St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SEVELAMER CARBONATE 2.4 G PO PACK

Facility

$18.29

Service Code	NDC 6586293108
Hospital Charge Code	6586293108
Hospital Revenue Code	250
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$9.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.14

SEVELAMER CARBONATE 2.4 G PO PACK

Facility

$18.29

Service Code	NDC 6438088100
Hospital Charge Code	6438088100
Hospital Revenue Code	250
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$9.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.14

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$2.22

Service Code	NDC 6909796793
Hospital Charge Code	6909796793
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.11
Rate for Payer: Aetna Government	$1.11
Rate for Payer: Brighton Health Commercial	$1.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.51
Rate for Payer: EmblemHealth Commercial	$1.11
Rate for Payer: Group Health Inc Commercial	$1.11
Rate for Payer: Group Health Inc Medicare	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.11
Rate for Payer: Hamaspik Choice Inc Medicare	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.44

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$2.22

Service Code	NDC 6909796793
Hospital Charge Code	6909796793
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.11

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$6.10

Service Code	NDC 6516205827
Hospital Charge Code	6516205827
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: EmblemHealth Commercial	$3.05
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$6.10

Service Code	NDC 6586292127
Hospital Charge Code	6586292127
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: EmblemHealth Commercial	$3.05
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$6.10

Service Code	NDC 6586292127
Hospital Charge Code	6586292127
Hospital Revenue Code	250
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$6.10

Service Code	NDC 6516205827
Hospital Charge Code	6516205827
Hospital Revenue Code	250
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$8.90

Service Code	NDC 5026872011
Hospital Charge Code	5026872011
Hospital Revenue Code	250
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.45

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$6.10

Service Code	NDC 5511178927
Hospital Charge Code	5511178927
Hospital Revenue Code	250
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$8.90

Service Code	NDC 5026872011
Hospital Charge Code	5026872011
Hospital Revenue Code	250
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$7.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.45
Rate for Payer: Aetna Government	$4.45
Rate for Payer: Brighton Health Commercial	$6.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.05
Rate for Payer: EmblemHealth Commercial	$4.45
Rate for Payer: Group Health Inc Commercial	$4.45
Rate for Payer: Group Health Inc Medicare	$3.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.45
Rate for Payer: Hamaspik Choice Inc Medicare	$4.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.78

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$3.46

Service Code	NDC 0904670706
Hospital Charge Code	0904670706
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$1.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.73

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$6.10

Service Code	NDC 5511178927
Hospital Charge Code	5511178927
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: EmblemHealth Commercial	$3.05
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$3.46

Service Code	NDC 0904670706
Hospital Charge Code	0904670706
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$2.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.73
Rate for Payer: Aetna Government	$1.73
Rate for Payer: Brighton Health Commercial	$2.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.35
Rate for Payer: EmblemHealth Commercial	$1.73
Rate for Payer: Group Health Inc Commercial	$1.73
Rate for Payer: Group Health Inc Medicare	$1.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.73
Rate for Payer: Hamaspik Choice Inc Medicare	$1.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.25

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$7.14

Service Code	NDC 5846801301
Hospital Charge Code	5846801301
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$5.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.57
Rate for Payer: Aetna Government	$3.57
Rate for Payer: Brighton Health Commercial	$5.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.85
Rate for Payer: EmblemHealth Commercial	$3.57
Rate for Payer: Group Health Inc Commercial	$3.57
Rate for Payer: Group Health Inc Medicare	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.57
Rate for Payer: Hamaspik Choice Inc Medicare	$3.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.64

SEVELAMER CARBONATE 800 MG PO TABS

Facility

$7.14

Service Code	NDC 5846801301
Hospital Charge Code	5846801301
Hospital Revenue Code	250
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$3.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.57

SEVOFLURANE IN SOLN

Facility

$0.65

Service Code	NDC 0527612374
Hospital Charge Code	0527612374
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: EmblemHealth Commercial	$0.32
Rate for Payer: Group Health Inc Commercial	$0.32
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32
Rate for Payer: Hamaspik Choice Inc Medicare	$0.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

SEVOFLURANE IN SOLN

Facility

$0.65

Service Code	NDC 0527612374
Hospital Charge Code	0527612374
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32

SEVOFLURANE IN SOLN

Facility

$0.65

Service Code	NDC 1001965164
Hospital Charge Code	1001965164
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

SEVOFLURANE IN SOLN

Facility

$0.65

Service Code	NDC 1001965164
Hospital Charge Code	1001965164
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
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	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: EmblemHealth Commercial	$0.33
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	$0.42

