St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ETHICON MESH PROLENE 6X6

Facility

$1,247.00

Service Code	HCPCS C1781
Hospital Charge Code	40209967
Hospital Revenue Code	278
Min. Negotiated Rate	$623.50
Max. Negotiated Rate	$623.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$623.50
Rate for Payer: Hamaspik Choice Inc Medicare	$623.50

ETHICON SKIN STAPLER WIDE

Facility

$54.00

Hospital Charge Code	40008301
Hospital Revenue Code	270
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$43.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.00
Rate for Payer: Aetna Government	$27.00
Rate for Payer: Brighton Health Commercial	$40.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.72
Rate for Payer: Group Health Inc Commercial	$27.00
Rate for Payer: Group Health Inc Medicare	$18.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.00
Rate for Payer: Hamaspik Choice Inc Medicare	$27.00

ETHI ECHELON ENDO 60MM STAPLER

Facility

$2,264.72

Hospital Charge Code	40004202
Hospital Revenue Code	272
Min. Negotiated Rate	$792.65
Max. Negotiated Rate	$1,811.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,245.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,132.36
Rate for Payer: Aetna Government	$1,132.36
Rate for Payer: Brighton Health Commercial	$1,698.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,811.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,540.01
Rate for Payer: Group Health Inc Commercial	$1,132.36
Rate for Payer: Group Health Inc Medicare	$792.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,132.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1,132.36

ETHI MESH PRO 12X12 IN

Facility

$277.00

Service Code	HCPCS C1781
Hospital Charge Code	40008309
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$290.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$166.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$138.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.28
Rate for Payer: EmblemHealth Commercial	$138.50
Rate for Payer: Fidelis Medicare Advantage	$290.85
Rate for Payer: Group Health Inc Commercial	$138.50
Rate for Payer: Group Health Inc Medicare	$96.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.50
Rate for Payer: Hamaspik Choice Inc Medicare	$138.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.05

ETHI MESH PRO 12X12 IN

Facility

$277.00

Service Code	HCPCS C1781
Hospital Charge Code	40008309
Hospital Revenue Code	278
Min. Negotiated Rate	$138.50
Max. Negotiated Rate	$138.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.50
Rate for Payer: Hamaspik Choice Inc Medicare	$138.50

ETHI MESH PRO 6X6 IN

Facility

$736.60

Service Code	HCPCS C1781
Hospital Charge Code	40008310
Hospital Revenue Code	278
Min. Negotiated Rate	$368.30
Max. Negotiated Rate	$368.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.30
Rate for Payer: Hamaspik Choice Inc Medicare	$368.30

ETHI MESH PRO 6X6 IN

Facility

$736.60

Service Code	HCPCS C1781
Hospital Charge Code	40008310
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$773.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$405.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$441.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$368.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$423.54
Rate for Payer: EmblemHealth Commercial	$368.30
Rate for Payer: Fidelis Medicare Advantage	$773.43
Rate for Payer: Group Health Inc Commercial	$368.30
Rate for Payer: Group Health Inc Medicare	$257.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.30
Rate for Payer: Hamaspik Choice Inc Medicare	$368.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$478.79

ETHINYL ESTRADIOL + LEVONORGESTREL 0.03

Facility

$2.00

Hospital Charge Code	41643897
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

ETHINYL ESTRADIOL + LEVONORGESTREL 0.03

Facility

$2.00

Hospital Charge Code	41653897
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

ETHIODIZED OIL INJ - NF

Facility

$151.00

Hospital Charge Code	41653274
Hospital Revenue Code	250
Min. Negotiated Rate	$52.85
Max. Negotiated Rate	$120.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.50
Rate for Payer: Aetna Government	$75.50
Rate for Payer: Brighton Health Commercial	$113.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.68
Rate for Payer: Group Health Inc Commercial	$75.50
Rate for Payer: Group Health Inc Medicare	$52.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.50
Rate for Payer: Hamaspik Choice Inc Medicare	$75.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$98.15

ETHIODIZED OIL INJ - NF

Facility

$151.00

Hospital Charge Code	41643274
Hospital Revenue Code	250
Min. Negotiated Rate	$52.85
Max. Negotiated Rate	$120.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.50
Rate for Payer: Aetna Government	$75.50
Rate for Payer: Brighton Health Commercial	$113.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.68
Rate for Payer: Group Health Inc Commercial	$75.50
Rate for Payer: Group Health Inc Medicare	$52.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.50
Rate for Payer: Hamaspik Choice Inc Medicare	$75.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$98.15

ETHIONAMIDE 250MG TAB

Facility

$6.96

Hospital Charge Code	41653992
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.48
Rate for Payer: Aetna Government	$3.48
Rate for Payer: Brighton Health Commercial	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.73
Rate for Payer: Group Health Inc Commercial	$3.48
Rate for Payer: Group Health Inc Medicare	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.48
Rate for Payer: Hamaspik Choice Inc Medicare	$3.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.52

ETHIONAMIDE 250MG TAB

Facility

$6.96

Hospital Charge Code	41643992
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.48
Rate for Payer: Aetna Government	$3.48
Rate for Payer: Brighton Health Commercial	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.73
Rate for Payer: Group Health Inc Commercial	$3.48
Rate for Payer: Group Health Inc Medicare	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.48
Rate for Payer: Hamaspik Choice Inc Medicare	$3.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.52

