue Code	250
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

ASPIRIN 81 MG PO TBEC

Facility

$0.07

Service Code	NDC 1284353637
Hospital Charge Code	1284353637
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12

Facility

$8.36

Service Code	NDC 6846240560
Hospital Charge Code	6846240560
Hospital Revenue Code	250
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.18

ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12

Facility

$8.36

Service Code	NDC 6516259606
Hospital Charge Code	6516259606
Hospital Revenue Code	250
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$6.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.18
Rate for Payer: Aetna Government	$4.18
Rate for Payer: Brighton Health Commercial	$6.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.68
Rate for Payer: EmblemHealth Commercial	$4.18
Rate for Payer: Group Health Inc Commercial	$4.18
Rate for Payer: Group Health Inc Medicare	$2.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.18
Rate for Payer: Hamaspik Choice Inc Medicare	$4.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.43

ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12

Facility

$8.36

Service Code	NDC 6846240560
Hospital Charge Code	6846240560
Hospital Revenue Code	250
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$6.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.18
Rate for Payer: Aetna Government	$4.18
Rate for Payer: Brighton Health Commercial	$6.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.68
Rate for Payer: EmblemHealth Commercial	$4.18
Rate for Payer: Group Health Inc Commercial	$4.18
Rate for Payer: Group Health Inc Medicare	$2.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.18
Rate for Payer: Hamaspik Choice Inc Medicare	$4.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.43

ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12

Facility

$8.36

Service Code	NDC 6516259606
Hospital Charge Code	6516259606
Hospital Revenue Code	250
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.18

Asthma

Facility

$61,069.39

Service Code	APR-DRG 1414
Min. Negotiated Rate	$14,682.00
Max. Negotiated Rate	$61,069.39
Rate for Payer: Affinity Essential Plan 1&2	$61,069.39
Rate for Payer: Affinity Essential Plan 3&4	$61,069.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,141.95
Rate for Payer: Amida Care Medicaid	$27,141.95
Rate for Payer: EmblemHealth Essential Plan 1&2	$61,069.39
Rate for Payer: EmblemHealth Essential Plan 3&4	$27,141.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,141.95
Rate for Payer: Fidelis Qualified Health Plan	$32,570.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,141.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,141.95
Rate for Payer: Healthfirst Commercial	$26,275.00
Rate for Payer: Healthfirst Essential Plan	$61,069.39
Rate for Payer: Healthfirst QHP	$14,682.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,141.95
Rate for Payer: SOMOS Essential	$61,069.39
Rate for Payer: United Healthcare Essential Plan 1&2	$61,069.39
Rate for Payer: United Healthcare Essential Plan 3&4	$61,069.39
Rate for Payer: United Healthcare Medicaid	$27,141.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,141.95

Asthma

Facility

$42,873.41

Service Code	APR-DRG 1412
Min. Negotiated Rate	$6,513.00
Max. Negotiated Rate	$42,873.41
Rate for Payer: Affinity Essential Plan 1&2	$42,873.41
Rate for Payer: Affinity Essential Plan 3&4	$42,873.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,054.85
Rate for Payer: Amida Care Medicaid	$19,054.85
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,873.41
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,054.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,054.85
Rate for Payer: Fidelis Qualified Health Plan	$22,865.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,054.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,054.85
Rate for Payer: Healthfirst Commercial	$11,421.00
Rate for Payer: Healthfirst Essential Plan	$42,873.41
Rate for Payer: Healthfirst QHP	$6,513.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,054.85
Rate for Payer: SOMOS Essential	$42,873.41
Rate for Payer: United Healthcare Essential Plan 1&2	$42,873.41
Rate for Payer: United Healthcare Essential Plan 3&4	$42,873.41
Rate for Payer: United Healthcare Medicaid	$19,054.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,054.85

Asthma

Facility

$40,346.10

Service Code	APR-DRG 1411
Min. Negotiated Rate	$5,381.00
Max. Negotiated Rate	$40,346.10
Rate for Payer: Affinity Essential Plan 1&2	$40,346.10
Rate for Payer: Affinity Essential Plan 3&4	$40,346.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,931.60
Rate for Payer: Amida Care Medicaid	$17,931.60
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,346.10
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,931.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,931.60
Rate for Payer: Fidelis Qualified Health Plan	$21,517.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,931.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,931.60
Rate for Payer: Healthfirst Commercial	$9,251.00
Rate for Payer: Healthfirst Essential Plan	$40,346.10
Rate for Payer: Healthfirst QHP	$5,381.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,931.60
Rate for Payer: SOMOS Essential	$40,346.10
Rate for Payer: United Healthcare Essential Plan 1&2	$40,346.10
Rate for Payer: United Healthcare Essential Plan 3&4	$40,346.10
Rate for Payer: United Healthcare Medicaid	$17,931.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,931.60

Asthma

Facility

$48,508.43

Service Code	APR-DRG 1413
Min. Negotiated Rate	$8,994.00
Max. Negotiated Rate	$48,508.43
Rate for Payer: Affinity Essential Plan 1&2	$48,508.43
Rate for Payer: Affinity Essential Plan 3&4	$48,508.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,559.30
Rate for Payer: Amida Care Medicaid	$21,559.30
Rate for Payer: EmblemHealth Essential Plan 1&2	$48,508.43
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,559.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,559.30
Rate for Payer: Fidelis Qualified Health Plan	$25,871.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,559.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,559.30
Rate for Payer: Healthfirst Commercial	$15,622.00
Rate for Payer: Healthfirst Essential Plan	$48,508.43
Rate for Payer: Healthfirst QHP	$8,994.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,559.30
Rate for Payer: SOMOS Essential	$48,508.43
Rate for Payer: United Healthcare Essential Plan 1&2	$48,508.43
Rate for Payer: United Healthcare Essential Plan 3&4	$48,508.43
Rate for Payer: United Healthcare Medicaid	$21,559.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,559.30

ASTHMA

Facility

$285.71

Service Code	EAPG 00575
Min. Negotiated Rate	$208.29
Max. Negotiated Rate	$285.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$208.29
Rate for Payer: Healthfirst Commercial	$285.71

ATAZANAVIR-COBICISTAT 300-150 MG PO TABS

Facility

$64.22

Service Code	NDC 0003364111
Hospital Charge Code	0003364111
Hospital Revenue Code	250
Min. Negotiated Rate	$32.11
Max. Negotiated Rate	$32.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.11

ATAZANAVIR-COBICISTAT 300-150 MG PO TABS

Facility

$64.22

Service Code	NDC 0003364111
Hospital Charge Code	0003364111
Hospital Revenue Code	250
Min. Negotiated Rate	$22.48
Max. Negotiated Rate	$51.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.11
Rate for Payer: Aetna Government	$32.11
Rate for Payer: Brighton Health Commercial	$48.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.67
Rate for Payer: EmblemHealth Commercial	$32.11
Rate for Payer: Group Health Inc Commercial	$32.11
Rate for Payer: Group Health Inc Medicare	$22.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.11
Rate for Payer: Hamaspik Choice Inc Medicare	$32.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.74

Know your out-of-pocket cost for care.

All Charges