St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PEGFILGRASTIM-JMDB 6 MG/0.6ML SC SOSY [162648]

Facility

$4,175.00

Service Code	HCPCS Q5108
Hospital Charge Code	67457083306
Hospital Revenue Code	250
Min. Negotiated Rate	$85.78
Max. Negotiated Rate	$3,340.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,296.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$122.54
Rate for Payer: Aetna Government	$122.54
Rate for Payer: Affinity Essential Plan 1&2	$85.78
Rate for Payer: Affinity Essential Plan 3&4	$85.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$85.78
Rate for Payer: Brighton Health Commercial	$3,131.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$122.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,340.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,839.00
Rate for Payer: Elderplan Medicare Advantage	$122.54
Rate for Payer: EmblemHealth Commercial	$122.54
Rate for Payer: Fidelis Essential Plan Aliesa	$104.16
Rate for Payer: Fidelis Essential Plan QHP	$109.06
Rate for Payer: Fidelis Medicare Advantage	$122.54
Rate for Payer: Fidelis Qualified Health Plan	$109.06
Rate for Payer: Group Health Inc Commercial	$122.54
Rate for Payer: Group Health Inc Medicare	$122.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,087.50
Rate for Payer: Hamaspik Choice Inc Medicare	$122.54
Rate for Payer: Healthfirst Medicare Advantage	$104.16
Rate for Payer: Healthfirst QHP	$122.54
Rate for Payer: Humana Medicare	$124.99
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$164.04
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$173.88
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$173.88
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$173.88
Rate for Payer: Senior Whole Health Medicare Advantage	$122.54
Rate for Payer: United Healthcare Medicare Advantage	$122.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,713.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$98.03
Rate for Payer: Wellcare Medicare	$116.41

PEGFILGRASTIM-JMDB 6 MG/0.6ML SC SOSY [162648]

Facility

$4,175.00

Service Code	HCPCS Q5108
Hospital Charge Code	83257000541
Hospital Revenue Code	250
Min. Negotiated Rate	$85.78
Max. Negotiated Rate	$3,340.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,296.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$122.54
Rate for Payer: Aetna Government	$122.54
Rate for Payer: Affinity Essential Plan 1&2	$85.78
Rate for Payer: Affinity Essential Plan 3&4	$85.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$85.78
Rate for Payer: Brighton Health Commercial	$3,131.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$122.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,340.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,839.00
Rate for Payer: Elderplan Medicare Advantage	$122.54
Rate for Payer: EmblemHealth Commercial	$122.54
Rate for Payer: Fidelis Essential Plan Aliesa	$104.16
Rate for Payer: Fidelis Essential Plan QHP	$109.06
Rate for Payer: Fidelis Medicare Advantage	$122.54
Rate for Payer: Fidelis Qualified Health Plan	$109.06
Rate for Payer: Group Health Inc Commercial	$122.54
Rate for Payer: Group Health Inc Medicare	$122.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,087.50
Rate for Payer: Hamaspik Choice Inc Medicare	$122.54
Rate for Payer: Healthfirst Medicare Advantage	$104.16
Rate for Payer: Healthfirst QHP	$122.54
Rate for Payer: Humana Medicare	$124.99
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$164.04
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$173.88
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$173.88
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$173.88
Rate for Payer: Senior Whole Health Medicare Advantage	$122.54
Rate for Payer: United Healthcare Medicare Advantage	$122.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,713.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$98.03
Rate for Payer: Wellcare Medicare	$116.41

PEGFILGRASTIM KIT 6MG/0.6ML

Facility

$1,062.22

Service Code	HCPCS J3490
Hospital Charge Code	41656625
Hospital Revenue Code	636
Min. Negotiated Rate	$531.11
Max. Negotiated Rate	$531.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$531.11
Rate for Payer: Hamaspik Choice Inc Medicare	$531.11

