St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Acute myocardial infarction

Facility

$57,532.57

Service Code	APR-DRG 1903
Min. Negotiated Rate	$14,364.00
Max. Negotiated Rate	$57,532.57
Rate for Payer: Affinity Essential Plan 1&2	$57,532.57
Rate for Payer: Affinity Essential Plan 3&4	$57,532.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,570.03
Rate for Payer: Amida Care Medicaid	$25,570.03
Rate for Payer: EmblemHealth Essential Plan 1&2	$57,532.57
Rate for Payer: EmblemHealth Essential Plan 3&4	$25,570.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,570.03
Rate for Payer: Fidelis Qualified Health Plan	$30,684.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,570.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,570.03
Rate for Payer: Healthfirst Commercial	$26,129.00
Rate for Payer: Healthfirst Essential Plan	$57,532.57
Rate for Payer: Healthfirst QHP	$14,364.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,570.03
Rate for Payer: SOMOS Essential	$57,532.57
Rate for Payer: United Healthcare Essential Plan 1&2	$57,532.57
Rate for Payer: United Healthcare Essential Plan 3&4	$57,532.57
Rate for Payer: United Healthcare Medicaid	$25,570.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,570.03

Acute myocardial infarction

Facility

$81,493.72

Service Code	APR-DRG 1904
Min. Negotiated Rate	$24,966.00
Max. Negotiated Rate	$81,493.72
Rate for Payer: Affinity Essential Plan 1&2	$81,493.72
Rate for Payer: Affinity Essential Plan 3&4	$81,493.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$36,219.43
Rate for Payer: Amida Care Medicaid	$36,219.43
Rate for Payer: EmblemHealth Essential Plan 1&2	$81,493.72
Rate for Payer: EmblemHealth Essential Plan 3&4	$36,219.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,219.43
Rate for Payer: Fidelis Qualified Health Plan	$43,463.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,219.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,219.43
Rate for Payer: Healthfirst Commercial	$45,975.00
Rate for Payer: Healthfirst Essential Plan	$81,493.72
Rate for Payer: Healthfirst QHP	$24,966.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,219.43
Rate for Payer: SOMOS Essential	$81,493.72
Rate for Payer: United Healthcare Essential Plan 1&2	$81,493.72
Rate for Payer: United Healthcare Essential Plan 3&4	$81,493.72
Rate for Payer: United Healthcare Medicaid	$36,219.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,219.43

Acute myocardial infarction

Facility

$44,955.76

Service Code	APR-DRG 1901
Min. Negotiated Rate	$8,833.00
Max. Negotiated Rate	$44,955.76
Rate for Payer: Affinity Essential Plan 1&2	$44,955.76
Rate for Payer: Affinity Essential Plan 3&4	$44,955.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,980.34
Rate for Payer: Amida Care Medicaid	$19,980.34
Rate for Payer: EmblemHealth Essential Plan 1&2	$44,955.76
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,980.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,980.34
Rate for Payer: Fidelis Qualified Health Plan	$23,976.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,980.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,980.34
Rate for Payer: Healthfirst Commercial	$14,788.00
Rate for Payer: Healthfirst Essential Plan	$44,955.76
Rate for Payer: Healthfirst QHP	$8,833.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,980.34
Rate for Payer: SOMOS Essential	$44,955.76
Rate for Payer: United Healthcare Essential Plan 1&2	$44,955.76
Rate for Payer: United Healthcare Essential Plan 3&4	$44,955.76
Rate for Payer: United Healthcare Medicaid	$19,980.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,980.34

ACUTE MYOCARDIAL INFARCTION

Facility

$469.86

Service Code	EAPG 00591
Min. Negotiated Rate	$340.20
Max. Negotiated Rate	$469.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$340.20
Rate for Payer: Healthfirst Commercial	$469.86

Acute & subacute endocarditis

Facility

$69,885.99

Service Code	APR-DRG 1933
Min. Negotiated Rate	$24,164.00
Max. Negotiated Rate	$69,885.99
Rate for Payer: Affinity Essential Plan 1&2	$69,885.99
Rate for Payer: Affinity Essential Plan 3&4	$69,885.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,060.44
Rate for Payer: Amida Care Medicaid	$31,060.44
Rate for Payer: EmblemHealth Essential Plan 1&2	$69,885.99
Rate for Payer: EmblemHealth Essential Plan 3&4	$31,060.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,060.44
Rate for Payer: Fidelis Qualified Health Plan	$37,272.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,060.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,060.44
Rate for Payer: Healthfirst Commercial	$39,405.00
Rate for Payer: Healthfirst Essential Plan	$69,885.99
Rate for Payer: Healthfirst QHP	$24,164.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,060.44
Rate for Payer: SOMOS Essential	$69,885.99
Rate for Payer: United Healthcare Essential Plan 1&2	$69,885.99
Rate for Payer: United Healthcare Essential Plan 3&4	$69,885.99
Rate for Payer: United Healthcare Medicaid	$31,060.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,060.44

