St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ABACAVIR SULFATE-LAMIVUDINE 600-300 MG PO TABS

Facility

$46.50

Service Code	NDC 6818028806
Hospital Charge Code	6818028806
Hospital Revenue Code	250
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$23.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.25

ABATACEPT 250 MG IV SOLR

Facility

$1.00

Service Code	HCPCS J0129
Hospital Charge Code	0003218713
Hospital Revenue Code	258
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$3,617.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.11
Rate for Payer: Aetna Government	$44.11
Rate for Payer: Affinity Essential Plan 1&2	$81.38
Rate for Payer: Affinity Essential Plan 3&4	$81.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$36.17
Rate for Payer: Amida Care Medicaid	$36.17
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$44.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$44.11
Rate for Payer: EmblemHealth Commercial	$44.11
Rate for Payer: EmblemHealth Essential Plan 1&2	$81.38
Rate for Payer: EmblemHealth Essential Plan 3&4	$36.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36.17
Rate for Payer: Fidelis Essential Plan Aliesa	$81.38
Rate for Payer: Fidelis Essential Plan QHP	$81.38
Rate for Payer: Fidelis Medicare Advantage	$44.11
Rate for Payer: Fidelis Qualified Health Plan	$37.98
Rate for Payer: Group Health Inc Commercial	$44.11
Rate for Payer: Group Health Inc Medicare	$44.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.17
Rate for Payer: Hamaspik Choice Inc Medicare	$44.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,617.00
Rate for Payer: Healthfirst Essential Plan	$81.38
Rate for Payer: Healthfirst Medicare Advantage	$37.49
Rate for Payer: Healthfirst QHP	$58.96
Rate for Payer: Humana Medicare	$44.99
Rate for Payer: Senior Whole Health Medicare Advantage	$44.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36.17
Rate for Payer: SOMOS Essential	$81.38
Rate for Payer: United Healthcare Essential Plan 1&2	$81.38
Rate for Payer: United Healthcare Essential Plan 3&4	$39.79
Rate for Payer: United Healthcare Medicaid	$36.17
Rate for Payer: United Healthcare Medicare Advantage	$44.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36.17
Rate for Payer: Wellcare Medicare	$41.90

ABATACEPT 250 MG IV SOLR

Facility

$1.00

Service Code	HCPCS J0129
Hospital Charge Code	0003218713
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

ABDOMINAL HERNIA REPAIR

Facility

$2,747.07

Service Code	EAPG 03035
Min. Negotiated Rate	$2,747.07
Max. Negotiated Rate	$2,747.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,747.07

Abdominal pain

Facility

$41,987.00

Service Code	APR-DRG 2512
Min. Negotiated Rate	$6,593.00
Max. Negotiated Rate	$41,987.00
Rate for Payer: Affinity Essential Plan 1&2	$41,987.00
Rate for Payer: Affinity Essential Plan 3&4	$41,987.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,660.89
Rate for Payer: Amida Care Medicaid	$18,660.89
Rate for Payer: EmblemHealth Essential Plan 1&2	$41,987.00
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,660.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,660.89
Rate for Payer: Fidelis Qualified Health Plan	$22,393.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,660.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,660.89
Rate for Payer: Healthfirst Commercial	$11,114.00
Rate for Payer: Healthfirst Essential Plan	$41,987.00
Rate for Payer: Healthfirst QHP	$6,593.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,660.89
Rate for Payer: SOMOS Essential	$41,987.00
Rate for Payer: United Healthcare Essential Plan 1&2	$41,987.00
Rate for Payer: United Healthcare Essential Plan 3&4	$41,987.00
Rate for Payer: United Healthcare Medicaid	$18,660.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,660.89

