St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$0.65

Service Code	NDC 67457090320
Hospital Charge Code	67457090320
Hospital Revenue Code	278
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Fidelis Medicare Advantage	$0.69
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$1.18

Service Code	NDC 67457090200
Hospital Charge Code	67457090200
Hospital Revenue Code	278
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$0.96

Service Code	NDC 55150022110
Hospital Charge Code	55150022110
Hospital Revenue Code	278
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$1.18

Service Code	NDC 67457090200
Hospital Charge Code	67457090200
Hospital Revenue Code	278
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$1.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.59
Rate for Payer: Aetna Government	$0.59
Rate for Payer: Brighton Health Commercial	$0.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: EmblemHealth Commercial	$0.59
Rate for Payer: Fidelis Medicare Advantage	$1.24
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$0.96

Service Code	NDC 55150022110
Hospital Charge Code	55150022110
Hospital Revenue Code	278
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$1.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.55
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Fidelis Medicare Advantage	$1.01
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$0.29

Service Code	NDC 72266014701
Hospital Charge Code	72266014701
Hospital Revenue Code	278
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15

ETOMIDATE INJECTION 2MG/ML, 10ML

Facility

$17.80

Hospital Charge Code	41646046
Hospital Revenue Code	250
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$14.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.90
Rate for Payer: Aetna Government	$8.90
Rate for Payer: Brighton Health Commercial	$13.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.10
Rate for Payer: Group Health Inc Commercial	$8.90
Rate for Payer: Group Health Inc Medicare	$6.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.90
Rate for Payer: Hamaspik Choice Inc Medicare	$8.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.57

ETOMIDATE INJECTION 2MG/ML, 10ML

Facility

$17.80

Hospital Charge Code	41656046
Hospital Revenue Code	250
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$14.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.90
Rate for Payer: Aetna Government	$8.90
Rate for Payer: Brighton Health Commercial	$13.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.10
Rate for Payer: Group Health Inc Commercial	$8.90
Rate for Payer: Group Health Inc Medicare	$6.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.90
Rate for Payer: Hamaspik Choice Inc Medicare	$8.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.57

ETONOGESTREL 68MG

Facility

$39.30

Service Code	HCPCS J7307
Hospital Charge Code	41656614
Hospital Revenue Code	636
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.65
Rate for Payer: Hamaspik Choice Inc Medicare	$19.65

ETONOGESTREL 68MG

Facility

$39.30

Service Code	HCPCS J7307
Hospital Charge Code	41656614
Hospital Revenue Code	636
Min. Negotiated Rate	$13.76
Max. Negotiated Rate	$1,030.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,030.64
Rate for Payer: Aetna Government	$1,030.64
Rate for Payer: Brighton Health Commercial	$23.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.60
Rate for Payer: Group Health Inc Commercial	$19.65
Rate for Payer: Group Health Inc Medicare	$13.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.65
Rate for Payer: Hamaspik Choice Inc Medicare	$19.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.55

ETONOGESTREL 68 MG SC IMPL [77012]

Facility

$1,387.54

Service Code	HCPCS J7307
Hospital Charge Code	78206014501
Hospital Revenue Code	250
Min. Negotiated Rate	$485.64
Max. Negotiated Rate	$1,110.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$763.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,030.64
Rate for Payer: Aetna Government	$1,030.64
Rate for Payer: Brighton Health Commercial	$1,040.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,110.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$943.53
Rate for Payer: Group Health Inc Commercial	$693.77
Rate for Payer: Group Health Inc Medicare	$485.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$693.77
Rate for Payer: Hamaspik Choice Inc Medicare	$693.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$901.90

ETOPOSIDE 100 MG/5ML IV SOLN [124656]

Facility

$2.25

Service Code	HCPCS J9181
Hospital Charge Code	00143951001
Hospital Revenue Code	278
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1.12

ETOPOSIDE 100 MG/5ML IV SOLN [124656]

Facility

$2.25

Service Code	HCPCS J9181
Hospital Charge Code	00143951001
Hospital Revenue Code	278
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$2.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.29
Rate for Payer: EmblemHealth Commercial	$1.12
Rate for Payer: Fidelis Medicare Advantage	$2.36
Rate for Payer: Group Health Inc Commercial	$1.12
Rate for Payer: Group Health Inc Medicare	$0.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.46

ETOPOSIDE 100 MG/5ML IV SOLN [124656]

Facility

$2.27

Service Code	HCPCS J9181
Hospital Charge Code	16729011431
Hospital Revenue Code	278
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1.14