Acute & subacute endocarditis

Facility

$50,163.41

Service Code	APR-DRG 1931
Min. Negotiated Rate	$10,225.00
Max. Negotiated Rate	$50,163.41
Rate for Payer: Affinity Essential Plan 1&2	$50,163.41
Rate for Payer: Affinity Essential Plan 3&4	$50,163.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,294.85
Rate for Payer: Amida Care Medicaid	$22,294.85
Rate for Payer: EmblemHealth Essential Plan 1&2	$50,163.41
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,294.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,294.85
Rate for Payer: Fidelis Qualified Health Plan	$26,753.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,294.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,294.85
Rate for Payer: Healthfirst Commercial	$17,672.00
Rate for Payer: Healthfirst Essential Plan	$50,163.41
Rate for Payer: Healthfirst QHP	$10,225.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,294.85
Rate for Payer: SOMOS Essential	$50,163.41
Rate for Payer: United Healthcare Essential Plan 1&2	$50,163.41
Rate for Payer: United Healthcare Essential Plan 3&4	$50,163.41
Rate for Payer: United Healthcare Medicaid	$22,294.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,294.85

Acute & subacute endocarditis

Facility

$56,253.96

Service Code	APR-DRG 1932
Min. Negotiated Rate	$13,507.00
Max. Negotiated Rate	$56,253.96
Rate for Payer: Affinity Essential Plan 1&2	$56,253.96
Rate for Payer: Affinity Essential Plan 3&4	$56,253.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,001.76
Rate for Payer: Amida Care Medicaid	$25,001.76
Rate for Payer: EmblemHealth Essential Plan 1&2	$56,253.96
Rate for Payer: EmblemHealth Essential Plan 3&4	$25,001.76
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,001.76
Rate for Payer: Fidelis Qualified Health Plan	$30,002.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,001.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,001.76
Rate for Payer: Healthfirst Commercial	$24,076.00
Rate for Payer: Healthfirst Essential Plan	$56,253.96
Rate for Payer: Healthfirst QHP	$13,507.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,001.76
Rate for Payer: SOMOS Essential	$56,253.96
Rate for Payer: United Healthcare Essential Plan 1&2	$56,253.96
Rate for Payer: United Healthcare Essential Plan 3&4	$56,253.96
Rate for Payer: United Healthcare Medicaid	$25,001.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,001.76

Acute & subacute endocarditis

Facility

$110,530.62

Service Code	APR-DRG 1934
Min. Negotiated Rate	$41,208.00
Max. Negotiated Rate	$110,530.62
Rate for Payer: Affinity Essential Plan 1&2	$110,530.62
Rate for Payer: Affinity Essential Plan 3&4	$110,530.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$49,124.72
Rate for Payer: Amida Care Medicaid	$49,124.72
Rate for Payer: EmblemHealth Essential Plan 1&2	$110,530.62
Rate for Payer: EmblemHealth Essential Plan 3&4	$49,124.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$49,124.72
Rate for Payer: Fidelis Qualified Health Plan	$58,949.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$49,124.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$49,124.72
Rate for Payer: Healthfirst Commercial	$70,632.00
Rate for Payer: Healthfirst Essential Plan	$110,530.62
Rate for Payer: Healthfirst QHP	$41,208.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$49,124.72
Rate for Payer: SOMOS Essential	$110,530.62
Rate for Payer: United Healthcare Essential Plan 1&2	$110,530.62
Rate for Payer: United Healthcare Essential Plan 3&4	$110,530.62
Rate for Payer: United Healthcare Medicaid	$49,124.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$49,124.72

ACYCLOVIR 200 MG/5ML PO SUSP

Facility

$0.94

Service Code	NDC 0472008216
Hospital Charge Code	0472008216
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47

ACYCLOVIR 200 MG/5ML PO SUSP

Facility

$0.94

Service Code	NDC 5038381016
Hospital Charge Code	5038381016
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47

ACYCLOVIR 200 MG/5ML PO SUSP

Facility

$0.94

Service Code	NDC 0472008216
Hospital Charge Code	0472008216
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.47
Rate for Payer: Aetna Government	$0.47
Rate for Payer: Brighton Health Commercial	$0.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.64
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	$0.61

