St. Barnabas Hospital

All Charges

Charge

Type

Price

AXILLARY NODE RESECTION

Facility OP

$14,640.10

Service Code	HCPCS 38740
Hospital Charge Code	40010590
Hospital Revenue Code	360
Min. Negotiated Rate	$813.24
Max. Negotiated Rate	$7,320.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,672.53
Rate for Payer: Aetna Government	$6,672.53
Rate for Payer: Cash Price	$6,672.53
Rate for Payer: Cash Price	$6,672.53
Rate for Payer: Cash Price	$6,672.53
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,672.53
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	$6,672.53
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$813.24
Rate for Payer: Fidelis Essential Plan Aliesa	$5,671.65
Rate for Payer: Fidelis Essential Plan QHP	$5,938.55
Rate for Payer: Fidelis Medicare Advantage	$6,672.53
Rate for Payer: Fidelis Qualified Health Plan	$5,938.55
Rate for Payer: Group Health Inc Commercial	$6,672.53
Rate for Payer: Group Health Inc Medicare	$6,672.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,320.05
Rate for Payer: Hamaspik Choice Inc Medicare	$6,672.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$903.60
Rate for Payer: Healthfirst Medicare Advantage	$5,671.65
Rate for Payer: Healthfirst QHP	$6,672.53
Rate for Payer: Senior Whole Health Medicare Advantage	$6,672.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,672.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,338.02
Rate for Payer: Wellcare Medicare	$6,338.90

AXILLO FEMORAL BYPASS

Facility OP

$5,173.56

Service Code	HCPCS 35533
Hospital Charge Code	40031845
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,845.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,704.40
Rate for Payer: Aetna Government	$1,704.40
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,724.31
Rate for Payer: Group Health Inc Commercial	$2,586.78
Rate for Payer: Group Health Inc Medicare	$1,810.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,586.78
Rate for Payer: Hamaspik Choice Inc Medicare	$2,586.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,915.90

AXLE STR

Facility IP

$3,371.25

Service Code	HCPCS C1776
Hospital Charge Code	64907253
Hospital Revenue Code	278
Min. Negotiated Rate	$1,685.62
Max. Negotiated Rate	$1,685.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,685.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,685.62

AXLE STR

Facility OP

$3,371.25

Service Code	HCPCS C1776
Hospital Charge Code	64907253
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,539.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,854.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,685.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,938.47
Rate for Payer: Fidelis Medicare Advantage	$3,539.81
Rate for Payer: Group Health Inc Commercial	$1,685.62
Rate for Payer: Group Health Inc Medicare	$1,179.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,685.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,685.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,191.31

AZATHIOPRINE 50 MG TAB

Facility IP

$0.30

Service Code	HCPCS J7500
Hospital Charge Code	41643109
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15

AZATHIOPRINE 50 MG TAB

Facility OP

$0.30

Service Code	HCPCS J7500
Hospital Charge Code	41643109
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$13.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.58
Rate for Payer: Aetna Government	$6.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12.33
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$13.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.71
Rate for Payer: SOMOS Essential	$2.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

AZATHIOPRINE 50 MG TAB

Facility IP

$0.30

Service Code	HCPCS J7500
Hospital Charge Code	41653109
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15

AZATHIOPRINE 50 MG TAB

Facility OP

$0.30

Service Code	HCPCS J7500
Hospital Charge Code	41653109
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$13.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.58
Rate for Payer: Aetna Government	$6.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12.33
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$13.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.71
Rate for Payer: SOMOS Essential	$2.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

AZITHROMYCIN 100 MG/5 ML SUSP

Facility OP

$1.56

Service Code	HCPCS Q0144
Hospital Charge Code	41654643
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$20.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.10
Rate for Payer: Aetna Government	$20.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: Group Health Inc Commercial	$0.78
Rate for Payer: Group Health Inc Medicare	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78
Rate for Payer: Hamaspik Choice Inc Medicare	$0.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.01

AZITHROMYCIN 100 MG/5 ML SUSP

Facility IP

$1.56

Service Code	HCPCS Q0144
Hospital Charge Code	41644643
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78
Rate for Payer: Hamaspik Choice Inc Medicare	$0.78

AZITHROMYCIN 100 MG/5 ML SUSP

Facility OP

$1.56

Service Code	HCPCS Q0144
Hospital Charge Code	41644643
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$20.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.10
Rate for Payer: Aetna Government	$20.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: Group Health Inc Commercial	$0.78
Rate for Payer: Group Health Inc Medicare	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78
Rate for Payer: Hamaspik Choice Inc Medicare	$0.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.01

AZITHROMYCIN 100 MG/5 ML SUSP

Facility IP

$1.56

Service Code	HCPCS Q0144
Hospital Charge Code	41654643
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78
Rate for Payer: Hamaspik Choice Inc Medicare	$0.78

