St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DEXTROSE-SODIUM CHLORIDE 5-0.45 % IV SOLN

Facility

$0.01

Service Code	NDC 0338008503
Hospital Charge Code	0338008503
Hospital Revenue Code	258
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

DEXTROSE-SODIUM CHLORIDE 5-0.45 % IV SOLN

Facility

$0.01

Service Code	NDC 0338008503
Hospital Charge Code	0338008503
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	0338008904
Hospital Revenue Code	258
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	0338008904
Hospital Revenue Code	258
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	0338008903
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	0338008903
Hospital Revenue Code	258
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
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: Healthfirst CHP/FHP/Medicaid	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

Diabetes

Facility

$76,688.82

Service Code	APR-DRG 4204
Min. Negotiated Rate	$21,056.00
Max. Negotiated Rate	$76,688.82
Rate for Payer: Affinity Essential Plan 1&2	$76,688.82
Rate for Payer: Affinity Essential Plan 3&4	$76,688.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,083.92
Rate for Payer: Amida Care Medicaid	$34,083.92
Rate for Payer: EmblemHealth Essential Plan 1&2	$76,688.82
Rate for Payer: EmblemHealth Essential Plan 3&4	$34,083.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,083.92
Rate for Payer: Fidelis Qualified Health Plan	$40,900.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,083.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,083.92
Rate for Payer: Healthfirst Commercial	$43,948.00
Rate for Payer: Healthfirst Essential Plan	$76,688.82
Rate for Payer: Healthfirst QHP	$21,056.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,083.92
Rate for Payer: SOMOS Essential	$76,688.82
Rate for Payer: United Healthcare Essential Plan 1&2	$76,688.82
Rate for Payer: United Healthcare Essential Plan 3&4	$76,688.82
Rate for Payer: United Healthcare Medicaid	$34,083.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,083.92

Diabetes

Facility

$40,029.53

Service Code	APR-DRG 4201
Min. Negotiated Rate	$5,458.00
Max. Negotiated Rate	$40,029.53
Rate for Payer: Affinity Essential Plan 1&2	$40,029.53
Rate for Payer: Affinity Essential Plan 3&4	$40,029.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,790.90
Rate for Payer: Amida Care Medicaid	$17,790.90
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,029.53
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,790.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,790.90
Rate for Payer: Fidelis Qualified Health Plan	$21,349.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,790.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,790.90
Rate for Payer: Healthfirst Commercial	$9,360.00
Rate for Payer: Healthfirst Essential Plan	$40,029.53
Rate for Payer: Healthfirst QHP	$5,458.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,790.90
Rate for Payer: SOMOS Essential	$40,029.53
Rate for Payer: United Healthcare Essential Plan 1&2	$40,029.53
Rate for Payer: United Healthcare Essential Plan 3&4	$40,029.53
Rate for Payer: United Healthcare Medicaid	$17,790.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,790.90

Diabetes

Facility

$49,204.89

Service Code	APR-DRG 4203
Min. Negotiated Rate	$9,693.00
Max. Negotiated Rate	$49,204.89
Rate for Payer: Affinity Essential Plan 1&2	$49,204.89
Rate for Payer: Affinity Essential Plan 3&4	$49,204.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,868.84
Rate for Payer: Amida Care Medicaid	$21,868.84
Rate for Payer: EmblemHealth Essential Plan 1&2	$49,204.89
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,868.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,868.84
Rate for Payer: Fidelis Qualified Health Plan	$26,242.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,868.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,868.84
Rate for Payer: Healthfirst Commercial	$17,116.00
Rate for Payer: Healthfirst Essential Plan	$49,204.89
Rate for Payer: Healthfirst QHP	$9,693.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,868.84
Rate for Payer: SOMOS Essential	$49,204.89
Rate for Payer: United Healthcare Essential Plan 1&2	$49,204.89
Rate for Payer: United Healthcare Essential Plan 3&4	$49,204.89
Rate for Payer: United Healthcare Medicaid	$21,868.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,868.84

Diabetes

Facility

$43,116.12

Service Code	APR-DRG 4202
Min. Negotiated Rate	$7,028.00
Max. Negotiated Rate	$43,116.12
Rate for Payer: Affinity Essential Plan 1&2	$43,116.12
Rate for Payer: Affinity Essential Plan 3&4	$43,116.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,162.72
Rate for Payer: Amida Care Medicaid	$19,162.72
Rate for Payer: EmblemHealth Essential Plan 1&2	$43,116.12
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,162.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,162.72
Rate for Payer: Fidelis Qualified Health Plan	$22,995.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,162.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,162.72
Rate for Payer: Healthfirst Commercial	$11,924.00
Rate for Payer: Healthfirst Essential Plan	$43,116.12
Rate for Payer: Healthfirst QHP	$7,028.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,162.72
Rate for Payer: SOMOS Essential	$43,116.12
Rate for Payer: United Healthcare Essential Plan 1&2	$43,116.12
Rate for Payer: United Healthcare Essential Plan 3&4	$43,116.12
Rate for Payer: United Healthcare Medicaid	$19,162.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,162.72