Abdominal pain

Facility

$46,920.29

Service Code	APR-DRG 2513
Min. Negotiated Rate	$9,096.00
Max. Negotiated Rate	$46,920.29
Rate for Payer: Affinity Essential Plan 1&2	$46,920.29
Rate for Payer: Affinity Essential Plan 3&4	$46,920.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,853.46
Rate for Payer: Amida Care Medicaid	$20,853.46
Rate for Payer: EmblemHealth Essential Plan 1&2	$46,920.29
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,853.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,853.46
Rate for Payer: Fidelis Qualified Health Plan	$25,024.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,853.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,853.46
Rate for Payer: Healthfirst Commercial	$15,791.00
Rate for Payer: Healthfirst Essential Plan	$46,920.29
Rate for Payer: Healthfirst QHP	$9,096.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,853.46
Rate for Payer: SOMOS Essential	$46,920.29
Rate for Payer: United Healthcare Essential Plan 1&2	$46,920.29
Rate for Payer: United Healthcare Essential Plan 3&4	$46,920.29
Rate for Payer: United Healthcare Medicaid	$20,853.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,853.46

Abdominal pain

Facility

$39,549.38

Service Code	APR-DRG 2511
Min. Negotiated Rate	$5,201.00
Max. Negotiated Rate	$39,549.38
Rate for Payer: Affinity Essential Plan 1&2	$39,549.38
Rate for Payer: Affinity Essential Plan 3&4	$39,549.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,577.50
Rate for Payer: Amida Care Medicaid	$17,577.50
Rate for Payer: EmblemHealth Essential Plan 1&2	$39,549.38
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,577.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,577.50
Rate for Payer: Fidelis Qualified Health Plan	$21,093.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,577.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,577.50
Rate for Payer: Healthfirst Commercial	$8,839.00
Rate for Payer: Healthfirst Essential Plan	$39,549.38
Rate for Payer: Healthfirst QHP	$5,201.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,577.50
Rate for Payer: SOMOS Essential	$39,549.38
Rate for Payer: United Healthcare Essential Plan 1&2	$39,549.38
Rate for Payer: United Healthcare Essential Plan 3&4	$39,549.38
Rate for Payer: United Healthcare Medicaid	$17,577.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,577.50

Abdominal pain

Facility

$66,071.27

Service Code	APR-DRG 2514
Min. Negotiated Rate	$15,408.00
Max. Negotiated Rate	$66,071.27
Rate for Payer: Affinity Essential Plan 1&2	$66,071.27
Rate for Payer: Affinity Essential Plan 3&4	$66,071.27
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,365.01
Rate for Payer: Amida Care Medicaid	$29,365.01
Rate for Payer: EmblemHealth Essential Plan 1&2	$66,071.27
Rate for Payer: EmblemHealth Essential Plan 3&4	$29,365.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,365.01
Rate for Payer: Fidelis Qualified Health Plan	$35,238.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,365.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,365.01
Rate for Payer: Healthfirst Commercial	$32,442.00
Rate for Payer: Healthfirst Essential Plan	$66,071.27
Rate for Payer: Healthfirst QHP	$15,408.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,365.01
Rate for Payer: SOMOS Essential	$66,071.27
Rate for Payer: United Healthcare Essential Plan 1&2	$66,071.27
Rate for Payer: United Healthcare Essential Plan 3&4	$66,071.27
Rate for Payer: United Healthcare Medicaid	$29,365.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,365.01

ABDOMINAL PAIN

Facility

$246.44

Service Code	EAPG 00628
Min. Negotiated Rate	$178.20
Max. Negotiated Rate	$246.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$178.20
Rate for Payer: Healthfirst Commercial	$246.44

ABDOMINAL PARACENTESIS AND RELATED PERITONEAL DRAINAGE PROCEDURES

Facility

$761.40

Service Code	EAPG 00150
Min. Negotiated Rate	$761.40
Max. Negotiated Rate	$761.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$761.40