SHOULDER AND UPPER ARM PROCEDURES

Facility

$2,876.67

Service Code	EAPG 00025
Min. Negotiated Rate	$2,876.67
Max. Negotiated Rate	$2,876.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,876.67

Shoulder & elbow joint replacement #

Facility

$62,717.33

Service Code	APR-DRG 3222
Min. Negotiated Rate	$27,874.37
Max. Negotiated Rate	$62,717.33
Rate for Payer: Affinity Essential Plan 1&2	$62,717.33
Rate for Payer: Affinity Essential Plan 3&4	$62,717.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,874.37
Rate for Payer: Amida Care Medicaid	$27,874.37
Rate for Payer: EmblemHealth Essential Plan 1&2	$62,717.33
Rate for Payer: EmblemHealth Essential Plan 3&4	$27,874.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,874.37
Rate for Payer: Fidelis Qualified Health Plan	$33,449.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,874.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,874.37
Rate for Payer: Healthfirst Essential Plan	$62,717.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,874.37
Rate for Payer: SOMOS Essential	$62,717.33
Rate for Payer: United Healthcare Essential Plan 1&2	$62,717.33
Rate for Payer: United Healthcare Essential Plan 3&4	$62,717.33
Rate for Payer: United Healthcare Medicaid	$27,874.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,874.37

Shoulder & elbow joint replacement #

Facility

$59,810.13

Service Code	APR-DRG 3221
Min. Negotiated Rate	$26,582.28
Max. Negotiated Rate	$59,810.13
Rate for Payer: Affinity Essential Plan 1&2	$59,810.13
Rate for Payer: Affinity Essential Plan 3&4	$59,810.13
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,582.28
Rate for Payer: Amida Care Medicaid	$26,582.28
Rate for Payer: EmblemHealth Essential Plan 1&2	$59,810.13
Rate for Payer: EmblemHealth Essential Plan 3&4	$26,582.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,582.28
Rate for Payer: Fidelis Qualified Health Plan	$31,898.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,582.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,582.28
Rate for Payer: Healthfirst Essential Plan	$59,810.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,582.28
Rate for Payer: SOMOS Essential	$59,810.13
Rate for Payer: United Healthcare Essential Plan 1&2	$59,810.13
Rate for Payer: United Healthcare Essential Plan 3&4	$59,810.13
Rate for Payer: United Healthcare Medicaid	$26,582.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,582.28

Shoulder & elbow joint replacement #

Facility

$83,435.38

Service Code	APR-DRG 3223
Min. Negotiated Rate	$37,082.39
Max. Negotiated Rate	$83,435.38
Rate for Payer: Affinity Essential Plan 1&2	$83,435.38
Rate for Payer: Affinity Essential Plan 3&4	$83,435.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$37,082.39
Rate for Payer: Amida Care Medicaid	$37,082.39
Rate for Payer: EmblemHealth Essential Plan 1&2	$83,435.38
Rate for Payer: EmblemHealth Essential Plan 3&4	$37,082.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,082.39
Rate for Payer: Fidelis Qualified Health Plan	$44,498.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,082.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,082.39
Rate for Payer: Healthfirst Essential Plan	$83,435.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,082.39
Rate for Payer: SOMOS Essential	$83,435.38
Rate for Payer: United Healthcare Essential Plan 1&2	$83,435.38
Rate for Payer: United Healthcare Essential Plan 3&4	$83,435.38
Rate for Payer: United Healthcare Medicaid	$37,082.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,082.39

Shoulder & elbow joint replacement #

Facility

$92,137.66

Service Code	APR-DRG 3224
Min. Negotiated Rate	$40,950.07
Max. Negotiated Rate	$92,137.66
Rate for Payer: Affinity Essential Plan 1&2	$92,137.66
Rate for Payer: Affinity Essential Plan 3&4	$92,137.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$40,950.07
Rate for Payer: Amida Care Medicaid	$40,950.07
Rate for Payer: EmblemHealth Essential Plan 1&2	$92,137.66
Rate for Payer: EmblemHealth Essential Plan 3&4	$40,950.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40,950.07
Rate for Payer: Fidelis Qualified Health Plan	$49,140.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$40,950.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$40,950.07
Rate for Payer: Healthfirst Essential Plan	$92,137.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40,950.07
Rate for Payer: SOMOS Essential	$92,137.66
Rate for Payer: United Healthcare Essential Plan 1&2	$92,137.66
Rate for Payer: United Healthcare Essential Plan 3&4	$92,137.66
Rate for Payer: United Healthcare Medicaid	$40,950.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40,950.07

Know your out-of-pocket cost for care.

All Charges