St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PIPERACILLIN + TAZOBACTAM 2.25 GRAM INJ

Facility

$2.61

Service Code	HCPCS J2543
Hospital Charge Code	41644511
Hospital Revenue Code	636
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30

PIPERACILLIN + TAZOBACTAM 2.25 GRAM INJ

Facility

$2.61

Service Code	HCPCS J2543
Hospital Charge Code	41654511
Hospital Revenue Code	636
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30

PIPERACILLIN + TAZOBACTAM 2.25 GRAM INJ

Facility

$2.61

Service Code	HCPCS J2543
Hospital Charge Code	41654511
Hospital Revenue Code	636
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.48
Rate for Payer: Aetna Government	$1.48
Rate for Payer: Brighton Health Commercial	$1.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.50
Rate for Payer: Group Health Inc Commercial	$1.30
Rate for Payer: Group Health Inc Medicare	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.11
Rate for Payer: SOMOS Essential	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.70

PIPERACILLIN + TAZOBACTAM 2.25 GRAM INJ

Facility

$2.61

Service Code	HCPCS J2543
Hospital Charge Code	41644511
Hospital Revenue Code	636
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.48
Rate for Payer: Aetna Government	$1.48
Rate for Payer: Brighton Health Commercial	$1.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.50
Rate for Payer: Group Health Inc Commercial	$1.30
Rate for Payer: Group Health Inc Medicare	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.11
Rate for Payer: SOMOS Essential	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.70

PIPERACILLIN +TAZOBACTAM 4.5 GRAM INJ

Facility

$2.81

Service Code	HCPCS J2543
Hospital Charge Code	41644512
Hospital Revenue Code	636
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.48
Rate for Payer: Aetna Government	$1.48
Rate for Payer: Brighton Health Commercial	$1.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.62
Rate for Payer: Group Health Inc Commercial	$1.40
Rate for Payer: Group Health Inc Medicare	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.11
Rate for Payer: SOMOS Essential	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.83

PIPERACILLIN +TAZOBACTAM 4.5 GRAM INJ

Facility

$2.81

Service Code	HCPCS J2543
Hospital Charge Code	41644512
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1.40

PIPERACILLIN +TAZOBACTAM 4.5 GRAM INJ

Facility

$2.81

Service Code	HCPCS J2543
Hospital Charge Code	41654512
Hospital Revenue Code	636
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.48
Rate for Payer: Aetna Government	$1.48
Rate for Payer: Brighton Health Commercial	$1.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.62
Rate for Payer: Group Health Inc Commercial	$1.40
Rate for Payer: Group Health Inc Medicare	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.11
Rate for Payer: SOMOS Essential	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.83

PIPERACILLIN +TAZOBACTAM 4.5 GRAM INJ

Facility

$2.81

Service Code	HCPCS J2543
Hospital Charge Code	41654512
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1.40

PIPERACILLIN +TAZOBACTAM 50 MG/ML INJ PE

Facility

$14.00

Hospital Charge Code	41654841
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00

PIPERACILLIN +TAZOBACTAM 50 MG/ML INJ PE

Facility

$14.00

Hospital Charge Code	41644841
Hospital Revenue Code	636
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$9.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.00
Rate for Payer: Aetna Government	$7.00
Rate for Payer: Brighton Health Commercial	$8.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.05
Rate for Payer: Group Health Inc Commercial	$7.00
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.10

PIPERACILLIN +TAZOBACTAM 50 MG/ML INJ PE

Facility

$14.00

Hospital Charge Code	41644841
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00

PIPERACILLIN +TAZOBACTAM 50 MG/ML INJ PE

Facility

$14.00

Hospital Charge Code	41654841
Hospital Revenue Code	636
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$9.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.00
Rate for Payer: Aetna Government	$7.00
Rate for Payer: Brighton Health Commercial	$8.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.05
Rate for Payer: Group Health Inc Commercial	$7.00
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.10

PIPERCIL/TAZOBACTAM 3.375G/1.125G

Facility

$7.65

Service Code	HCPCS J2543
Hospital Charge Code	41648177
Hospital Revenue Code	636
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$3.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.82
Rate for Payer: Hamaspik Choice Inc Medicare	$3.82

PIPERCIL/TAZOBACTAM 3.375G/1.125G

Facility

$7.65

Service Code	HCPCS J2543
Hospital Charge Code	41658177
Hospital Revenue Code	636
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$4.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.48
Rate for Payer: Aetna Government	$1.48
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.40
Rate for Payer: Group Health Inc Commercial	$3.82
Rate for Payer: Group Health Inc Medicare	$2.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.82
Rate for Payer: Hamaspik Choice Inc Medicare	$3.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.11
Rate for Payer: SOMOS Essential	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.97

PIPERCIL/TAZOBACTAM 3.375G/1.125G

Facility

$7.65

Service Code	HCPCS J2543
Hospital Charge Code	41648177
Hospital Revenue Code	636
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$4.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.48
Rate for Payer: Aetna Government	$1.48
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.40
Rate for Payer: Group Health Inc Commercial	$3.82
Rate for Payer: Group Health Inc Medicare	$2.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.82
Rate for Payer: Hamaspik Choice Inc Medicare	$3.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.11
Rate for Payer: SOMOS Essential	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.97

PIPERCIL/TAZOBACTAM 3.375G/1.125G

Facility

$7.65

Service Code	HCPCS J2543
Hospital Charge Code	41658177
Hospital Revenue Code	636
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$3.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.82
Rate for Payer: Hamaspik Choice Inc Medicare	$3.82

PL50-LEUKOCYTE FILTER

Facility

$434.63

Service Code	HCPCS 86950
Hospital Charge Code	40701191
Hospital Revenue Code	300
Rate for Payer: Cash Price	$197.52

