St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ADENOSINE 6 MG/2ML IV SOLN

Facility

$3.75

Service Code	HCPCS J0153
Hospital Charge Code	6745785500
Hospital Revenue Code	258
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88

ADENOSINE 6 MG/2ML IV SOLN

Facility

$3.75

Service Code	HCPCS J0153
Hospital Charge Code	6745785502
Hospital Revenue Code	258
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$3.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
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	$1.88
Rate for Payer: Group Health Inc Commercial	$1.88
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.44

ADENOSINE 6 MG/2ML IV SOLN

Facility

$3.75

Service Code	HCPCS J0153
Hospital Charge Code	6745785500
Hospital Revenue Code	258
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$3.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
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	$1.88
Rate for Payer: Group Health Inc Commercial	$1.88
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.44

ADENOSINE 6 MG/2ML IV SOLN

Facility

$6.57

Service Code	HCPCS J0153
Hospital Charge Code	6332365102
Hospital Revenue Code	258
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$5.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$4.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.47
Rate for Payer: EmblemHealth Commercial	$3.29
Rate for Payer: Group Health Inc Commercial	$3.29
Rate for Payer: Group Health Inc Medicare	$2.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.29
Rate for Payer: Hamaspik Choice Inc Medicare	$3.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.27

ADENOSINE 6 MG/2ML IV SOLN

Facility

$3.75

Service Code	HCPCS J0153
Hospital Charge Code	6745785502
Hospital Revenue Code	258
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88

ADENOSINE 6 MG/2ML IV SOLN

Facility

$9.60

Service Code	HCPCS J0153
Hospital Charge Code	2502130167
Hospital Revenue Code	258
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$7.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.53
Rate for Payer: EmblemHealth Commercial	$4.80
Rate for Payer: Group Health Inc Commercial	$4.80
Rate for Payer: Group Health Inc Medicare	$3.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.80
Rate for Payer: Hamaspik Choice Inc Medicare	$4.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.24

ADENOSINE 6 MG/2ML IV SOLN

Facility

$9.54

Service Code	HCPCS J0153
Hospital Charge Code	6332365189
Hospital Revenue Code	258
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$7.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$7.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.49
Rate for Payer: EmblemHealth Commercial	$4.77
Rate for Payer: Group Health Inc Commercial	$4.77
Rate for Payer: Group Health Inc Medicare	$3.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.77
Rate for Payer: Hamaspik Choice Inc Medicare	$4.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.20

ADENOSINE 6 MG/2ML IV SOLN

Facility

$9.60

Service Code	HCPCS J0153
Hospital Charge Code	2502130167
Hospital Revenue Code	258
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.80

ADENOSINE 6 MG/2ML IV SOLN

Facility

$9.54

Service Code	HCPCS J0153
Hospital Charge Code	6332365189
Hospital Revenue Code	258
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$4.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.77

ADENOSINE 6 MG/2ML IV SOLN

Facility

$6.57

Service Code	HCPCS J0153
Hospital Charge Code	6332365102
Hospital Revenue Code	258
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$3.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.29

ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN

Facility

$7.15

Service Code	HCPCS J0153
Hospital Charge Code	5515019301
Hospital Revenue Code	258
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$3.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.58

ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN

Facility

$7.15

Service Code	HCPCS J0153
Hospital Charge Code	5515019301
Hospital Revenue Code	258
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$5.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$5.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.86
Rate for Payer: EmblemHealth Commercial	$3.58
Rate for Payer: Group Health Inc Commercial	$3.58
Rate for Payer: Group Health Inc Medicare	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.58
Rate for Payer: Hamaspik Choice Inc Medicare	$3.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.65

ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES

Facility

$211.05

Service Code	EAPG 00825
Min. Negotiated Rate	$152.74
Max. Negotiated Rate	$211.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.74
Rate for Payer: Healthfirst Commercial	$211.05