ABLYSINOL IA SOLN

Facility

$199.90

Service Code	NDC 5428810502
Hospital Charge Code	5428810502
Hospital Revenue Code	250
Min. Negotiated Rate	$69.97
Max. Negotiated Rate	$159.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$109.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$99.95
Rate for Payer: Aetna Government	$99.95
Rate for Payer: Brighton Health Commercial	$149.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$159.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$135.93
Rate for Payer: EmblemHealth Commercial	$99.95
Rate for Payer: Group Health Inc Commercial	$99.95
Rate for Payer: Group Health Inc Medicare	$69.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.95
Rate for Payer: Hamaspik Choice Inc Medicare	$99.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$129.94

ABLYSINOL IA SOLN

Facility

$199.90

Service Code	NDC 5428810502
Hospital Charge Code	5428810502
Hospital Revenue Code	250
Min. Negotiated Rate	$99.95
Max. Negotiated Rate	$99.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.95

ABLYSINOL IA SOLN

Facility

$199.90

Service Code	NDC 5428810515
Hospital Charge Code	5428810515
Hospital Revenue Code	250
Min. Negotiated Rate	$99.95
Max. Negotiated Rate	$99.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.95

ABLYSINOL IA SOLN

Facility

$199.90

Service Code	NDC 5428810515
Hospital Charge Code	5428810515
Hospital Revenue Code	250
Min. Negotiated Rate	$69.97
Max. Negotiated Rate	$159.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$109.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$99.95
Rate for Payer: Aetna Government	$99.95
Rate for Payer: Brighton Health Commercial	$149.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$159.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$135.93
Rate for Payer: EmblemHealth Commercial	$99.95
Rate for Payer: Group Health Inc Commercial	$99.95
Rate for Payer: Group Health Inc Medicare	$69.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.95
Rate for Payer: Hamaspik Choice Inc Medicare	$99.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$129.94

ABORTION AND MISCARRIAGE TREATMENT AND PROCEDURES

Facility

$1,322.30

Service Code	EAPG 00194
Min. Negotiated Rate	$960.43
Max. Negotiated Rate	$1,322.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$960.43
Rate for Payer: Healthfirst Commercial	$1,322.30

ABORTION RELATED DIAGNOSES

Facility

$235.53

Service Code	EAPG 00763
Min. Negotiated Rate	$171.26
Max. Negotiated Rate	$235.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$171.26
Rate for Payer: Healthfirst Commercial	$235.53

Abortion w/o D&C, aspiration curettage or hysterotomy

Facility

$44,772.86

Service Code	APR-DRG 5644
Min. Negotiated Rate	$7,191.00
Max. Negotiated Rate	$44,772.86
Rate for Payer: Affinity Essential Plan 1&2	$44,772.86
Rate for Payer: Affinity Essential Plan 3&4	$44,772.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,899.05
Rate for Payer: Amida Care Medicaid	$19,899.05
Rate for Payer: EmblemHealth Essential Plan 1&2	$44,772.86
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,899.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,899.05
Rate for Payer: Fidelis Qualified Health Plan	$23,878.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,899.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,899.05
Rate for Payer: Healthfirst Commercial	$13,637.00
Rate for Payer: Healthfirst Essential Plan	$44,772.86
Rate for Payer: Healthfirst QHP	$7,191.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,899.05
Rate for Payer: SOMOS Essential	$44,772.86
Rate for Payer: United Healthcare Essential Plan 1&2	$44,772.86
Rate for Payer: United Healthcare Essential Plan 3&4	$44,772.86
Rate for Payer: United Healthcare Medicaid	$19,899.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,899.05

Abortion w/o D&C, aspiration curettage or hysterotomy

Facility

$39,443.85

Service Code	APR-DRG 5642
Min. Negotiated Rate	$5,175.00
Max. Negotiated Rate	$39,443.85
Rate for Payer: Affinity Essential Plan 1&2	$39,443.85
Rate for Payer: Affinity Essential Plan 3&4	$39,443.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,530.60
Rate for Payer: Amida Care Medicaid	$17,530.60
Rate for Payer: EmblemHealth Essential Plan 1&2	$39,443.85
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,530.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,530.60
Rate for Payer: Fidelis Qualified Health Plan	$21,036.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,530.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,530.60
Rate for Payer: Healthfirst Commercial	$8,899.00
Rate for Payer: Healthfirst Essential Plan	$39,443.85
Rate for Payer: Healthfirst QHP	$5,175.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,530.60
Rate for Payer: SOMOS Essential	$39,443.85
Rate for Payer: United Healthcare Essential Plan 1&2	$39,443.85
Rate for Payer: United Healthcare Essential Plan 3&4	$39,443.85
Rate for Payer: United Healthcare Medicaid	$17,530.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,530.60