ETHI REL ECHELO 60 3.6MM X 60

Facility

$4,313.76

Hospital Charge Code	40004204
Hospital Revenue Code	272
Min. Negotiated Rate	$1,509.82
Max. Negotiated Rate	$3,451.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,372.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,156.88
Rate for Payer: Aetna Government	$2,156.88
Rate for Payer: Brighton Health Commercial	$3,235.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,451.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,933.36
Rate for Payer: Group Health Inc Commercial	$2,156.88
Rate for Payer: Group Health Inc Medicare	$1,509.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,156.88
Rate for Payer: Hamaspik Choice Inc Medicare	$2,156.88

ETHI VENTRAL PATCH 4.3X4.3CM PVPS

Facility

$1,030.00

Service Code	HCPCS C1781
Hospital Charge Code	40208103
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,081.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$566.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$618.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$515.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$592.25
Rate for Payer: EmblemHealth Commercial	$515.00
Rate for Payer: Fidelis Medicare Advantage	$1,081.50
Rate for Payer: Group Health Inc Commercial	$515.00
Rate for Payer: Group Health Inc Medicare	$360.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.50

ETHI VENTRAL PATCH 4.3X4.3CM PVPS

Facility

$1,030.00

Service Code	HCPCS C1781
Hospital Charge Code	40208103
Hospital Revenue Code	278
Min. Negotiated Rate	$515.00
Max. Negotiated Rate	$515.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00

ETHI VENTRAL PTCH 6.4X6.4CM PVPM

Facility

$1,232.00

Service Code	HCPCS C1781
Hospital Charge Code	40208100
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,293.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$677.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$739.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$616.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$708.40
Rate for Payer: EmblemHealth Commercial	$616.00
Rate for Payer: Fidelis Medicare Advantage	$1,293.60
Rate for Payer: Group Health Inc Commercial	$616.00
Rate for Payer: Group Health Inc Medicare	$431.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$616.00
Rate for Payer: Hamaspik Choice Inc Medicare	$616.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$800.80

ETHI VENTRAL PTCH 6.4X6.4CM PVPM

Facility

$1,232.00

Service Code	HCPCS C1781
Hospital Charge Code	40208100
Hospital Revenue Code	278
Min. Negotiated Rate	$616.00
Max. Negotiated Rate	$616.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$616.00
Rate for Payer: Hamaspik Choice Inc Medicare	$616.00

ETHOSUXIMIDE 250 MG/5ML PO SOLN [38489]

Facility

$0.50

Service Code	NDC 00121067016
Hospital Charge Code	00121067016
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

ETHOSUXIMIDE 250MG/5ML SYRUP

Facility

$0.08

Hospital Charge Code	41652662
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	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
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

ETHOSUXIMIDE 250MG/5ML SYRUP

Facility

$0.08

Hospital Charge Code	41642662
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	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
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

ETHOSUXIMIDE (ZARONTIN) SERUM

Facility

$40.85

Service Code	HCPCS 80168
Hospital Charge Code	40609716
Hospital Revenue Code	301
Rate for Payer: Cash Price	$16.34

ETHOSUXIMIDE (ZARONTIN) SERUM

Facility

$40.85

Service Code	HCPCS 80168
Hospital Charge Code	40609716
Hospital Revenue Code	301
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$30.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.34
Rate for Payer: Aetna Government	$16.34
Rate for Payer: Affinity Essential Plan 1&2	$11.44
Rate for Payer: Affinity Essential Plan 3&4	$11.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.44
Rate for Payer: Brighton Health Commercial	$30.64
Rate for Payer: Cash Price	$16.34
Rate for Payer: Cash Price	$16.34
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.98
Rate for Payer: Elderplan Medicare Advantage	$16.34
Rate for Payer: EmblemHealth Commercial	$16.34
Rate for Payer: Fidelis Essential Plan Aliesa	$13.89
Rate for Payer: Fidelis Essential Plan QHP	$14.54
Rate for Payer: Fidelis Medicare Advantage	$16.34
Rate for Payer: Fidelis Qualified Health Plan	$14.54
Rate for Payer: Group Health Inc Commercial	$16.34
Rate for Payer: Group Health Inc Medicare	$16.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.42
Rate for Payer: Hamaspik Choice Inc Medicare	$16.34
Rate for Payer: Healthfirst Medicare Advantage	$16.34
Rate for Payer: Healthfirst QHP	$16.34
Rate for Payer: Humana Medicare	$16.67
Rate for Payer: Senior Whole Health Medicare Advantage	$16.34
Rate for Payer: United Healthcare Commercial	$20.70
Rate for Payer: United Healthcare Medicare Advantage	$16.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.07
Rate for Payer: Wellcare Medicare	$14.71

ETHYL ALCOHOL 100 % SOLN [21960]

Facility

$0.00

Service Code	NDC 50483300004
Hospital Charge Code	50483300004
Hospital Revenue Code	250
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	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$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	$0.00

ETHYL ALCOHOL 100 % SOLN [21960]

Facility

$0.00

Service Code	NDC 50483300005
Hospital Charge Code	50483300005
Hospital Revenue Code	250
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	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$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	$0.00

Know your out-of-pocket cost for care.

All Charges