St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ATAZANAVIR SULFATE 200 MG PO CAPS

Facility

$27.80

Service Code	NDC 6586271260
Hospital Charge Code	6586271260
Hospital Revenue Code	250
Min. Negotiated Rate	$13.90
Max. Negotiated Rate	$13.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.90

ATAZANAVIR SULFATE 200 MG PO CAPS

Facility

$27.80

Service Code	NDC 3172265460
Hospital Charge Code	3172265460
Hospital Revenue Code	250
Min. Negotiated Rate	$13.90
Max. Negotiated Rate	$13.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.90

ATAZANAVIR SULFATE 200 MG PO CAPS

Facility

$27.80

Service Code	NDC 3172265460
Hospital Charge Code	3172265460
Hospital Revenue Code	250
Min. Negotiated Rate	$9.73
Max. Negotiated Rate	$22.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.90
Rate for Payer: Aetna Government	$13.90
Rate for Payer: Brighton Health Commercial	$20.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.91
Rate for Payer: EmblemHealth Commercial	$13.90
Rate for Payer: Group Health Inc Commercial	$13.90
Rate for Payer: Group Health Inc Medicare	$9.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.90
Rate for Payer: Hamaspik Choice Inc Medicare	$13.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.07

ATAZANAVIR SULFATE 200 MG PO CAPS

Facility

$27.80

Service Code	NDC 6586271260
Hospital Charge Code	6586271260
Hospital Revenue Code	250
Min. Negotiated Rate	$9.73
Max. Negotiated Rate	$22.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.90
Rate for Payer: Aetna Government	$13.90
Rate for Payer: Brighton Health Commercial	$20.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.91
Rate for Payer: EmblemHealth Commercial	$13.90
Rate for Payer: Group Health Inc Commercial	$13.90
Rate for Payer: Group Health Inc Medicare	$9.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.90
Rate for Payer: Hamaspik Choice Inc Medicare	$13.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.07

ATAZANAVIR SULFATE 300 MG PO CAPS

Facility

$55.08

Service Code	NDC 6923811383
Hospital Charge Code	6923811383
Hospital Revenue Code	250
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$44.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.54
Rate for Payer: Aetna Government	$27.54
Rate for Payer: Brighton Health Commercial	$41.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.45
Rate for Payer: EmblemHealth Commercial	$27.54
Rate for Payer: Group Health Inc Commercial	$27.54
Rate for Payer: Group Health Inc Medicare	$19.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.54
Rate for Payer: Hamaspik Choice Inc Medicare	$27.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.80

ATAZANAVIR SULFATE 300 MG PO CAPS

Facility

$55.08

Service Code	NDC 6586271330
Hospital Charge Code	6586271330
Hospital Revenue Code	250
Min. Negotiated Rate	$27.54
Max. Negotiated Rate	$27.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.54

ATAZANAVIR SULFATE 300 MG PO CAPS

Facility

$55.08

Service Code	NDC 6586271330
Hospital Charge Code	6586271330
Hospital Revenue Code	250
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$44.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.54
Rate for Payer: Aetna Government	$27.54
Rate for Payer: Brighton Health Commercial	$41.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.45
Rate for Payer: EmblemHealth Commercial	$27.54
Rate for Payer: Group Health Inc Commercial	$27.54
Rate for Payer: Group Health Inc Medicare	$19.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.54
Rate for Payer: Hamaspik Choice Inc Medicare	$27.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.80

ATAZANAVIR SULFATE 300 MG PO CAPS

Facility

$55.08

Service Code	NDC 6923811383
Hospital Charge Code	6923811383
Hospital Revenue Code	250
Min. Negotiated Rate	$27.54
Max. Negotiated Rate	$27.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.54

ATENOLOL 25 MG PO TABS

Facility

$0.82

Service Code	NDC 0093078701
Hospital Charge Code	0093078701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41

ATENOLOL 25 MG PO TABS

Facility

$0.24

Service Code	NDC 0904718761
Hospital Charge Code	0904718761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12

ATENOLOL 25 MG PO TABS

Facility

$0.24

Service Code	NDC 0904718761
Hospital Charge Code	0904718761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: EmblemHealth Commercial	$0.12
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

ATENOLOL 25 MG PO TABS

Facility

$0.82

Service Code	NDC 0093078701
Hospital Charge Code	0093078701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.41
Rate for Payer: Aetna Government	$0.41
Rate for Payer: Brighton Health Commercial	$0.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.56
Rate for Payer: EmblemHealth Commercial	$0.41
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.53

ATENOLOL 50 MG PO TABS

Facility

$0.83

Service Code	NDC 0093075201
Hospital Charge Code	0093075201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.54

ATENOLOL 50 MG PO TABS

Facility

$0.83

Service Code	NDC 6586216901
Hospital Charge Code	6586216901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

ATENOLOL 50 MG PO TABS

Facility

$0.89

Service Code	NDC 5107968420
Hospital Charge Code	5107968420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: EmblemHealth Commercial	$0.45
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.58

ATENOLOL 50 MG PO TABS

Facility

$0.83

Service Code	NDC 0093075201
Hospital Charge Code	0093075201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

