St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DRONABINOL 2.5 MG PO CAPS

Facility

$5.67

Service Code	HCPCS Q0167
Hospital Charge Code	0904714461
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83

DRONABINOL 2.5 MG PO CAPS

Facility

$1.66

Service Code	HCPCS Q0167
Hospital Charge Code	4285886706
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.83

DRONABINOL 2.5 MG PO CAPS

Facility

$1.66

Service Code	HCPCS Q0167
Hospital Charge Code	4285886706
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$1.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.13
Rate for Payer: EmblemHealth Commercial	$0.83
Rate for Payer: Group Health Inc Commercial	$0.83
Rate for Payer: Group Health Inc Medicare	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.83
Rate for Payer: Hamaspik Choice Inc Medicare	$0.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.08

DRONABINOL 2.5 MG PO CAPS

Facility

$6.51

Service Code	HCPCS Q0167
Hospital Charge Code	6787775360
Hospital Revenue Code	250
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$3.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.26

DRONABINOL 2.5 MG PO CAPS

Facility

$5.67

Service Code	HCPCS Q0167
Hospital Charge Code	0904714461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$4.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$4.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.85
Rate for Payer: EmblemHealth Commercial	$2.83
Rate for Payer: Group Health Inc Commercial	$2.83
Rate for Payer: Group Health Inc Medicare	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83
Rate for Payer: Hamaspik Choice Inc Medicare	$2.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.68

DRONEDARONE HCL 400 MG PO TABS

Facility

$15.96

Service Code	NDC 0024414260
Hospital Charge Code	0024414260
Hospital Revenue Code	250
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$7.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.98

DRONEDARONE HCL 400 MG PO TABS

Facility

$15.96

Service Code	NDC 0024414260
Hospital Charge Code	0024414260
Hospital Revenue Code	250
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$12.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.98
Rate for Payer: Aetna Government	$7.98
Rate for Payer: Brighton Health Commercial	$11.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.85
Rate for Payer: EmblemHealth Commercial	$7.98
Rate for Payer: Group Health Inc Commercial	$7.98
Rate for Payer: Group Health Inc Medicare	$5.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.98
Rate for Payer: Hamaspik Choice Inc Medicare	$7.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.37

Drug & alcohol abuse or dependence, left against medical advice

Facility

$14,903.00

Service Code	APR-DRG 7704
Min. Negotiated Rate	$3,315.88
Max. Negotiated Rate	$14,903.00
Rate for Payer: Affinity Essential Plan 1&2	$3,315.88
Rate for Payer: Affinity Essential Plan 3&4	$3,315.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,315.88
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,315.88
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,460.73
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,315.88
Rate for Payer: Fidelis Qualified Health Plan	$3,979.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,315.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,315.88
Rate for Payer: Healthfirst Commercial	$14,903.00
Rate for Payer: Healthfirst Essential Plan	$7,460.73
Rate for Payer: Healthfirst QHP	$6,034.90
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,315.88
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,460.73
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,460.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,315.88
Rate for Payer: SOMOS Essential	$7,460.73
Rate for Payer: United Healthcare Essential Plan 1&2	$7,460.73
Rate for Payer: United Healthcare Essential Plan 3&4	$7,460.73
Rate for Payer: United Healthcare Medicaid	$3,315.88

Drug & alcohol abuse or dependence, left against medical advice

Facility

$7,460.73

Service Code	APR-DRG 7701
Min. Negotiated Rate	$3,315.88
Max. Negotiated Rate	$7,460.73
Rate for Payer: Affinity Essential Plan 1&2	$3,315.88
Rate for Payer: Affinity Essential Plan 3&4	$3,315.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,315.88
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,315.88
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,460.73
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,315.88
Rate for Payer: Fidelis Qualified Health Plan	$3,979.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,315.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,315.88
Rate for Payer: Healthfirst Commercial	$7,244.00
Rate for Payer: Healthfirst Essential Plan	$7,460.73
Rate for Payer: Healthfirst QHP	$6,034.90
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,315.88
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,460.73
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,460.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,315.88
Rate for Payer: SOMOS Essential	$7,460.73
Rate for Payer: United Healthcare Essential Plan 1&2	$7,460.73
Rate for Payer: United Healthcare Essential Plan 3&4	$7,460.73
Rate for Payer: United Healthcare Medicaid	$3,315.88

Drug & alcohol abuse or dependence, left against medical advice

Facility

$12,809.00

Service Code	APR-DRG 7703
Min. Negotiated Rate	$3,315.88
Max. Negotiated Rate	$12,809.00
Rate for Payer: Affinity Essential Plan 1&2	$3,315.88
Rate for Payer: Affinity Essential Plan 3&4	$3,315.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,315.88
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,315.88
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,460.73
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,315.88
Rate for Payer: Fidelis Qualified Health Plan	$3,979.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,315.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,315.88
Rate for Payer: Healthfirst Commercial	$12,809.00
Rate for Payer: Healthfirst Essential Plan	$7,460.73
Rate for Payer: Healthfirst QHP	$6,034.90
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,315.88
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,460.73
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,460.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,315.88
Rate for Payer: SOMOS Essential	$7,460.73
Rate for Payer: United Healthcare Essential Plan 1&2	$7,460.73
Rate for Payer: United Healthcare Essential Plan 3&4	$7,460.73
Rate for Payer: United Healthcare Medicaid	$3,315.88

