St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ENFAMIL INFANT FORMULA W IRON

Facility

$0.45

Hospital Charge Code	41640252
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

ENFAMIL PREMATURE 30 CAL

Facility

$0.45

Hospital Charge Code	41650254
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

ENFAMIL PREMATURE 30 CAL

Facility

$0.45

Hospital Charge Code	41640254
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

ENFAMIL PREMATURE HIGH PROTEIN 24

Facility

$0.45

Hospital Charge Code	41650253
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

ENFAMIL PREMATURE HIGH PROTEIN 24

Facility

$0.45

Hospital Charge Code	41640253
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

ENFAMIL PREMATURE PO LIQD [112419]

Facility

$0.03

Service Code	NDC 00087511568
Hospital Charge Code	00087511568
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

ENFAMIL PREMATURE PO LIQD [112419]

Facility

$0.03

Service Code	NDC 00087511571
Hospital Charge Code	00087511571
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

ENFAMIL PREMATURE PO LIQD [112419]

Facility

$0.03

Service Code	NDC 00087511569
Hospital Charge Code	00087511569
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

ENFAMIL PRMATURE IRON FORTIFED 20

Facility

$0.45

Hospital Charge Code	41650256
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

ENFAMIL PRMATURE IRON FORTIFED 20

Facility

$0.45

Hospital Charge Code	41640256
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

ENFAMIL PRMATURE IRON FORTIFED 24

Facility

$0.45

Hospital Charge Code	41640259
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

ENFAMIL PRMATURE IRON FORTIFED 24

Facility

$0.45

Hospital Charge Code	41650259
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

ENFIT 10ML SYRINGE

Facility

$120.00

Hospital Charge Code	64903714
Hospital Revenue Code	270
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$96.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$60.00
Rate for Payer: Aetna Government	$60.00
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.60
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

ENFORTUMAB VEDOTIN-EJFV 20 MG IV SOLR [170496]

Facility

$3,370.80

Service Code	HCPCS J9177
Hospital Charge Code	51144002001
Hospital Revenue Code	278
Min. Negotiated Rate	$1,685.40
Max. Negotiated Rate	$1,685.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,685.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,685.40

ENFORTUMAB VEDOTIN-EJFV 20 MG IV SOLR [170496]

Facility

$3,370.80

Service Code	HCPCS J9177
Hospital Charge Code	51144002001
Hospital Revenue Code	278
Min. Negotiated Rate	$28.02
Max. Negotiated Rate	$2,191.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,853.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.03
Rate for Payer: Aetna Government	$35.03
Rate for Payer: Brighton Health Commercial	$2,022.48
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$35.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,685.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,938.21
Rate for Payer: Elderplan Medicare Advantage	$35.03
Rate for Payer: EmblemHealth Commercial	$1,685.40
Rate for Payer: Fidelis Medicare Advantage	$35.03
Rate for Payer: Group Health Inc Commercial	$35.03
Rate for Payer: Group Health Inc Medicare	$35.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,685.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,685.40
Rate for Payer: Healthfirst Medicare Advantage	$29.77
Rate for Payer: Healthfirst QHP	$35.03
Rate for Payer: Humana Medicare	$35.73
Rate for Payer: Senior Whole Health Medicare Advantage	$35.03
Rate for Payer: United Healthcare Medicare Advantage	$35.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,191.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28.02

ENFORTUMAB VEDOTIN-EJFV 30 MG IV SOLR [170497]

Facility

$5,056.20

Service Code	HCPCS J9177
Hospital Charge Code	51144003001
Hospital Revenue Code	278
Min. Negotiated Rate	$28.02
Max. Negotiated Rate	$3,286.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,780.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.03
Rate for Payer: Aetna Government	$35.03
Rate for Payer: Brighton Health Commercial	$3,033.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$35.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,528.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,907.32
Rate for Payer: Elderplan Medicare Advantage	$35.03
Rate for Payer: EmblemHealth Commercial	$2,528.10
Rate for Payer: Fidelis Medicare Advantage	$35.03
Rate for Payer: Group Health Inc Commercial	$35.03
Rate for Payer: Group Health Inc Medicare	$35.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,528.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2,528.10
Rate for Payer: Healthfirst Medicare Advantage	$29.77
Rate for Payer: Healthfirst QHP	$35.03
Rate for Payer: Humana Medicare	$35.73
Rate for Payer: Senior Whole Health Medicare Advantage	$35.03
Rate for Payer: United Healthcare Medicare Advantage	$35.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,286.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28.02