PEGFILGRASTIM KIT 6MG/0.6ML

Facility

$1,062.22

Service Code	HCPCS J3490
Hospital Charge Code	41656625
Hospital Revenue Code	636
Min. Negotiated Rate	$371.78
Max. Negotiated Rate	$690.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$584.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$531.11
Rate for Payer: Aetna Government	$531.11
Rate for Payer: Brighton Health Commercial	$637.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$531.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$610.78
Rate for Payer: Group Health Inc Commercial	$531.11
Rate for Payer: Group Health Inc Medicare	$371.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$531.11
Rate for Payer: Hamaspik Choice Inc Medicare	$531.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$690.44

PEGFILGRASTIM KIT 6MG/0.6ML

Facility

$1,062.22

Service Code	HCPCS J3490
Hospital Charge Code	41646625
Hospital Revenue Code	636
Min. Negotiated Rate	$371.78
Max. Negotiated Rate	$690.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$584.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$531.11
Rate for Payer: Aetna Government	$531.11
Rate for Payer: Brighton Health Commercial	$637.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$531.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$610.78
Rate for Payer: Group Health Inc Commercial	$531.11
Rate for Payer: Group Health Inc Medicare	$371.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$531.11
Rate for Payer: Hamaspik Choice Inc Medicare	$531.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$690.44

PEGFILGRASTIM KIT 6MG/0.6ML

Facility

$1,062.22

Service Code	HCPCS J3490
Hospital Charge Code	41646625
Hospital Revenue Code	636
Min. Negotiated Rate	$531.11
Max. Negotiated Rate	$531.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$531.11
Rate for Payer: Hamaspik Choice Inc Medicare	$531.11

PEGFILGRASTIM-PBBK 6 MG/0.6ML SC SOSY [188014]

Facility

$5,000.00

Service Code	NDC 70121162701
Hospital Charge Code	70121162701
Hospital Revenue Code	250
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,750.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,500.00
Rate for Payer: Aetna Government	$2,500.00
Rate for Payer: Brighton Health Commercial	$3,750.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,400.00
Rate for Payer: Group Health Inc Commercial	$2,500.00
Rate for Payer: Group Health Inc Medicare	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,250.00

PEG FIX DIS FEM

Facility

$1,463.00

Service Code	HCPCS C1713
Hospital Charge Code	64907323
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,536.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$804.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$877.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$731.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$841.22
Rate for Payer: EmblemHealth Commercial	$731.50
Rate for Payer: Fidelis Medicare Advantage	$1,536.15
Rate for Payer: Group Health Inc Commercial	$731.50
Rate for Payer: Group Health Inc Medicare	$512.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$731.50
Rate for Payer: Hamaspik Choice Inc Medicare	$731.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$950.95

PEG FIX DIS FEM

Facility

$1,463.00

Service Code	HCPCS C1713
Hospital Charge Code	64907323
Hospital Revenue Code	278
Min. Negotiated Rate	$731.50
Max. Negotiated Rate	$731.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$731.50
Rate for Payer: Hamaspik Choice Inc Medicare	$731.50

PEG HI COMP LOCK 2.7 HCLPTS

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64906995
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$299.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$142.50
Rate for Payer: Fidelis Medicare Advantage	$299.25
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.25

PEG HI COMP LOCK 2.7 HCLPTS

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64906995
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

PEGINTERFERON 80MCG/0.5ML INJ

Facility

$0.02

Service Code	HCPCS J3490
Hospital Charge Code	41643074
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

PEGINTERFERON 80MCG/0.5ML INJ

Facility

$0.02

Service Code	HCPCS J3490
Hospital Charge Code	41653074
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

PEGINTERFERON 80MCG/0.5ML INJ

Facility

$0.02

Service Code	HCPCS J3490
Hospital Charge Code	41643074
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

PEGINTERFERON 80MCG/0.5ML INJ

Facility

$0.02

Service Code	HCPCS J3490
Hospital Charge Code	41653074
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