Adjustment disorders & neuroses except depressive diagnoses

Facility

$9,936.00

Service Code	APR-DRG 7552
Min. Negotiated Rate	$3,390.29
Max. Negotiated Rate	$9,936.00
Rate for Payer: Affinity Essential Plan 1&2	$3,390.29
Rate for Payer: Affinity Essential Plan 3&4	$3,390.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,390.29
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,390.29
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,628.15
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,390.29
Rate for Payer: Fidelis Qualified Health Plan	$4,068.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,390.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,390.29
Rate for Payer: Healthfirst Commercial	$9,936.00
Rate for Payer: Healthfirst Essential Plan	$7,628.15
Rate for Payer: Healthfirst QHP	$6,170.33
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,390.29
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,628.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,628.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,390.29
Rate for Payer: SOMOS Essential	$7,628.15
Rate for Payer: United Healthcare Essential Plan 1&2	$7,628.15
Rate for Payer: United Healthcare Essential Plan 3&4	$7,628.15
Rate for Payer: United Healthcare Medicaid	$3,390.29

Adjustment disorders & neuroses except depressive diagnoses

Facility

$9,936.00

Service Code	APR-DRG 7553
Min. Negotiated Rate	$3,390.29
Max. Negotiated Rate	$9,936.00
Rate for Payer: Affinity Essential Plan 1&2	$3,390.29
Rate for Payer: Affinity Essential Plan 3&4	$3,390.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,390.29
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,390.29
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,628.15
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,390.29
Rate for Payer: Fidelis Qualified Health Plan	$4,068.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,390.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,390.29
Rate for Payer: Healthfirst Commercial	$9,936.00
Rate for Payer: Healthfirst Essential Plan	$7,628.15
Rate for Payer: Healthfirst QHP	$6,170.33
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,390.29
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,628.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,628.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,390.29
Rate for Payer: SOMOS Essential	$7,628.15
Rate for Payer: United Healthcare Essential Plan 1&2	$7,628.15
Rate for Payer: United Healthcare Essential Plan 3&4	$7,628.15
Rate for Payer: United Healthcare Medicaid	$3,390.29

Adjustment disorders & neuroses except depressive diagnoses

Facility

$9,913.00

Service Code	APR-DRG 7551
Min. Negotiated Rate	$3,390.29
Max. Negotiated Rate	$9,913.00
Rate for Payer: Affinity Essential Plan 1&2	$3,390.29
Rate for Payer: Affinity Essential Plan 3&4	$3,390.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,390.29
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,390.29
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,628.15
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,390.29
Rate for Payer: Fidelis Qualified Health Plan	$4,068.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,390.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,390.29
Rate for Payer: Healthfirst Commercial	$9,913.00
Rate for Payer: Healthfirst Essential Plan	$7,628.15
Rate for Payer: Healthfirst QHP	$6,170.33
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,390.29
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,628.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,628.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,390.29
Rate for Payer: SOMOS Essential	$7,628.15
Rate for Payer: United Healthcare Essential Plan 1&2	$7,628.15
Rate for Payer: United Healthcare Essential Plan 3&4	$7,628.15
Rate for Payer: United Healthcare Medicaid	$3,390.29

Adjustment disorders & neuroses except depressive diagnoses

Facility

$9,936.00

Service Code	APR-DRG 7554
Min. Negotiated Rate	$3,390.29
Max. Negotiated Rate	$9,936.00
Rate for Payer: Affinity Essential Plan 1&2	$3,390.29
Rate for Payer: Affinity Essential Plan 3&4	$3,390.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,390.29
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,390.29
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,628.15
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,390.29
Rate for Payer: Fidelis Qualified Health Plan	$4,068.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,390.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,390.29
Rate for Payer: Healthfirst Commercial	$9,936.00
Rate for Payer: Healthfirst Essential Plan	$7,628.15
Rate for Payer: Healthfirst QHP	$6,170.33
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,390.29
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,628.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,628.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,390.29
Rate for Payer: SOMOS Essential	$7,628.15
Rate for Payer: United Healthcare Essential Plan 1&2	$7,628.15
Rate for Payer: United Healthcare Essential Plan 3&4	$7,628.15
Rate for Payer: United Healthcare Medicaid	$3,390.29

