St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BICTEGRAVIR-EMTRICITAB-TENOFOV 50-200-25 MG PO TABS

Facility

$159.25

Service Code	NDC 6195825013
Hospital Charge Code	6195825013
Hospital Revenue Code	250
Min. Negotiated Rate	$79.62
Max. Negotiated Rate	$79.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.62

BICTEGRAVIR-EMTRICITAB-TENOFOV 50-200-25 MG PO TABS

Facility

$159.25

Service Code	NDC 6195825011
Hospital Charge Code	6195825011
Hospital Revenue Code	250
Min. Negotiated Rate	$79.62
Max. Negotiated Rate	$79.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.62

Bipolar disorders

Facility

$19,688.00

Service Code	APR-DRG 7534
Min. Negotiated Rate	$3,501.63
Max. Negotiated Rate	$19,688.00
Rate for Payer: Affinity Essential Plan 1&2	$3,501.63
Rate for Payer: Affinity Essential Plan 3&4	$3,501.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,501.63
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,501.63
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,878.67
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,501.63
Rate for Payer: Fidelis Qualified Health Plan	$4,201.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,501.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,501.63
Rate for Payer: Healthfirst Commercial	$19,688.00
Rate for Payer: Healthfirst Essential Plan	$7,878.67
Rate for Payer: Healthfirst QHP	$6,372.97
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,501.63
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,878.67
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,878.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,501.63
Rate for Payer: SOMOS Essential	$7,878.67
Rate for Payer: United Healthcare Essential Plan 1&2	$7,878.67
Rate for Payer: United Healthcare Essential Plan 3&4	$7,878.67
Rate for Payer: United Healthcare Medicaid	$3,501.63

Bipolar disorders

Facility

$16,278.00

Service Code	APR-DRG 7532
Min. Negotiated Rate	$3,351.95
Max. Negotiated Rate	$16,278.00
Rate for Payer: Affinity Essential Plan 1&2	$3,351.95
Rate for Payer: Affinity Essential Plan 3&4	$3,351.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,351.95
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,351.95
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,541.89
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,351.95
Rate for Payer: Fidelis Qualified Health Plan	$4,022.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,351.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,351.95
Rate for Payer: Healthfirst Commercial	$16,278.00
Rate for Payer: Healthfirst Essential Plan	$7,541.89
Rate for Payer: Healthfirst QHP	$6,100.55
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,351.95
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,541.89
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,541.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,351.95
Rate for Payer: SOMOS Essential	$7,541.89
Rate for Payer: United Healthcare Essential Plan 1&2	$7,541.89
Rate for Payer: United Healthcare Essential Plan 3&4	$7,541.89
Rate for Payer: United Healthcare Medicaid	$3,351.95

Bipolar disorders

Facility

$16,278.00

Service Code	APR-DRG 7531
Min. Negotiated Rate	$3,309.29
Max. Negotiated Rate	$16,278.00
Rate for Payer: Affinity Essential Plan 1&2	$3,309.29
Rate for Payer: Affinity Essential Plan 3&4	$3,309.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,309.29
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,309.29
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,445.90
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,309.29
Rate for Payer: Fidelis Qualified Health Plan	$3,971.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,309.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,309.29
Rate for Payer: Healthfirst Commercial	$16,278.00
Rate for Payer: Healthfirst Essential Plan	$7,445.90
Rate for Payer: Healthfirst QHP	$6,022.91
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,309.29
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,445.90
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,445.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,309.29
Rate for Payer: SOMOS Essential	$7,445.90
Rate for Payer: United Healthcare Essential Plan 1&2	$7,445.90
Rate for Payer: United Healthcare Essential Plan 3&4	$7,445.90
Rate for Payer: United Healthcare Medicaid	$3,309.29