ATENOLOL 50 MG PO TABS

Facility

$0.83

Service Code	NDC 6586216901
Hospital Charge Code	6586216901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.54

ATENOLOL 50 MG PO TABS

Facility

$0.89

Service Code	NDC 5107968420
Hospital Charge Code	5107968420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45

ATEZOLIZUMAB 1200 MG/20ML IV SOLN

Facility

$636.36

Service Code	HCPCS J9022
Hospital Charge Code	5024291701
Hospital Revenue Code	258
Min. Negotiated Rate	$318.18
Max. Negotiated Rate	$318.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.18

ATEZOLIZUMAB 1200 MG/20ML IV SOLN

Facility

$636.36

Service Code	HCPCS J9022
Hospital Charge Code	5024291701
Hospital Revenue Code	258
Min. Negotiated Rate	$63.94
Max. Negotiated Rate	$509.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$350.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$91.34
Rate for Payer: Aetna Government	$91.34
Rate for Payer: Affinity Essential Plan 1&2	$63.94
Rate for Payer: Affinity Essential Plan 3&4	$63.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$63.94
Rate for Payer: Brighton Health Commercial	$477.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$91.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$509.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$432.72
Rate for Payer: Elderplan Medicare Advantage	$91.34
Rate for Payer: EmblemHealth Commercial	$91.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$82.21
Rate for Payer: Fidelis Essential Plan Aliesa	$77.64
Rate for Payer: Fidelis Essential Plan QHP	$81.29
Rate for Payer: Fidelis Medicare Advantage	$91.34
Rate for Payer: Fidelis Qualified Health Plan	$81.29
Rate for Payer: Group Health Inc Commercial	$91.34
Rate for Payer: Group Health Inc Medicare	$91.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.34
Rate for Payer: Hamaspik Choice Inc Medicare	$91.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$91.34
Rate for Payer: Healthfirst Medicare Advantage	$77.64
Rate for Payer: Healthfirst QHP	$91.34
Rate for Payer: Humana Medicare	$93.17
Rate for Payer: Senior Whole Health Medicare Advantage	$91.34
Rate for Payer: United Healthcare Medicare Advantage	$91.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$413.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$86.77
Rate for Payer: Wellcare Medicare	$86.77

ATEZOLIZUMAB 840 MG/14ML IV SOLN

Facility

$636.36

Service Code	HCPCS J9022
Hospital Charge Code	5024291801
Hospital Revenue Code	258
Min. Negotiated Rate	$318.18
Max. Negotiated Rate	$318.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.18

ATEZOLIZUMAB 840 MG/14ML IV SOLN

Facility

$636.36

Service Code	HCPCS J9022
Hospital Charge Code	5024291801
Hospital Revenue Code	258
Min. Negotiated Rate	$63.94
Max. Negotiated Rate	$509.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$350.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$91.34
Rate for Payer: Aetna Government	$91.34
Rate for Payer: Affinity Essential Plan 1&2	$63.94
Rate for Payer: Affinity Essential Plan 3&4	$63.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$63.94
Rate for Payer: Brighton Health Commercial	$477.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$91.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$509.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$432.72
Rate for Payer: Elderplan Medicare Advantage	$91.34
Rate for Payer: EmblemHealth Commercial	$91.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$82.21
Rate for Payer: Fidelis Essential Plan Aliesa	$77.64
Rate for Payer: Fidelis Essential Plan QHP	$81.29
Rate for Payer: Fidelis Medicare Advantage	$91.34
Rate for Payer: Fidelis Qualified Health Plan	$81.29
Rate for Payer: Group Health Inc Commercial	$91.34
Rate for Payer: Group Health Inc Medicare	$91.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.34
Rate for Payer: Hamaspik Choice Inc Medicare	$91.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$91.34
Rate for Payer: Healthfirst Medicare Advantage	$77.64
Rate for Payer: Healthfirst QHP	$91.34
Rate for Payer: Humana Medicare	$93.17
Rate for Payer: Senior Whole Health Medicare Advantage	$91.34
Rate for Payer: United Healthcare Medicare Advantage	$91.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$413.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$86.77
Rate for Payer: Wellcare Medicare	$86.77

ATOMOXETINE HCL 40 MG PO CAPS

Facility

$15.47

Service Code	NDC 0093354556
Hospital Charge Code	0093354556
Hospital Revenue Code	250
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$7.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.73

ATOMOXETINE HCL 40 MG PO CAPS

Facility

$15.47

Service Code	NDC 5511152130
Hospital Charge Code	5511152130
Hospital Revenue Code	250
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$7.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.73

ATOMOXETINE HCL 40 MG PO CAPS

Facility

$15.47

Service Code	NDC 0093354556
Hospital Charge Code	0093354556
Hospital Revenue Code	250
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$12.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.73
Rate for Payer: Aetna Government	$7.73
Rate for Payer: Brighton Health Commercial	$11.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.52
Rate for Payer: EmblemHealth Commercial	$7.73
Rate for Payer: Group Health Inc Commercial	$7.73
Rate for Payer: Group Health Inc Medicare	$5.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.73
Rate for Payer: Hamaspik Choice Inc Medicare	$7.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.05

Know your out-of-pocket cost for care.

All Charges