St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO

Professional

Both

$405.51

Service Code	HCPCS 95717
Min. Negotiated Rate	$55.94
Max. Negotiated Rate	$264.60
Rate for Payer: Amida Care Medicaid	$55.94
Rate for Payer: Cash Price	$117.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$117.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$105.84
Rate for Payer: Fidelis Essential Plan Aliesa	$105.84
Rate for Payer: Fidelis Essential Plan QHP	$111.72
Rate for Payer: Fidelis Medicare Advantage	$117.60
Rate for Payer: Fidelis Qualified Health Plan	$111.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$117.60
Rate for Payer: Hamaspik Choice Inc Medicare	$117.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$88.20
Rate for Payer: Healthfirst Commercial	$117.60
Rate for Payer: Healthfirst Essential Plan	$264.60
Rate for Payer: Healthfirst Medicare Advantage	$111.72
Rate for Payer: Healthfirst QHP	$117.60
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$82.32
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$117.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$99.96
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$82.32
Rate for Payer: Senior Whole Health Medicare Advantage	$117.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88.20
Rate for Payer: SOMOS Essential	$88.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.60

PR EEG PHYS/QHP 2-12 HR WITH VEEG

Professional

Both

$539.04

Service Code	HCPCS 95718
Min. Negotiated Rate	$73.81
Max. Negotiated Rate	$333.02
Rate for Payer: Amida Care Medicaid	$73.81
Rate for Payer: Cash Price	$149.83
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$148.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$133.21
Rate for Payer: Fidelis Essential Plan Aliesa	$133.21
Rate for Payer: Fidelis Essential Plan QHP	$140.61
Rate for Payer: Fidelis Medicare Advantage	$148.01
Rate for Payer: Fidelis Qualified Health Plan	$140.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.01
Rate for Payer: Hamaspik Choice Inc Medicare	$148.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$111.01
Rate for Payer: Healthfirst Commercial	$148.01
Rate for Payer: Healthfirst Essential Plan	$333.02
Rate for Payer: Healthfirst Medicare Advantage	$140.61
Rate for Payer: Healthfirst QHP	$148.01
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$103.61
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$148.01
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$125.81
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$103.61
Rate for Payer: Senior Whole Health Medicare Advantage	$148.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$111.01
Rate for Payer: SOMOS Essential	$111.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.01

PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID

Professional

Both

$634.31

Service Code	HCPCS 95719
Min. Negotiated Rate	$87.10
Max. Negotiated Rate	$397.78
Rate for Payer: Amida Care Medicaid	$87.10
Rate for Payer: Cash Price	$178.58
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$176.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$159.11
Rate for Payer: Fidelis Essential Plan Aliesa	$159.11
Rate for Payer: Fidelis Essential Plan QHP	$167.95
Rate for Payer: Fidelis Medicare Advantage	$176.79
Rate for Payer: Fidelis Qualified Health Plan	$167.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$176.79
Rate for Payer: Hamaspik Choice Inc Medicare	$176.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$132.59
Rate for Payer: Healthfirst Commercial	$176.79
Rate for Payer: Healthfirst Essential Plan	$397.78
Rate for Payer: Healthfirst Medicare Advantage	$167.95
Rate for Payer: Healthfirst QHP	$176.79
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$123.75
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$176.79
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$150.27
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$123.75
Rate for Payer: Senior Whole Health Medicare Advantage	$176.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$132.59
Rate for Payer: SOMOS Essential	$132.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$176.79

PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG

Professional

Both

$834.37

Service Code	HCPCS 95720
Min. Negotiated Rate	$114.31
Max. Negotiated Rate	$510.35
Rate for Payer: Amida Care Medicaid	$114.31
Rate for Payer: Cash Price	$230.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$226.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$204.14
Rate for Payer: Fidelis Essential Plan Aliesa	$204.14
Rate for Payer: Fidelis Essential Plan QHP	$215.48
Rate for Payer: Fidelis Medicare Advantage	$226.82
Rate for Payer: Fidelis Qualified Health Plan	$215.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.82
Rate for Payer: Hamaspik Choice Inc Medicare	$226.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$170.12
Rate for Payer: Healthfirst Commercial	$226.82
Rate for Payer: Healthfirst Essential Plan	$510.35
Rate for Payer: Healthfirst Medicare Advantage	$215.48
Rate for Payer: Healthfirst QHP	$226.82
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$158.77
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$226.82
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$192.80
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$158.77
Rate for Payer: Senior Whole Health Medicare Advantage	$226.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$170.12
Rate for Payer: SOMOS Essential	$170.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$226.82

PR EEG W/O VID BY TECH EA INCR 12-26 HR INTMT MNTR

Professional

Both

$2,123.66

Service Code	HCPCS 95709
Min. Negotiated Rate	$65.33
Max. Negotiated Rate	$65.33
Rate for Payer: Amida Care Medicaid	$65.33

PR EEG W/O VID BY TECH EA INCR 12-26HR UNMONITORED

Professional

Both

$626.05

Service Code	HCPCS 95708
Min. Negotiated Rate	$52.26
Max. Negotiated Rate	$52.26
Rate for Payer: Amida Care Medicaid	$52.26

PR EEG W/O VIDEO BY TECH 2-12HR CONTINUOUS R-T MNTR

Professional

Both

$1,643.71

Service Code	HCPCS 95707
Min. Negotiated Rate	$50.36
Max. Negotiated Rate	$50.36
Rate for Payer: Amida Care Medicaid	$50.36

