St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

THERAPEUTIC DRUG MONITORING

Facility

$33.79

Service Code	EAPG 00405
Min. Negotiated Rate	$25.46
Max. Negotiated Rate	$33.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.46
Rate for Payer: Healthfirst Commercial	$33.79

THERAPEUTIC NUCLEAR MEDICINE

Facility

$676.81

Service Code	EAPG 00340
Min. Negotiated Rate	$490.63
Max. Negotiated Rate	$676.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$490.63
Rate for Payer: Healthfirst Commercial	$676.81

THERA-TABS M PO TABS

Facility

$0.05

Service Code	NDC 5789662101
Hospital Charge Code	5789662101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

THERA-TABS M PO TABS

Facility

$0.05

Service Code	NDC 5789662101
Hospital Charge Code	5789662101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

THERA-TABS M PO TABS

Facility

$0.04

Service Code	NDC 5789662110
Hospital Charge Code	5789662110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

THERA-TABS M PO TABS

Facility

$0.04

Service Code	NDC 5789662110
Hospital Charge Code	5789662110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$5.33

Service Code	HCPCS J3411
Hospital Charge Code	6745719600
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$2.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.67

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$3.72

Service Code	HCPCS J3411
Hospital Charge Code	7248550701
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$3.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.08
Rate for Payer: Aetna Government	$3.08
Rate for Payer: Brighton Health Commercial	$2.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.53
Rate for Payer: EmblemHealth Commercial	$1.86
Rate for Payer: Group Health Inc Commercial	$1.86
Rate for Payer: Group Health Inc Medicare	$1.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.86
Rate for Payer: Hamaspik Choice Inc Medicare	$1.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.42

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$5.97

Service Code	HCPCS J3411
Hospital Charge Code	6332301302
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.08
Rate for Payer: Aetna Government	$3.08
Rate for Payer: Brighton Health Commercial	$4.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.06
Rate for Payer: EmblemHealth Commercial	$2.98
Rate for Payer: Group Health Inc Commercial	$2.98
Rate for Payer: Group Health Inc Medicare	$2.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.98
Rate for Payer: Hamaspik Choice Inc Medicare	$2.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.88

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$5.33

Service Code	HCPCS J3411
Hospital Charge Code	6745719602
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.08
Rate for Payer: Aetna Government	$3.08
Rate for Payer: Brighton Health Commercial	$4.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.63
Rate for Payer: EmblemHealth Commercial	$2.67
Rate for Payer: Group Health Inc Commercial	$2.67
Rate for Payer: Group Health Inc Medicare	$1.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.67
Rate for Payer: Hamaspik Choice Inc Medicare	$2.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.47

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$5.33

Service Code	HCPCS J3411
Hospital Charge Code	6745719602
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$2.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.67

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$5.33

Service Code	HCPCS J3411
Hospital Charge Code	6745719600
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.08
Rate for Payer: Aetna Government	$3.08
Rate for Payer: Brighton Health Commercial	$4.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.63
Rate for Payer: EmblemHealth Commercial	$2.67
Rate for Payer: Group Health Inc Commercial	$2.67
Rate for Payer: Group Health Inc Medicare	$1.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.67
Rate for Payer: Hamaspik Choice Inc Medicare	$2.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.47

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$5.97

Service Code	HCPCS J3411
Hospital Charge Code	2502150002
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.08
Rate for Payer: Aetna Government	$3.08
Rate for Payer: Brighton Health Commercial	$4.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.06
Rate for Payer: EmblemHealth Commercial	$2.98
Rate for Payer: Group Health Inc Commercial	$2.98
Rate for Payer: Group Health Inc Medicare	$2.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.98
Rate for Payer: Hamaspik Choice Inc Medicare	$2.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.88

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$5.97

Service Code	HCPCS J3411
Hospital Charge Code	2502150002
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.98

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$3.94

Service Code	HCPCS J3411
Hospital Charge Code	5515027301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$3.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.08
Rate for Payer: Aetna Government	$3.08
Rate for Payer: Brighton Health Commercial	$2.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.68
Rate for Payer: EmblemHealth Commercial	$1.97
Rate for Payer: Group Health Inc Commercial	$1.97
Rate for Payer: Group Health Inc Medicare	$1.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.97
Rate for Payer: Hamaspik Choice Inc Medicare	$1.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.56

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$3.94

Service Code	HCPCS J3411
Hospital Charge Code	5515027301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.97

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$4.15

Service Code	HCPCS J3411
Hospital Charge Code	6332301326
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$3.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.08
Rate for Payer: Aetna Government	$3.08
Rate for Payer: Brighton Health Commercial	$3.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.82
Rate for Payer: EmblemHealth Commercial	$2.08
Rate for Payer: Group Health Inc Commercial	$2.08
Rate for Payer: Group Health Inc Medicare	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.08
Rate for Payer: Hamaspik Choice Inc Medicare	$2.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.70

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$4.15

Service Code	HCPCS J3411
Hospital Charge Code	6332301326
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$2.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.08

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$5.97

Service Code	HCPCS J3411
Hospital Charge Code	6332301302
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.98

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$5.97

Service Code	HCPCS J3411
Hospital Charge Code	6332301301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.08
Rate for Payer: Aetna Government	$3.08
Rate for Payer: Brighton Health Commercial	$4.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.06
Rate for Payer: EmblemHealth Commercial	$2.98
Rate for Payer: Group Health Inc Commercial	$2.98
Rate for Payer: Group Health Inc Medicare	$2.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.98
Rate for Payer: Hamaspik Choice Inc Medicare	$2.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.88

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$3.66

Service Code	HCPCS J3411
Hospital Charge Code	6514512925
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$3.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.08
Rate for Payer: Aetna Government	$3.08
Rate for Payer: Brighton Health Commercial	$2.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.49
Rate for Payer: EmblemHealth Commercial	$1.83
Rate for Payer: Group Health Inc Commercial	$1.83
Rate for Payer: Group Health Inc Medicare	$1.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.83
Rate for Payer: Hamaspik Choice Inc Medicare	$1.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.38

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$3.66

Service Code	HCPCS J3411
Hospital Charge Code	6514512925
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$1.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.83

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$3.67

Service Code	HCPCS J3411
Hospital Charge Code	6514512901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$3.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.08
Rate for Payer: Aetna Government	$3.08
Rate for Payer: Brighton Health Commercial	$2.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.49
Rate for Payer: EmblemHealth Commercial	$1.83
Rate for Payer: Group Health Inc Commercial	$1.83
Rate for Payer: Group Health Inc Medicare	$1.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.83
Rate for Payer: Hamaspik Choice Inc Medicare	$1.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.38

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$5.97

Service Code	HCPCS J3411
Hospital Charge Code	6332301301
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.98

THIAMINE HCL 100 MG/ML IJ SOLN

Facility

$3.67

Service Code	HCPCS J3411
Hospital Charge Code	6514512901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$1.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.83

Know your out-of-pocket cost for care.

All Charges