St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ETHACRYNATE SODIUM 50 MG IV SOLR [9979]

Facility

$4,560.00

Service Code	NDC 42023015701
Hospital Charge Code	42023015701
Hospital Revenue Code	278
Min. Negotiated Rate	$2,280.00
Max. Negotiated Rate	$2,280.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,280.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,280.00

ETHACRYNIC ACID 25 MG PO TABS [9980]

Facility

$24.19

Service Code	NDC 69238112601
Hospital Charge Code	69238112601
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: 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 TAB

Facility

$7.00

Hospital Charge Code	41653955
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

ETHACRYNIC ACID 25 MG TAB

Facility

$7.00

Hospital Charge Code	41643955
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

ETHAMBUTOL 100 MG TAB

Facility

$2.00

Hospital Charge Code	41650643
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

ETHAMBUTOL 100 MG TAB

Facility

$2.00

Hospital Charge Code	41640643
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

ETHAMBUTOL 400 MG TAB

Facility

$1.68

Hospital Charge Code	41653501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

ETHAMBUTOL 400 MG TAB

Facility

$1.68

Hospital Charge Code	41643501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

ETHAMBUTOL HCL 100 MG PO TABS [9982]

Facility

$0.59

Service Code	NDC 68180028001
Hospital Charge Code	68180028001
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: 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 400 MG PO TABS [9983]

Facility

$0.72

Service Code	NDC 54879000201
Hospital Charge Code	54879000201
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: 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 [9983]

Facility

$0.98

Service Code	NDC 68850001202
Hospital Charge Code	68850001202
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.66
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.63

ETHAMBUTOL, SERUM/PLASMA

Facility

$105.00

Service Code	HCPCS 80375
Hospital Charge Code	40609882
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$84.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$78.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.40
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50
Rate for Payer: United Healthcare Commercial	$19.94

ETHANOL URINE

Facility

$32.15

Service Code	HCPCS 80320
Hospital Charge Code	40609713
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$25.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$24.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.86
Rate for Payer: Group Health Inc Commercial	$16.08
Rate for Payer: Group Health Inc Medicare	$11.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.08
Rate for Payer: Hamaspik Choice Inc Medicare	$16.08
Rate for Payer: United Healthcare Commercial	$21.17

ETHIBOND MINI QUICK ANCHOR

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	40200172
Hospital Revenue Code	278
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00

ETHIBOND MINI QUICK ANCHOR

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	40200172
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$682.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$390.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$325.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$373.75
Rate for Payer: EmblemHealth Commercial	$325.00
Rate for Payer: Fidelis Medicare Advantage	$682.50
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$422.50

ETHICON 0.15X50X40MM PDS FLEX PLT

Facility

$858.00

Service Code	HCPCS C1713
Hospital Charge Code	40205627
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$900.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$471.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$514.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$429.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$493.35
Rate for Payer: EmblemHealth Commercial	$429.00
Rate for Payer: Fidelis Medicare Advantage	$900.90
Rate for Payer: Group Health Inc Commercial	$429.00
Rate for Payer: Group Health Inc Medicare	$300.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$429.00
Rate for Payer: Hamaspik Choice Inc Medicare	$429.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$557.70

ETHICON 0.15X50X40MM PDS FLEX PLT

Facility

$858.00

Service Code	HCPCS C1713
Hospital Charge Code	40205627
Hospital Revenue Code	278
Min. Negotiated Rate	$429.00
Max. Negotiated Rate	$429.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$429.00
Rate for Payer: Hamaspik Choice Inc Medicare	$429.00

ETHICON E FLEX 35 VASC STAPLER

Facility

$2,112.00

Hospital Charge Code	40008272
Hospital Revenue Code	272
Min. Negotiated Rate	$739.20
Max. Negotiated Rate	$1,689.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,161.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,056.00
Rate for Payer: Aetna Government	$1,056.00
Rate for Payer: Brighton Health Commercial	$1,584.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,689.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,436.16
Rate for Payer: Group Health Inc Commercial	$1,056.00
Rate for Payer: Group Health Inc Medicare	$739.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,056.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,056.00

ETHICON MESH KNIT VICRYL 12X12

Facility

$2,400.00

Service Code	HCPCS C1781
Hospital Charge Code	40209931
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00

ETHICON MESH KNIT VICRYL 12X12

Facility

$2,400.00

Service Code	HCPCS C1781
Hospital Charge Code	40209931
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,320.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,440.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,380.00
Rate for Payer: EmblemHealth Commercial	$1,200.00
Rate for Payer: Fidelis Medicare Advantage	$2,520.00
Rate for Payer: Group Health Inc Commercial	$1,200.00
Rate for Payer: Group Health Inc Medicare	$840.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,560.00

ETHICON MESH PROLENE 12X12

Facility

$471.80

Service Code	HCPCS C1781
Hospital Charge Code	40209932
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$495.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$259.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$283.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$271.28
Rate for Payer: EmblemHealth Commercial	$235.90
Rate for Payer: Fidelis Medicare Advantage	$495.39
Rate for Payer: Group Health Inc Commercial	$235.90
Rate for Payer: Group Health Inc Medicare	$165.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.90
Rate for Payer: Hamaspik Choice Inc Medicare	$235.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$306.67

ETHICON MESH PROLENE 12X12

Facility

$471.80

Service Code	HCPCS C1781
Hospital Charge Code	40209932
Hospital Revenue Code	278
Min. Negotiated Rate	$235.90
Max. Negotiated Rate	$235.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.90
Rate for Payer: Hamaspik Choice Inc Medicare	$235.90

ETHICON MESH PROLENE 3X6

Facility

$166.00

Service Code	HCPCS C1781
Hospital Charge Code	40209974
Hospital Revenue Code	278
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$174.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$99.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$83.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.45
Rate for Payer: EmblemHealth Commercial	$83.00
Rate for Payer: Fidelis Medicare Advantage	$174.30
Rate for Payer: Group Health Inc Commercial	$83.00
Rate for Payer: Group Health Inc Medicare	$58.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.00
Rate for Payer: Hamaspik Choice Inc Medicare	$83.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$107.90

ETHICON MESH PROLENE 3X6

Facility

$166.00

Service Code	HCPCS C1781
Hospital Charge Code	40209974
Hospital Revenue Code	278
Min. Negotiated Rate	$83.00
Max. Negotiated Rate	$83.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.00
Rate for Payer: Hamaspik Choice Inc Medicare	$83.00

ETHICON MESH PROLENE 6X6

Facility

$1,247.00

Service Code	HCPCS C1781
Hospital Charge Code	40209967
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,309.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$685.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$748.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$623.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$717.02
Rate for Payer: EmblemHealth Commercial	$623.50
Rate for Payer: Fidelis Medicare Advantage	$1,309.35
Rate for Payer: Group Health Inc Commercial	$623.50
Rate for Payer: Group Health Inc Medicare	$436.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$623.50
Rate for Payer: Hamaspik Choice Inc Medicare	$623.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$810.55

Know your out-of-pocket cost for care.

All Charges