St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PREGABALIN 150 MG CAP

Facility

$6.12

Hospital Charge Code	41644709
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.16
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

PREGABALIN 150 MG CAP

Facility

$6.12

Hospital Charge Code	41654709
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.16
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

PREGABALIN 150 MG PO CAPS [42166]

Facility

$1.14

Service Code	NDC 00904700261
Hospital Charge Code	00904700261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Brighton Health Commercial	$0.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: Group Health Inc Commercial	$0.57
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57
Rate for Payer: Hamaspik Choice Inc Medicare	$0.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.74

PREGABALIN 150 MG PO CAPS [42166]

Facility

$8.43

Service Code	NDC 72205001590
Hospital Charge Code	72205001590
Hospital Revenue Code	250
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$6.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.21
Rate for Payer: Aetna Government	$4.21
Rate for Payer: Brighton Health Commercial	$6.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.73
Rate for Payer: Group Health Inc Commercial	$4.21
Rate for Payer: Group Health Inc Medicare	$2.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.21
Rate for Payer: Hamaspik Choice Inc Medicare	$4.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.48

PREGABALIN 25MG CAP

Facility

$5.55

Hospital Charge Code	41654759
Hospital Revenue Code	250
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$4.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.78
Rate for Payer: Aetna Government	$2.78
Rate for Payer: Brighton Health Commercial	$4.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.77
Rate for Payer: Group Health Inc Commercial	$2.78
Rate for Payer: Group Health Inc Medicare	$1.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.78
Rate for Payer: Hamaspik Choice Inc Medicare	$2.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.61

PREGABALIN 25MG CAP

Facility

$5.55

Hospital Charge Code	41644759
Hospital Revenue Code	250
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$4.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.78
Rate for Payer: Aetna Government	$2.78
Rate for Payer: Brighton Health Commercial	$4.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.77
Rate for Payer: Group Health Inc Commercial	$2.78
Rate for Payer: Group Health Inc Medicare	$1.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.78
Rate for Payer: Hamaspik Choice Inc Medicare	$2.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.61

PREGABALIN 25 MG PO CAPS [42162]

Facility

$12.14

Service Code	NDC 00071101268
Hospital Charge Code	00071101268
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$9.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.07
Rate for Payer: Aetna Government	$6.07
Rate for Payer: Brighton Health Commercial	$9.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.26
Rate for Payer: Group Health Inc Commercial	$6.07
Rate for Payer: Group Health Inc Medicare	$4.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.07
Rate for Payer: Hamaspik Choice Inc Medicare	$6.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.89

PREGABALIN 25 MG PO CAPS [42162]

Facility

$0.93

Service Code	NDC 00904699161
Hospital Charge Code	00904699161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.47
Rate for Payer: Aetna Government	$0.47
Rate for Payer: Brighton Health Commercial	$0.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.63
Rate for Payer: Group Health Inc Commercial	$0.47
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.60

PREGABALIN 300MG CAP

Facility

$5.00

Hospital Charge Code	41644316
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

PREGABALIN 300MG CAP

Facility

$5.00

Hospital Charge Code	41654316
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

PREGABALIN 300 MG PO CAPS [42169]

Facility

$12.14

Service Code	NDC 00071101868
Hospital Charge Code	00071101868
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$9.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.07
Rate for Payer: Aetna Government	$6.07
Rate for Payer: Brighton Health Commercial	$9.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.26
Rate for Payer: Group Health Inc Commercial	$6.07
Rate for Payer: Group Health Inc Medicare	$4.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.07
Rate for Payer: Hamaspik Choice Inc Medicare	$6.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.89

PREGABALIN 50 MG CAP

Facility

$6.12

Hospital Charge Code	41654708
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.16
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

PREGABALIN 50 MG CAP

Facility

$6.12

Hospital Charge Code	41644708
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.16
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

PREGABALIN 50 MG PO CAPS [42163]

Facility

$0.91

Service Code	NDC 00904699261
Hospital Charge Code	00904699261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.62
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

PREGABALIN 50 MG PO CAPS [42163]

Facility

$8.43

Service Code	NDC 72205001290
Hospital Charge Code	72205001290
Hospital Revenue Code	250
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$6.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.21
Rate for Payer: Aetna Government	$4.21
Rate for Payer: Brighton Health Commercial	$6.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.73
Rate for Payer: Group Health Inc Commercial	$4.21
Rate for Payer: Group Health Inc Medicare	$2.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.21
Rate for Payer: Hamaspik Choice Inc Medicare	$4.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.48

PREGABALIN 75MG CAP

Facility

$6.12

Hospital Charge Code	41644412
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.16
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

PREGABALIN 75MG CAP

Facility

$6.12

Hospital Charge Code	41654412
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.16
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

PREGABALIN 75 MG PO CAPS [42164]

Facility

$0.92

Service Code	NDC 00904700061
Hospital Charge Code	00904700061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.46
Rate for Payer: Aetna Government	$0.46
Rate for Payer: Brighton Health Commercial	$0.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.63
Rate for Payer: Group Health Inc Commercial	$0.46
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.60

PREGABALIN 75 MG PO CAPS [42164]

Facility

$8.43

Service Code	NDC 72205001390
Hospital Charge Code	72205001390
Hospital Revenue Code	250
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$6.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.21
Rate for Payer: Aetna Government	$4.21
Rate for Payer: Brighton Health Commercial	$6.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.73
Rate for Payer: Group Health Inc Commercial	$4.21
Rate for Payer: Group Health Inc Medicare	$2.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.21
Rate for Payer: Hamaspik Choice Inc Medicare	$4.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.48

PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE

Professional

Both

$929.99

Service Code	HCPCS 43270
Min. Negotiated Rate	$697.49
Max. Negotiated Rate	$697.49
Rate for Payer: Cash Price	$252.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$697.49
Rate for Payer: SOMOS Essential	$697.49

PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM

Professional

Both

$643.06

Service Code	HCPCS 43249
Min. Negotiated Rate	$482.30
Max. Negotiated Rate	$482.30
Rate for Payer: Cash Price	$174.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$482.30
Rate for Payer: SOMOS Essential	$482.30

PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES

Professional

Both

$1,015.63

Service Code	HCPCS 43244
Min. Negotiated Rate	$761.72
Max. Negotiated Rate	$761.72
Rate for Payer: Cash Price	$276.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$761.72
Rate for Payer: SOMOS Essential	$761.72

PR EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD

Professional

Both

$973.60

Service Code	HCPCS 43257
Min. Negotiated Rate	$730.20
Max. Negotiated Rate	$730.20
Rate for Payer: Cash Price	$267.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$730.20
Rate for Payer: SOMOS Essential	$730.20

PR EGD DILATION GASTRIC/DUODENAL STRICTURE

Professional

Both

$740.60

Service Code	HCPCS 43245
Min. Negotiated Rate	$555.45
Max. Negotiated Rate	$555.45
Rate for Payer: Cash Price	$200.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$555.45
Rate for Payer: SOMOS Essential	$555.45

PR EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION

Professional

Both

$910.84

Service Code	HCPCS 43266
Min. Negotiated Rate	$683.13
Max. Negotiated Rate	$683.13
Rate for Payer: Cash Price	$247.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$683.13
Rate for Payer: SOMOS Essential	$683.13

Know your out-of-pocket cost for care.

All Charges