Abortion w/o D&C, aspiration curettage or hysterotomy

Facility

$38,434.34

Service Code	APR-DRG 5641
Min. Negotiated Rate	$4,613.00
Max. Negotiated Rate	$38,434.34
Rate for Payer: Affinity Essential Plan 1&2	$38,434.34
Rate for Payer: Affinity Essential Plan 3&4	$38,434.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,081.93
Rate for Payer: Amida Care Medicaid	$17,081.93
Rate for Payer: EmblemHealth Essential Plan 1&2	$38,434.34
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,081.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,081.93
Rate for Payer: Fidelis Qualified Health Plan	$20,498.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,081.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,081.93
Rate for Payer: Healthfirst Commercial	$7,906.00
Rate for Payer: Healthfirst Essential Plan	$38,434.34
Rate for Payer: Healthfirst QHP	$4,613.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,081.93
Rate for Payer: SOMOS Essential	$38,434.34
Rate for Payer: United Healthcare Essential Plan 1&2	$38,434.34
Rate for Payer: United Healthcare Essential Plan 3&4	$38,434.34
Rate for Payer: United Healthcare Medicaid	$17,081.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,081.93

Abortion w/o D&C, aspiration curettage or hysterotomy

Facility

$42,628.95

Service Code	APR-DRG 5643
Min. Negotiated Rate	$6,657.00
Max. Negotiated Rate	$42,628.95
Rate for Payer: Affinity Essential Plan 1&2	$42,628.95
Rate for Payer: Affinity Essential Plan 3&4	$42,628.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,946.20
Rate for Payer: Amida Care Medicaid	$18,946.20
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,628.95
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,946.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,946.20
Rate for Payer: Fidelis Qualified Health Plan	$22,735.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,946.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,946.20
Rate for Payer: Healthfirst Commercial	$11,832.00
Rate for Payer: Healthfirst Essential Plan	$42,628.95
Rate for Payer: Healthfirst QHP	$6,657.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,946.20
Rate for Payer: SOMOS Essential	$42,628.95
Rate for Payer: United Healthcare Essential Plan 1&2	$42,628.95
Rate for Payer: United Healthcare Essential Plan 3&4	$42,628.95
Rate for Payer: United Healthcare Medicaid	$18,946.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,946.20

ACAM2000 IJ SOLR

Facility

$0.01

Service Code	NDC 7166533001
Hospital Charge Code	7166533001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

ACAM2000 IJ SOLR

Facility

$0.01

Service Code	NDC 7166533001
Hospital Charge Code	7166533001
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ACAMPROSATE CALCIUM 333 MG PO TBEC

Facility

$1.76

Service Code	NDC 6846243518
Hospital Charge Code	6846243518
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.88

ACAMPROSATE CALCIUM 333 MG PO TBEC

Facility

$1.76

Service Code	NDC 6838256928
Hospital Charge Code	6838256928
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.88

ACAMPROSATE CALCIUM 333 MG PO TBEC

Facility

$1.76

Service Code	NDC 6838256928
Hospital Charge Code	6838256928
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.88
Rate for Payer: Aetna Government	$0.88
Rate for Payer: Brighton Health Commercial	$1.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.19
Rate for Payer: EmblemHealth Commercial	$0.88
Rate for Payer: Group Health Inc Commercial	$0.88
Rate for Payer: Group Health Inc Medicare	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.88
Rate for Payer: Hamaspik Choice Inc Medicare	$0.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.14

Know your out-of-pocket cost for care.

All Charges