PR EEG W/O VIDEO BY TECH 2-12 HR INTERMITTENT MNTR

Professional

Both

$1,196.37

Service Code	HCPCS 95706
Min. Negotiated Rate	$41.97
Max. Negotiated Rate	$41.97
Rate for Payer: Amida Care Medicaid	$41.97

PR EEG W/O VIDEO BY TECH 2-12 HR UNMONITORED

Professional

Both

$372.75

Service Code	HCPCS 95705
Min. Negotiated Rate	$33.57
Max. Negotiated Rate	$33.57
Rate for Payer: Amida Care Medicaid	$33.57

PR EEG W/O VID TECH EA INCR 12-26 HR CONT R-T MNTR

Professional

Both

$2,748.76

Service Code	HCPCS 95710
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$78.40
Rate for Payer: Amida Care Medicaid	$78.40

PREGABALIN 100 MG PO CAPS

Facility

$8.43

Service Code	NDC 5022835390
Hospital Charge Code	5022835390
Hospital Revenue Code	250
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$4.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.21

PREGABALIN 100 MG PO CAPS

Facility

$1.01

Service Code	NDC 0904700161
Hospital Charge Code	0904700161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.69
Rate for Payer: EmblemHealth Commercial	$0.50
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

PREGABALIN 100 MG PO CAPS

Facility

$8.43

Service Code	NDC 5022835390
Hospital Charge Code	5022835390
Hospital Revenue Code	250
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$6.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.21
Rate for Payer: Aetna Government	$4.21
Rate for Payer: Brighton Health Commercial	$6.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.73
Rate for Payer: EmblemHealth Commercial	$4.21
Rate for Payer: Group Health Inc Commercial	$4.21
Rate for Payer: Group Health Inc Medicare	$2.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.21
Rate for Payer: Hamaspik Choice Inc Medicare	$4.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.48

PREGABALIN 100 MG PO CAPS

Facility

$1.01

Service Code	NDC 0904700161
Hospital Charge Code	0904700161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

PREGABALIN 150 MG PO CAPS

Facility

$1.14

Service Code	NDC 0904700261
Hospital Charge Code	0904700261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Brighton Health Commercial	$0.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: EmblemHealth Commercial	$0.57
Rate for Payer: Group Health Inc Commercial	$0.57
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57
Rate for Payer: Hamaspik Choice Inc Medicare	$0.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.74

PREGABALIN 150 MG PO CAPS

Facility

$8.43

Service Code	NDC 7220501590
Hospital Charge Code	7220501590
Hospital Revenue Code	250
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$6.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.21
Rate for Payer: Aetna Government	$4.21
Rate for Payer: Brighton Health Commercial	$6.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.73
Rate for Payer: EmblemHealth Commercial	$4.21
Rate for Payer: Group Health Inc Commercial	$4.21
Rate for Payer: Group Health Inc Medicare	$2.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.21
Rate for Payer: Hamaspik Choice Inc Medicare	$4.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.48

PREGABALIN 150 MG PO CAPS

Facility

$1.14

Service Code	NDC 0904700261
Hospital Charge Code	0904700261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57

PREGABALIN 150 MG PO CAPS

Facility

$8.43

Service Code	NDC 7220501590
Hospital Charge Code	7220501590
Hospital Revenue Code	250
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$4.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.21

PREGABALIN 25 MG PO CAPS

Facility

$12.14

Service Code	NDC 0071101268
Hospital Charge Code	0071101268
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$9.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.07
Rate for Payer: Aetna Government	$6.07
Rate for Payer: Brighton Health Commercial	$9.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.26
Rate for Payer: EmblemHealth Commercial	$6.07
Rate for Payer: Group Health Inc Commercial	$6.07
Rate for Payer: Group Health Inc Medicare	$4.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.07
Rate for Payer: Hamaspik Choice Inc Medicare	$6.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.89

PREGABALIN 25 MG PO CAPS

Facility

$0.93

Service Code	NDC 0904699161
Hospital Charge Code	0904699161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.47
Rate for Payer: Aetna Government	$0.47
Rate for Payer: Brighton Health Commercial	$0.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.63
Rate for Payer: EmblemHealth Commercial	$0.47
Rate for Payer: Group Health Inc Commercial	$0.47
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.60

PREGABALIN 25 MG PO CAPS

Facility

$0.93

Service Code	NDC 0904699161
Hospital Charge Code	0904699161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47

PREGABALIN 25 MG PO CAPS

Facility

$12.14

Service Code	NDC 0071101268
Hospital Charge Code	0071101268
Hospital Revenue Code	250
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$6.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.07

PREGABALIN 300 MG PO CAPS

Facility

$12.14

Service Code	NDC 0071101868
Hospital Charge Code	0071101868
Hospital Revenue Code	250
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$6.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.07

PREGABALIN 300 MG PO CAPS

Facility

$12.14

Service Code	NDC 0071101868
Hospital Charge Code	0071101868
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$9.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.07
Rate for Payer: Aetna Government	$6.07
Rate for Payer: Brighton Health Commercial	$9.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.26
Rate for Payer: EmblemHealth Commercial	$6.07
Rate for Payer: Group Health Inc Commercial	$6.07
Rate for Payer: Group Health Inc Medicare	$4.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.07
Rate for Payer: Hamaspik Choice Inc Medicare	$6.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.89

PREGABALIN 50 MG PO CAPS

Facility

$0.91

Service Code	NDC 0904699261
Hospital Charge Code	0904699261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.62
Rate for Payer: EmblemHealth Commercial	$0.45
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

Know your out-of-pocket cost for care.

All Charges