ADO-TRASTUZUMAB EMTANSINE 100 MG IV SOLR

Facility

$4.00

Service Code	HCPCS J9354
Hospital Charge Code	5024208801
Hospital Revenue Code	258
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00

ADO-TRASTUZUMAB EMTANSINE 100 MG IV SOLR

Facility

$4.00

Service Code	HCPCS J9354
Hospital Charge Code	5024208801
Hospital Revenue Code	258
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$43.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.16
Rate for Payer: Aetna Government	$42.16
Rate for Payer: Affinity Essential Plan 1&2	$29.51
Rate for Payer: Affinity Essential Plan 3&4	$29.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$29.51
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$42.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Elderplan Medicare Advantage	$42.16
Rate for Payer: EmblemHealth Commercial	$42.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37.94
Rate for Payer: Fidelis Essential Plan Aliesa	$35.84
Rate for Payer: Fidelis Essential Plan QHP	$37.52
Rate for Payer: Fidelis Medicare Advantage	$42.16
Rate for Payer: Fidelis Qualified Health Plan	$37.52
Rate for Payer: Group Health Inc Commercial	$42.16
Rate for Payer: Group Health Inc Medicare	$42.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.16
Rate for Payer: Hamaspik Choice Inc Medicare	$42.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42.16
Rate for Payer: Healthfirst Medicare Advantage	$35.84
Rate for Payer: Healthfirst QHP	$42.16
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Senior Whole Health Medicare Advantage	$42.16
Rate for Payer: United Healthcare Medicare Advantage	$42.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40.05
Rate for Payer: Wellcare Medicare	$40.05

ADO-TRASTUZUMAB EMTANSINE 160 MG IV SOLR

Facility

$7.00

Service Code	HCPCS J9354
Hospital Charge Code	5024208701
Hospital Revenue Code	258
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$43.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.16
Rate for Payer: Aetna Government	$42.16
Rate for Payer: Affinity Essential Plan 1&2	$29.51
Rate for Payer: Affinity Essential Plan 3&4	$29.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$29.51
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$42.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Elderplan Medicare Advantage	$42.16
Rate for Payer: EmblemHealth Commercial	$42.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37.94
Rate for Payer: Fidelis Essential Plan Aliesa	$35.84
Rate for Payer: Fidelis Essential Plan QHP	$37.52
Rate for Payer: Fidelis Medicare Advantage	$42.16
Rate for Payer: Fidelis Qualified Health Plan	$37.52
Rate for Payer: Group Health Inc Commercial	$42.16
Rate for Payer: Group Health Inc Medicare	$42.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.16
Rate for Payer: Hamaspik Choice Inc Medicare	$42.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42.16
Rate for Payer: Healthfirst Medicare Advantage	$35.84
Rate for Payer: Healthfirst QHP	$42.16
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Senior Whole Health Medicare Advantage	$42.16
Rate for Payer: United Healthcare Medicare Advantage	$42.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40.05
Rate for Payer: Wellcare Medicare	$40.05

ADO-TRASTUZUMAB EMTANSINE 160 MG IV SOLR

Facility

$7.00

Service Code	HCPCS J9354
Hospital Charge Code	5024208701
Hospital Revenue Code	258
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50

ADULT PREVENTIVE MEDICINE

Facility

$222.15

Service Code	EAPG 00876
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$222.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$162.00
Rate for Payer: Healthfirst Commercial	$222.15

AFTERCARE, BURNS, CORROSIONS, OTHER INJURIES RELATED TO THE SKIN AND SUB TIS

Facility

$201.34

Service Code	EAPG 00787
Min. Negotiated Rate	$201.34
Max. Negotiated Rate	$201.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$201.34

AFTERCARE FOR JOINT REPLACEMENT

Facility

$208.77

Service Code	EAPG 00874
Min. Negotiated Rate	$150.43
Max. Negotiated Rate	$208.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$150.43
Rate for Payer: Healthfirst Commercial	$208.77

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE INJURIES

Facility

$171.26

Service Code	EAPG 00869
Min. Negotiated Rate	$171.26
Max. Negotiated Rate	$171.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$171.26

Know your out-of-pocket cost for care.

All Charges