DIABETES WITH NEUROLOGIC MANIFESTATIONS

Facility

$236.30

Service Code	EAPG 00712
Min. Negotiated Rate	$171.26
Max. Negotiated Rate	$236.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$171.26
Rate for Payer: Healthfirst Commercial	$236.30

DIABETES WITH OPHTHALMIC MANIFESTATIONS

Facility

$239.33

Service Code	EAPG 00710
Min. Negotiated Rate	$173.57
Max. Negotiated Rate	$239.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$173.57
Rate for Payer: Healthfirst Commercial	$239.33

DIABETES WITH OTHER MANIFESTATIONS & COMPLICATIONS

Facility

$216.56

Service Code	EAPG 00711
Min. Negotiated Rate	$157.37
Max. Negotiated Rate	$216.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$157.37
Rate for Payer: Healthfirst Commercial	$216.56

DIABETES WITHOUT COMPLICATIONS

Facility

$205.58

Service Code	EAPG 00713
Min. Negotiated Rate	$148.12
Max. Negotiated Rate	$205.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$148.12
Rate for Payer: Healthfirst Commercial	$205.58

DIABETES WITH RENAL MANIFESTATIONS

Facility

$191.82

Service Code	EAPG 00714
Min. Negotiated Rate	$138.86
Max. Negotiated Rate	$191.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$138.86
Rate for Payer: Healthfirst Commercial	$191.82

DIABETES WITH VASCULAR COMPLICATIONS INCLUDING FOOT AND OTHER SKIN ULCERS

Facility

$157.37

Service Code	EAPG 00715
Min. Negotiated Rate	$157.37
Max. Negotiated Rate	$157.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$157.37

DIAGNOSTIC CARDIAC CATHETERIZATION

Facility

$3,130.87

Service Code	EAPG 00084
Min. Negotiated Rate	$2,272.64
Max. Negotiated Rate	$3,130.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,272.64
Rate for Payer: Healthfirst Commercial	$3,130.87

DIAGNOSTIC DENTAL PROCEDURES

Facility

$74.36

Service Code	EAPG 00376
Min. Negotiated Rate	$53.23
Max. Negotiated Rate	$74.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53.23
Rate for Payer: Healthfirst Commercial	$74.36

DIALYSIS PROCEDURES

Facility

$435.23

Service Code	EAPG 00168
Min. Negotiated Rate	$317.06
Max. Negotiated Rate	$435.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$317.06
Rate for Payer: Healthfirst Commercial	$435.23

DIAPHRAGMATIC PROCEDURES AND RELATED HERNIA REPAIR

Facility

$2,934.53

Service Code	EAPG 00073
Min. Negotiated Rate	$2,934.53
Max. Negotiated Rate	$2,934.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,934.53

DIATRIZOATE MEGLUMINE & SODIUM 66-10 % PO SOLN

Facility

$0.70

Service Code	HCPCS Q9963
Hospital Charge Code	0270044540
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Brighton Health Commercial	$0.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
Rate for Payer: EmblemHealth Commercial	$0.35
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.45

DIATRIZOATE MEGLUMINE & SODIUM 66-10 % PO SOLN

Facility

$0.70

Service Code	HCPCS Q9963
Hospital Charge Code	0270044540
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35

DIAZEPAM 10 MG RE GEL

Facility

$364.06

Service Code	NDC 6868265220
Hospital Charge Code	6868265220
Hospital Revenue Code	250
Min. Negotiated Rate	$182.03
Max. Negotiated Rate	$182.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.03

DIAZEPAM 10 MG RE GEL

Facility

$364.06

Service Code	NDC 6868265220
Hospital Charge Code	6868265220
Hospital Revenue Code	250
Min. Negotiated Rate	$127.42
Max. Negotiated Rate	$291.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$200.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$182.03
Rate for Payer: Aetna Government	$182.03
Rate for Payer: Brighton Health Commercial	$273.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$291.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$247.56
Rate for Payer: EmblemHealth Commercial	$182.03
Rate for Payer: Group Health Inc Commercial	$182.03
Rate for Payer: Group Health Inc Medicare	$127.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.03
Rate for Payer: Hamaspik Choice Inc Medicare	$182.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$236.64

DIAZEPAM 2.5 MG RE GEL

Facility

$306.90

Service Code	NDC 6868265020
Hospital Charge Code	6868265020
Hospital Revenue Code	250
Min. Negotiated Rate	$153.45
Max. Negotiated Rate	$153.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.45

Know your out-of-pocket cost for care.

All Charges