ACYCLOVIR 200 MG/5ML PO SUSP

Facility

$0.94

Service Code	NDC 5038381016
Hospital Charge Code	5038381016
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.47
Rate for Payer: Aetna Government	$0.47
Rate for Payer: Brighton Health Commercial	$0.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.64
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	$0.61

ACYCLOVIR 200 MG PO CAPS

Facility

$0.13

Service Code	NDC 7583412401
Hospital Charge Code	7583412401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

ACYCLOVIR 200 MG PO CAPS

Facility

$1.53

Service Code	NDC 0904578961
Hospital Charge Code	0904578961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.76

ACYCLOVIR 200 MG PO CAPS

Facility

$0.13

Service Code	NDC 7583412401
Hospital Charge Code	7583412401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

ACYCLOVIR 200 MG PO CAPS

Facility

$1.53

Service Code	NDC 0904578961
Hospital Charge Code	0904578961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Brighton Health Commercial	$1.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.04
Rate for Payer: EmblemHealth Commercial	$0.76
Rate for Payer: Group Health Inc Commercial	$0.76
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.76
Rate for Payer: Hamaspik Choice Inc Medicare	$0.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.99

ACYCLOVIR 400 MG PO TABS

Facility

$2.17

Service Code	NDC 3172277701
Hospital Charge Code	3172277701
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.08

ACYCLOVIR 400 MG PO TABS

Facility

$3.75

Service Code	NDC 5026806115
Hospital Charge Code	5026806115
Hospital Revenue Code	250
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87

ACYCLOVIR 400 MG PO TABS

Facility

$3.75

Service Code	NDC 5026806115
Hospital Charge Code	5026806115
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$3.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.87
Rate for Payer: Aetna Government	$1.87
Rate for Payer: Brighton Health Commercial	$2.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.55
Rate for Payer: EmblemHealth Commercial	$1.87
Rate for Payer: Group Health Inc Commercial	$1.87
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.43

ACYCLOVIR 400 MG PO TABS

Facility

$2.17

Service Code	NDC 3172277701
Hospital Charge Code	3172277701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Brighton Health Commercial	$1.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.47
Rate for Payer: EmblemHealth Commercial	$1.08
Rate for Payer: Group Health Inc Commercial	$1.08
Rate for Payer: Group Health Inc Medicare	$0.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.41

ACYCLOVIR 800 MG PO TABS

Facility

$4.22

Service Code	NDC 5026806215
Hospital Charge Code	5026806215
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$3.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.11
Rate for Payer: Aetna Government	$2.11
Rate for Payer: Brighton Health Commercial	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.87
Rate for Payer: EmblemHealth Commercial	$2.11
Rate for Payer: Group Health Inc Commercial	$2.11
Rate for Payer: Group Health Inc Medicare	$1.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.11
Rate for Payer: Hamaspik Choice Inc Medicare	$2.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.74

ACYCLOVIR 800 MG PO TABS

Facility

$4.22

Service Code	NDC 3172277801
Hospital Charge Code	3172277801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$3.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.11
Rate for Payer: Aetna Government	$2.11
Rate for Payer: Brighton Health Commercial	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.87
Rate for Payer: EmblemHealth Commercial	$2.11
Rate for Payer: Group Health Inc Commercial	$2.11
Rate for Payer: Group Health Inc Medicare	$1.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.11
Rate for Payer: Hamaspik Choice Inc Medicare	$2.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.74

ACYCLOVIR 800 MG PO TABS

Facility

$4.22

Service Code	NDC 5026806211
Hospital Charge Code	5026806211
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$3.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.11
Rate for Payer: Aetna Government	$2.11
Rate for Payer: Brighton Health Commercial	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.87
Rate for Payer: EmblemHealth Commercial	$2.11
Rate for Payer: Group Health Inc Commercial	$2.11
Rate for Payer: Group Health Inc Medicare	$1.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.11
Rate for Payer: Hamaspik Choice Inc Medicare	$2.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.74

ACYCLOVIR 800 MG PO TABS

Facility

$4.22

Service Code	NDC 5026806211
Hospital Charge Code	5026806211
Hospital Revenue Code	250
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.11

ACYCLOVIR 800 MG PO TABS

Facility

$4.22

Service Code	NDC 3172277801
Hospital Charge Code	3172277801
Hospital Revenue Code	250
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.11

Know your out-of-pocket cost for care.

All Charges