ETOPOSIDE 100 MG/5ML IV SOLN [124656]

Facility

$2.27

Service Code	HCPCS J9181
Hospital Charge Code	16729011431
Hospital Revenue Code	278
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$2.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.31
Rate for Payer: EmblemHealth Commercial	$1.14
Rate for Payer: Fidelis Medicare Advantage	$2.39
Rate for Payer: Group Health Inc Commercial	$1.14
Rate for Payer: Group Health Inc Medicare	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.48

ETOPOSIDE 20 MG/ML INJ MDV

Facility

$8.00

Service Code	HCPCS J9181
Hospital Charge Code	41643832
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00

ETOPOSIDE 20 MG/ML INJ MDV

Facility

$8.00

Service Code	HCPCS J9181
Hospital Charge Code	41653832
Hospital Revenue Code	636
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$4.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.60
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.11
Rate for Payer: SOMOS Essential	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

ETOPOSIDE 20 MG/ML INJ MDV

Facility

$8.00

Service Code	HCPCS J9181
Hospital Charge Code	41643832
Hospital Revenue Code	636
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$4.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.60
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.11
Rate for Payer: SOMOS Essential	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

ETOPOSIDE 20 MG/ML INJ MDV

Facility

$8.00

Service Code	HCPCS J9181
Hospital Charge Code	41653832
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00

ETRAVIRINE 100 MG PO TABS [89432]

Facility

$14.98

Service Code	NDC 59676057001
Hospital Charge Code	59676057001
Hospital Revenue Code	250
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$11.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.49
Rate for Payer: Aetna Government	$7.49
Rate for Payer: Brighton Health Commercial	$11.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.19
Rate for Payer: Group Health Inc Commercial	$7.49
Rate for Payer: Group Health Inc Medicare	$5.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.49
Rate for Payer: Hamaspik Choice Inc Medicare	$7.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.74

ETRAVIRINE 100 MG TAB

Facility

$13.45

Hospital Charge Code	41644901
Hospital Revenue Code	250
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$10.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.72
Rate for Payer: Aetna Government	$6.72
Rate for Payer: Brighton Health Commercial	$10.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.15
Rate for Payer: Group Health Inc Commercial	$6.72
Rate for Payer: Group Health Inc Medicare	$4.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.72
Rate for Payer: Hamaspik Choice Inc Medicare	$6.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.74

ETRAVIRINE 100 MG TAB

Facility

$13.45

Hospital Charge Code	41654901
Hospital Revenue Code	250
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$10.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.72
Rate for Payer: Aetna Government	$6.72
Rate for Payer: Brighton Health Commercial	$10.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.15
Rate for Payer: Group Health Inc Commercial	$6.72
Rate for Payer: Group Health Inc Medicare	$4.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.72
Rate for Payer: Hamaspik Choice Inc Medicare	$6.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.74

ETRAVIRINE 200 MG PO TABS [108431]

Facility

$26.82

Service Code	NDC 60219172206
Hospital Charge Code	60219172206
Hospital Revenue Code	250
Min. Negotiated Rate	$9.39
Max. Negotiated Rate	$21.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.41
Rate for Payer: Aetna Government	$13.41
Rate for Payer: Brighton Health Commercial	$20.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.24
Rate for Payer: Group Health Inc Commercial	$13.41
Rate for Payer: Group Health Inc Medicare	$9.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.41
Rate for Payer: Hamaspik Choice Inc Medicare	$13.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.43

ETRAVIRINE 200MG TAB

Facility

$41.77

Hospital Charge Code	41646613
Hospital Revenue Code	250
Min. Negotiated Rate	$14.62
Max. Negotiated Rate	$33.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.89
Rate for Payer: Aetna Government	$20.89
Rate for Payer: Brighton Health Commercial	$31.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.40
Rate for Payer: Group Health Inc Commercial	$20.89
Rate for Payer: Group Health Inc Medicare	$14.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.89
Rate for Payer: Hamaspik Choice Inc Medicare	$20.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.15

ETRAVIRINE 200MG TAB

Facility

$41.77

Hospital Charge Code	41656613
Hospital Revenue Code	250
Min. Negotiated Rate	$14.62
Max. Negotiated Rate	$33.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.89
Rate for Payer: Aetna Government	$20.89
Rate for Payer: Brighton Health Commercial	$31.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.40
Rate for Payer: Group Health Inc Commercial	$20.89
Rate for Payer: Group Health Inc Medicare	$14.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.89
Rate for Payer: Hamaspik Choice Inc Medicare	$20.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.15

Know your out-of-pocket cost for care.

All Charges