AZITHROMYCIN 1 GRAM SACHET POWDER

Facility OP

$26.28

Service Code	HCPCS Q0144
Hospital Charge Code	41642995
Hospital Revenue Code	636
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$20.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.10
Rate for Payer: Aetna Government	$20.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.11
Rate for Payer: Group Health Inc Commercial	$13.14
Rate for Payer: Group Health Inc Medicare	$9.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.14
Rate for Payer: Hamaspik Choice Inc Medicare	$13.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.08

AZITHROMYCIN 1 GRAM SACHET POWDER

Facility IP

$26.28

Service Code	HCPCS Q0144
Hospital Charge Code	41642995
Hospital Revenue Code	636
Min. Negotiated Rate	$13.14
Max. Negotiated Rate	$13.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.14
Rate for Payer: Hamaspik Choice Inc Medicare	$13.14

AZITHROMYCIN 1 GRAM SACHET POWDER

Facility OP

$26.28

Service Code	HCPCS Q0144
Hospital Charge Code	41652995
Hospital Revenue Code	636
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$20.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.10
Rate for Payer: Aetna Government	$20.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.11
Rate for Payer: Group Health Inc Commercial	$13.14
Rate for Payer: Group Health Inc Medicare	$9.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.14
Rate for Payer: Hamaspik Choice Inc Medicare	$13.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.08

AZITHROMYCIN 1 GRAM SACHET POWDER

Facility IP

$26.28

Service Code	HCPCS Q0144
Hospital Charge Code	41652995
Hospital Revenue Code	636
Min. Negotiated Rate	$13.14
Max. Negotiated Rate	$13.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.14
Rate for Payer: Hamaspik Choice Inc Medicare	$13.14

AZITHROMYCIN 1% OPHTHALMIC SOLN

Facility OP

$167.92

Hospital Charge Code	41644989
Hospital Revenue Code	250
Min. Negotiated Rate	$58.77
Max. Negotiated Rate	$134.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$92.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$83.96
Rate for Payer: Aetna Government	$83.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$134.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$114.19
Rate for Payer: Group Health Inc Commercial	$83.96
Rate for Payer: Group Health Inc Medicare	$58.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.96
Rate for Payer: Hamaspik Choice Inc Medicare	$83.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$109.15

AZITHROMYCIN 1% OPHTHALMIC SOLN

Facility OP

$167.92

Hospital Charge Code	41654989
Hospital Revenue Code	250
Min. Negotiated Rate	$58.77
Max. Negotiated Rate	$134.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$92.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$83.96
Rate for Payer: Aetna Government	$83.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$134.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$114.19
Rate for Payer: Group Health Inc Commercial	$83.96
Rate for Payer: Group Health Inc Medicare	$58.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.96
Rate for Payer: Hamaspik Choice Inc Medicare	$83.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$109.15

AZITHROMYCIN 200 MG/5 ML SUSP

Facility OP

$1.00

Service Code	HCPCS Q0144
Hospital Charge Code	41654629
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$20.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.10
Rate for Payer: Aetna Government	$20.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

AZITHROMYCIN 200 MG/5 ML SUSP

Facility IP

$1.00

Service Code	HCPCS Q0144
Hospital Charge Code	41654629
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

AZITHROMYCIN 200 MG/5 ML SUSP

Facility OP

$1.00

Service Code	HCPCS Q0144
Hospital Charge Code	41644629
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$20.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.10
Rate for Payer: Aetna Government	$20.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

AZITHROMYCIN 200 MG/5 ML SUSP

Facility IP

$1.00

Service Code	HCPCS Q0144
Hospital Charge Code	41644629
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

AZITHROMYCIN 250 MG TAB

Facility OP

$20.60

Service Code	HCPCS Q0144
Hospital Charge Code	41644340
Hospital Revenue Code	636
Min. Negotiated Rate	$7.21
Max. Negotiated Rate	$20.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.10
Rate for Payer: Aetna Government	$20.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.84
Rate for Payer: Group Health Inc Commercial	$10.30
Rate for Payer: Group Health Inc Medicare	$7.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.30
Rate for Payer: Hamaspik Choice Inc Medicare	$10.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.39

AZITHROMYCIN 250 MG TAB

Facility IP

$20.60

Service Code	HCPCS Q0144
Hospital Charge Code	41654340
Hospital Revenue Code	636
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$10.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.30
Rate for Payer: Hamaspik Choice Inc Medicare	$10.30

AZITHROMYCIN 250 MG TAB

Facility IP

$20.60

Service Code	HCPCS Q0144
Hospital Charge Code	41644340
Hospital Revenue Code	636
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$10.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.30
Rate for Payer: Hamaspik Choice Inc Medicare	$10.30

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