ENFORTUMAB VEDOTIN-EJFV 30 MG IV SOLR [170497]

Facility

$5,056.20

Service Code	HCPCS J9177
Hospital Charge Code	51144003001
Hospital Revenue Code	278
Min. Negotiated Rate	$2,528.10
Max. Negotiated Rate	$2,528.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,528.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2,528.10

ENFUVIRTIDE 90 MG/ML INJ

Facility

$83.00

Service Code	HCPCS J3490
Hospital Charge Code	41653763
Hospital Revenue Code	636
Min. Negotiated Rate	$41.50
Max. Negotiated Rate	$41.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.50
Rate for Payer: Hamaspik Choice Inc Medicare	$41.50

ENFUVIRTIDE 90 MG/ML INJ

Facility

$83.00

Service Code	HCPCS J3490
Hospital Charge Code	41643763
Hospital Revenue Code	636
Min. Negotiated Rate	$41.50
Max. Negotiated Rate	$41.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.50
Rate for Payer: Hamaspik Choice Inc Medicare	$41.50

ENFUVIRTIDE 90 MG/ML INJ

Facility

$83.00

Service Code	HCPCS J3490
Hospital Charge Code	41653763
Hospital Revenue Code	636
Min. Negotiated Rate	$29.05
Max. Negotiated Rate	$53.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.50
Rate for Payer: Aetna Government	$41.50
Rate for Payer: Brighton Health Commercial	$49.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.72
Rate for Payer: Group Health Inc Commercial	$41.50
Rate for Payer: Group Health Inc Medicare	$29.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.50
Rate for Payer: Hamaspik Choice Inc Medicare	$41.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.95

ENFUVIRTIDE 90 MG/ML INJ

Facility

$83.00

Service Code	HCPCS J3490
Hospital Charge Code	41643763
Hospital Revenue Code	636
Min. Negotiated Rate	$29.05
Max. Negotiated Rate	$53.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.50
Rate for Payer: Aetna Government	$41.50
Rate for Payer: Brighton Health Commercial	$49.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.72
Rate for Payer: Group Health Inc Commercial	$41.50
Rate for Payer: Group Health Inc Medicare	$29.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.50
Rate for Payer: Hamaspik Choice Inc Medicare	$41.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.95

ENIR MANIPULATION COMPL CARE

Facility

$57.70

Service Code	HCPCS 99499
Hospital Charge Code	30400245
Hospital Revenue Code	510
Min. Negotiated Rate	$28.85
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.85
Rate for Payer: Aetna Government	$28.85
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.85
Rate for Payer: Hamaspik Choice Inc Medicare	$28.85
Rate for Payer: United Healthcare Commercial	$222.00

ENOXAPARIN 100 MG/ML INJ

Facility

$14.92

Service Code	HCPCS J1650
Hospital Charge Code	41652062
Hospital Revenue Code	636
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$7.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.46
Rate for Payer: Hamaspik Choice Inc Medicare	$7.46

ENOXAPARIN 100 MG/ML INJ

Facility

$14.92

Service Code	HCPCS J1650
Hospital Charge Code	41652062
Hospital Revenue Code	636
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$9.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Brighton Health Commercial	$8.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.58
Rate for Payer: Group Health Inc Commercial	$7.46
Rate for Payer: Group Health Inc Medicare	$5.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.46
Rate for Payer: Hamaspik Choice Inc Medicare	$7.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.66
Rate for Payer: SOMOS Essential	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.70

ENOXAPARIN 100 MG/ML INJ

Facility

$14.92

Service Code	HCPCS J1650
Hospital Charge Code	41642062
Hospital Revenue Code	636
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$7.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.46
Rate for Payer: Hamaspik Choice Inc Medicare	$7.46

Know your out-of-pocket cost for care.

All Charges