PEGINTERFERON ALFA 2A 180 MCG/ML INJ

Facility

$1,220.82

Service Code	HCPCS J3490
Hospital Charge Code	41653072
Hospital Revenue Code	636
Min. Negotiated Rate	$427.29
Max. Negotiated Rate	$793.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$671.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$610.41
Rate for Payer: Aetna Government	$610.41
Rate for Payer: Brighton Health Commercial	$732.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$610.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$701.97
Rate for Payer: Group Health Inc Commercial	$610.41
Rate for Payer: Group Health Inc Medicare	$427.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$610.41
Rate for Payer: Hamaspik Choice Inc Medicare	$610.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$793.53

PEGINTERFERON ALFA 2A 180 MCG/ML INJ

Facility

$1,220.82

Service Code	HCPCS J3490
Hospital Charge Code	41643072
Hospital Revenue Code	636
Min. Negotiated Rate	$427.29
Max. Negotiated Rate	$793.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$671.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$610.41
Rate for Payer: Aetna Government	$610.41
Rate for Payer: Brighton Health Commercial	$732.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$610.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$701.97
Rate for Payer: Group Health Inc Commercial	$610.41
Rate for Payer: Group Health Inc Medicare	$427.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$610.41
Rate for Payer: Hamaspik Choice Inc Medicare	$610.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$793.53

PEGINTERFERON ALFA 2A 180 MCG/ML INJ

Facility

$1,220.82

Service Code	HCPCS J3490
Hospital Charge Code	41643072
Hospital Revenue Code	636
Min. Negotiated Rate	$610.41
Max. Negotiated Rate	$610.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$610.41
Rate for Payer: Hamaspik Choice Inc Medicare	$610.41

PEGINTERFERON ALFA 2A 180 MCG/ML INJ

Facility

$1,220.82

Service Code	HCPCS J3490
Hospital Charge Code	41653072
Hospital Revenue Code	636
Min. Negotiated Rate	$610.41
Max. Negotiated Rate	$610.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$610.41
Rate for Payer: Hamaspik Choice Inc Medicare	$610.41

PEGINTERFERON ALFA-2A 180 MCG/ML SC SOLN [34034]

Facility

$1,225.79

Service Code	HCPCS S0145
Hospital Charge Code	00004035009
Hospital Revenue Code	250
Min. Negotiated Rate	$429.03
Max. Negotiated Rate	$980.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$674.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$845.80
Rate for Payer: Aetna Government	$845.80
Rate for Payer: Brighton Health Commercial	$919.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$980.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$833.54
Rate for Payer: Group Health Inc Commercial	$612.90
Rate for Payer: Group Health Inc Medicare	$429.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$612.90
Rate for Payer: Hamaspik Choice Inc Medicare	$612.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$796.76

PEG LOCKING HC 2.7

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64907032
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

PEG LOCKING HC 2.7

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64907032
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$299.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$142.50
Rate for Payer: Fidelis Medicare Advantage	$299.25
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.25

PEG LOCKING S 2.0

Facility

$228.00

Service Code	HCPCS C1713
Hospital Charge Code	64906899
Hospital Revenue Code	278
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$239.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$136.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$114.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.10
Rate for Payer: EmblemHealth Commercial	$114.00
Rate for Payer: Fidelis Medicare Advantage	$239.40
Rate for Payer: Group Health Inc Commercial	$114.00
Rate for Payer: Group Health Inc Medicare	$79.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.00
Rate for Payer: Hamaspik Choice Inc Medicare	$114.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.20

PEG LOCKING S 2.0

Facility

$228.00

Service Code	HCPCS C1713
Hospital Charge Code	64906899
Hospital Revenue Code	278
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$114.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.00
Rate for Payer: Hamaspik Choice Inc Medicare	$114.00

PEG LOCKING T8 2.0MM / L24MM

Facility

$563.13

Service Code	HCPCS C1713
Hospital Charge Code	64905781
Hospital Revenue Code	278
Min. Negotiated Rate	$281.56
Max. Negotiated Rate	$281.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.56
Rate for Payer: Hamaspik Choice Inc Medicare	$281.56

Know your out-of-pocket cost for care.

All Charges