PL50-LEUKOCYTE FILTER

Facility

$434.63

Service Code	HCPCS 86950
Hospital Charge Code	40701191
Hospital Revenue Code	300
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$325.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$197.52
Rate for Payer: Aetna Government	$197.52
Rate for Payer: Affinity Essential Plan 1&2	$138.26
Rate for Payer: Affinity Essential Plan 3&4	$138.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$138.26
Rate for Payer: Brighton Health Commercial	$325.97
Rate for Payer: Cash Price	$197.52
Rate for Payer: Cash Price	$197.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$197.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.72
Rate for Payer: Elderplan Medicare Advantage	$197.52
Rate for Payer: EmblemHealth Commercial	$197.52
Rate for Payer: Fidelis Essential Plan Aliesa	$167.89
Rate for Payer: Fidelis Essential Plan QHP	$175.79
Rate for Payer: Fidelis Medicare Advantage	$197.52
Rate for Payer: Fidelis Qualified Health Plan	$175.79
Rate for Payer: Group Health Inc Commercial	$197.52
Rate for Payer: Group Health Inc Medicare	$197.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.32
Rate for Payer: Hamaspik Choice Inc Medicare	$197.52
Rate for Payer: Healthfirst Medicare Advantage	$197.52
Rate for Payer: Healthfirst QHP	$197.52
Rate for Payer: Humana Medicare	$201.47
Rate for Payer: Senior Whole Health Medicare Advantage	$197.52
Rate for Payer: United Healthcare Commercial	$13.44
Rate for Payer: United Healthcare Medicare Advantage	$197.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$158.02
Rate for Payer: Wellcare Medicare	$177.77

PLACE BILIARY DRAIN CATH INT/EXT

Facility

$9,417.43

Service Code	HCPCS 47534
Hospital Charge Code	30106630
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$4,708.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,000.83
Rate for Payer: Aetna Government	$4,000.83
Rate for Payer: Affinity Essential Plan 1&2	$2,800.58
Rate for Payer: Affinity Essential Plan 3&4	$2,800.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,800.58
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$4,000.83
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$4,000.83
Rate for Payer: Cash Price	$4,000.83
Rate for Payer: Cash Price	$4,000.83
Rate for Payer: Cash Price	$4,000.83
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,000.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$4,000.83
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,400.71
Rate for Payer: Fidelis Essential Plan QHP	$3,560.74
Rate for Payer: Fidelis Medicare Advantage	$4,000.83
Rate for Payer: Fidelis Qualified Health Plan	$3,560.74
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,708.72
Rate for Payer: Hamaspik Choice Inc Medicare	$4,000.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$4,000.83
Rate for Payer: Humana Medicare	$4,080.85
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$4,000.83
Rate for Payer: Senior Whole Health Medicare Advantage	$4,000.83
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$4,000.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,000.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,200.66
Rate for Payer: Wellcare Medicare	$3,800.79

PLACE BILIARY DRAIN CATH INT/EXT

Facility

$9,417.43

Service Code	HCPCS 47534
Hospital Charge Code	30106630
Hospital Revenue Code	450
Rate for Payer: Cash Price	$4,000.83

PLACE DEVICE IMPACTED TOOTH

Facility

$300.00

Hospital Charge Code	42302186
Hospital Revenue Code	361
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$150.00
Rate for Payer: Aetna Government	$150.00
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

PLACE DEVICE ON IMPACTED TOOTH

Facility

$125.00

Service Code	HCPCS D7283
Hospital Charge Code	42300747
Hospital Revenue Code	361
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.05
Rate for Payer: Aetna Government	$55.05
Rate for Payer: Brighton Health Commercial	$93.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$62.50
Rate for Payer: Group Health Inc Medicare	$43.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.50
Rate for Payer: Hamaspik Choice Inc Medicare	$62.50

PLACE GASTOSTROMY TUBE

Facility

$4,716.98

Service Code	HCPCS 43246
Hospital Charge Code	40004112
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,200.46

PLACE GASTOSTROMY TUBE

Facility

$4,716.98

Service Code	HCPCS 43246
Hospital Charge Code	40004112
Hospital Revenue Code	360
Min. Negotiated Rate	$955.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,200.46
Rate for Payer: Aetna Government	$2,200.46
Rate for Payer: Affinity Essential Plan 1&2	$1,540.32
Rate for Payer: Affinity Essential Plan 3&4	$1,540.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,540.32
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Cash Price	$2,200.46
Rate for Payer: Cash Price	$2,200.46
Rate for Payer: Cash Price	$2,200.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,200.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$2,200.46
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,870.39
Rate for Payer: Fidelis Essential Plan QHP	$1,958.41
Rate for Payer: Fidelis Medicare Advantage	$2,200.46
Rate for Payer: Fidelis Qualified Health Plan	$1,958.41
Rate for Payer: Group Health Inc Commercial	$2,200.46
Rate for Payer: Group Health Inc Medicare	$2,200.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,358.49
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.46
Rate for Payer: Healthfirst Medicare Advantage	$1,870.39
Rate for Payer: Healthfirst QHP	$2,200.46
Rate for Payer: Humana Medicare	$2,244.47
Rate for Payer: Senior Whole Health Medicare Advantage	$2,200.46
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$2,200.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,200.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,760.37
Rate for Payer: Wellcare Medicare	$2,090.44

Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance (List separately in addition to code for primary procedure)

Facility

$2,915.00

Service Code	CPT 19282
Hospital Revenue Code	361
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.40
Rate for Payer: Aetna Government	$43.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: United Healthcare Commercial	$1,113.00

Know your out-of-pocket cost for care.

All Charges