St. Barnabas Hospital

All Charges

Charge

Type

Price

TDAP (VFC) 0.5ML IM SYR

Facility OP

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41659572
Hospital Revenue Code	636
Max. Negotiated Rate	$41.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34.87
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.43
Rate for Payer: SOMOS Essential	$41.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TDAP (VFC) 0.5ML IM SYR

Facility OP

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41649572
Hospital Revenue Code	636
Max. Negotiated Rate	$41.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34.87
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.43
Rate for Payer: SOMOS Essential	$41.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TDAP (VFC) 0.5ML IM SYR

Facility OP

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41659570
Hospital Revenue Code	636
Max. Negotiated Rate	$41.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34.87
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.43
Rate for Payer: SOMOS Essential	$41.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TDAP (VFC) 0.5ML IM SYR

Facility IP

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41649572
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

TDAP (VFC) 0.5ML IM SYR

Facility IP

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41659572
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

TDAP (VFC) 0.5ML IM VIAL

Facility OP

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41659571
Hospital Revenue Code	636
Max. Negotiated Rate	$41.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34.87
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.43
Rate for Payer: SOMOS Essential	$41.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TDAP (VFC) 0.5ML IM VIAL

Facility OP

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41649571
Hospital Revenue Code	636
Max. Negotiated Rate	$41.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34.87
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.43
Rate for Payer: SOMOS Essential	$41.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TDAP (VFC) 0.5ML IM VIAL

Facility IP

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41659571
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

TDAP (VFC) 0.5ML IM VIAL

Facility IP

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41649571
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

TDAP (VFC) O.5ML IM SYR

Facility IP

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41649570
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

TDAP (VFC) O.5ML IM SYR

Facility OP

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41649570
Hospital Revenue Code	636
Max. Negotiated Rate	$41.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34.87
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.43
Rate for Payer: SOMOS Essential	$41.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TD TOXINS (VFC) 0.5ML IM

Facility OP

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41649568
Hospital Revenue Code	636
Max. Negotiated Rate	$31.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.94
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TD TOXINS (VFC) 0.5ML IM

Facility IP

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41649568
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

TD TOXIODS (VFC) 0.5ML IM VIAL

Facility IP

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41649569
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

TD TOXIODS (VFC) 0.5ML IM VIAL

Facility OP

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41649569
Hospital Revenue Code	636
Max. Negotiated Rate	$31.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.94
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TD TOXIODS (VFC) O.5ML IM

Facility OP

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41659568
Hospital Revenue Code	636
Max. Negotiated Rate	$31.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.94
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TD TOXIODS (VFC) O.5ML IM

Facility IP

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41659568
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

TD TOXOIDS (VFC) 0.5ML IM VIAL

Facility IP

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41659569
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

TD TOXOIDS (VFC) 0.5ML IM VIAL

Facility OP

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41659569
Hospital Revenue Code	636
Max. Negotiated Rate	$31.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.94
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TD VACCINE, IM

Facility IP

$56.70

Service Code	HCPCS 90714
Hospital Charge Code	30300145
Hospital Revenue Code	636
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.35
Rate for Payer: Hamaspik Choice Inc Medicare	$28.35

TD VACCINE, IM

Facility OP

$56.70

Service Code	HCPCS 90714
Hospital Charge Code	30300145
Hospital Revenue Code	636
Min. Negotiated Rate	$19.84
Max. Negotiated Rate	$36.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.94
Rate for Payer: Group Health Inc Commercial	$28.35
Rate for Payer: Group Health Inc Medicare	$19.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.35
Rate for Payer: Hamaspik Choice Inc Medicare	$28.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.86

TD VACCINE NO PRSRV >/= 7 IM

Facility OP

$75.00

Service Code	HCPCS 90714
Hospital Charge Code	30103323
Hospital Revenue Code	636
Min. Negotiated Rate	$19.96
Max. Negotiated Rate	$48.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.94
Rate for Payer: Group Health Inc Commercial	$37.50
Rate for Payer: Group Health Inc Medicare	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$48.75

TD VACCINE NO PRSRV >/= 7 IM

Facility IP

$75.00

Service Code	HCPCS 90714
Hospital Charge Code	30103323
Hospital Revenue Code	636
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50

TECHNETIUM PC-99M EXAMETAZIME

Facility OP

$3,364.25

Service Code	HCPCS A9521
Hospital Charge Code	41646487
Hospital Revenue Code	343
Min. Negotiated Rate	$1,177.49
Max. Negotiated Rate	$2,691.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,850.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,265.82
Rate for Payer: Aetna Government	$1,265.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,691.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,287.69
Rate for Payer: Group Health Inc Commercial	$1,682.12
Rate for Payer: Group Health Inc Medicare	$1,177.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,682.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,682.12

TECHNETIUM TC-00M MEDRONATE

Facility OP

$43.00

Service Code	HCPCS A9503
Hospital Charge Code	41646489
Hospital Revenue Code	343
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$34.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.76
Rate for Payer: Aetna Government	$10.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.24
Rate for Payer: Group Health Inc Commercial	$21.50
Rate for Payer: Group Health Inc Medicare	$15.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.50
Rate for Payer: Hamaspik Choice Inc Medicare	$21.50

Price Transparency.

All Charges