Bipolar disorders

Facility

$19,688.00

Service Code	APR-DRG 7533
Min. Negotiated Rate	$3,402.38
Max. Negotiated Rate	$19,688.00
Rate for Payer: Affinity Essential Plan 1&2	$3,402.38
Rate for Payer: Affinity Essential Plan 3&4	$3,402.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,402.38
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,402.38
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,655.35
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,402.38
Rate for Payer: Fidelis Qualified Health Plan	$4,082.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,402.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,402.38
Rate for Payer: Healthfirst Commercial	$19,688.00
Rate for Payer: Healthfirst Essential Plan	$7,655.35
Rate for Payer: Healthfirst QHP	$6,192.33
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,402.38
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,655.35
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,655.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,402.38
Rate for Payer: SOMOS Essential	$7,655.35
Rate for Payer: United Healthcare Essential Plan 1&2	$7,655.35
Rate for Payer: United Healthcare Essential Plan 3&4	$7,655.35
Rate for Payer: United Healthcare Medicaid	$3,402.38

BIPOLAR DISORDERS

Facility

$211.05

Service Code	EAPG 00823
Min. Negotiated Rate	$152.74
Max. Negotiated Rate	$211.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.74
Rate for Payer: Healthfirst Commercial	$211.05

BISACODYL 10 MG RE SUPP

Facility

$0.26

Service Code	NDC 5789644312
Hospital Charge Code	5789644312
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

BISACODYL 10 MG RE SUPP

Facility

$0.42

Service Code	NDC 0574705012
Hospital Charge Code	0574705012
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21

BISACODYL 10 MG RE SUPP

Facility

$0.42

Service Code	NDC 0574705012
Hospital Charge Code	0574705012
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: EmblemHealth Commercial	$0.21
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

BISACODYL 10 MG RE SUPP

Facility

$0.32

Service Code	NDC 0574705050
Hospital Charge Code	0574705050
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: EmblemHealth Commercial	$0.16
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

BISACODYL 10 MG RE SUPP

Facility

$0.26

Service Code	NDC 5789644312
Hospital Charge Code	5789644312
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

BISACODYL 10 MG RE SUPP

Facility

$0.32

Service Code	NDC 0574705050
Hospital Charge Code	0574705050
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16

BISACODYL 5 MG PO TBEC

Facility

$0.02

Service Code	NDC 0904674860
Hospital Charge Code	0904674860
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

BISACODYL 5 MG PO TBEC

Facility

$0.07

Service Code	NDC 0904640761
Hospital Charge Code	0904640761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

BISACODYL 5 MG PO TBEC

Facility

$0.02

Service Code	NDC 5789644101
Hospital Charge Code	5789644101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

BISACODYL 5 MG PO TBEC

Facility

$0.02

Service Code	NDC 0904674860
Hospital Charge Code	0904674860
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	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
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	$0.01
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	$0.01

BISACODYL 5 MG PO TBEC

Facility

$0.07

Service Code	NDC 0904640761
Hospital Charge Code	0904640761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
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	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

BISACODYL 5 MG PO TBEC

Facility

$0.02

Service Code	NDC 5789644101
Hospital Charge Code	5789644101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
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	$0.01
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	$0.01

BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP

Facility

$0.02

Service Code	NDC 0149003956
Hospital Charge Code	0149003956
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	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
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	$0.01

BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP

Facility

$0.02

Service Code	NDC 0536128636
Hospital Charge Code	0536128636
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP

Facility

$0.02

Service Code	NDC 0536128636
Hospital Charge Code	0536128636
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
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	$0.01
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	$0.01

BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP

Facility

$0.02

Service Code	NDC 0149003956
Hospital Charge Code	0149003956
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

BISMUTH SUBSALICYLATE 262 MG PO CHEW

Facility

$0.19

Service Code	NDC 0149032040
Hospital Charge Code	0149032040
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

BISMUTH SUBSALICYLATE 262 MG PO CHEW

Facility

$0.19

Service Code	NDC 0149032040
Hospital Charge Code	0149032040
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

Know your out-of-pocket cost for care.

All Charges