Drug & alcohol abuse or dependence, left against medical advice

Facility

$8,443.00

Service Code	APR-DRG 7702
Min. Negotiated Rate	$3,315.88
Max. Negotiated Rate	$8,443.00
Rate for Payer: Affinity Essential Plan 1&2	$3,315.88
Rate for Payer: Affinity Essential Plan 3&4	$3,315.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,315.88
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,315.88
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,460.73
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,315.88
Rate for Payer: Fidelis Qualified Health Plan	$3,979.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,315.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,315.88
Rate for Payer: Healthfirst Commercial	$8,443.00
Rate for Payer: Healthfirst Essential Plan	$7,460.73
Rate for Payer: Healthfirst QHP	$6,034.90
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,315.88
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,460.73
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,460.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,315.88
Rate for Payer: SOMOS Essential	$7,460.73
Rate for Payer: United Healthcare Essential Plan 1&2	$7,460.73
Rate for Payer: United Healthcare Essential Plan 3&4	$7,460.73
Rate for Payer: United Healthcare Medicaid	$3,315.88

DTAP-HEPATITIS B RECOMB-IPV IM SUSY

Facility

$233.62

Service Code	NDC 5816081152
Hospital Charge Code	5816081152
Hospital Revenue Code	250
Min. Negotiated Rate	$116.81
Max. Negotiated Rate	$116.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.81

DTAP-HEPATITIS B RECOMB-IPV IM SUSY

Facility

$233.62

Service Code	NDC 5816081152
Hospital Charge Code	5816081152
Hospital Revenue Code	250
Min. Negotiated Rate	$81.77
Max. Negotiated Rate	$186.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$128.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$116.81
Rate for Payer: Aetna Government	$116.81
Rate for Payer: Brighton Health Commercial	$175.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$186.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$158.86
Rate for Payer: EmblemHealth Commercial	$116.81
Rate for Payer: Group Health Inc Commercial	$116.81
Rate for Payer: Group Health Inc Medicare	$81.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.81
Rate for Payer: Hamaspik Choice Inc Medicare	$116.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$151.85

DTAP-IPV-HIB-HEPATITIS B RECMB IM SUSP

Facility

$351.24

Service Code	NDC 6336124310
Hospital Charge Code	6336124310
Hospital Revenue Code	250
Min. Negotiated Rate	$122.93
Max. Negotiated Rate	$280.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$193.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.62
Rate for Payer: Aetna Government	$175.62
Rate for Payer: Brighton Health Commercial	$263.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.84
Rate for Payer: EmblemHealth Commercial	$175.62
Rate for Payer: Group Health Inc Commercial	$175.62
Rate for Payer: Group Health Inc Medicare	$122.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.62
Rate for Payer: Hamaspik Choice Inc Medicare	$175.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$228.31

DTAP-IPV-HIB-HEPATITIS B RECMB IM SUSP

Facility

$351.24

Service Code	NDC 6336124310
Hospital Charge Code	6336124310
Hospital Revenue Code	250
Min. Negotiated Rate	$175.62
Max. Negotiated Rate	$175.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.62

DTAP-IPV-HIB-HEPATITIS B RECMB IM SUSY

Facility

$351.24

Service Code	NDC 6336124315
Hospital Charge Code	6336124315
Hospital Revenue Code	250
Min. Negotiated Rate	$175.62
Max. Negotiated Rate	$175.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.62

DTAP-IPV-HIB-HEPATITIS B RECMB IM SUSY

Facility

$351.24

Service Code	NDC 6336124388
Hospital Charge Code	6336124388
Hospital Revenue Code	250
Min. Negotiated Rate	$122.93
Max. Negotiated Rate	$280.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$193.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.62
Rate for Payer: Aetna Government	$175.62
Rate for Payer: Brighton Health Commercial	$263.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.84
Rate for Payer: EmblemHealth Commercial	$175.62
Rate for Payer: Group Health Inc Commercial	$175.62
Rate for Payer: Group Health Inc Medicare	$122.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.62
Rate for Payer: Hamaspik Choice Inc Medicare	$175.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$228.31

DTAP-IPV-HIB-HEPATITIS B RECMB IM SUSY

Facility

$351.24

Service Code	NDC 6336124315
Hospital Charge Code	6336124315
Hospital Revenue Code	250
Min. Negotiated Rate	$122.93
Max. Negotiated Rate	$280.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$193.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.62
Rate for Payer: Aetna Government	$175.62
Rate for Payer: Brighton Health Commercial	$263.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.84
Rate for Payer: EmblemHealth Commercial	$175.62
Rate for Payer: Group Health Inc Commercial	$175.62
Rate for Payer: Group Health Inc Medicare	$122.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.62
Rate for Payer: Hamaspik Choice Inc Medicare	$175.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$228.31

DTAP-IPV-HIB-HEPATITIS B RECMB IM SUSY

Facility

$351.24

Service Code	NDC 6336124388
Hospital Charge Code	6336124388
Hospital Revenue Code	250
Min. Negotiated Rate	$175.62
Max. Negotiated Rate	$175.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.62

DTAP-IPV-HIB VACCINE IM SUSR

Facility

$136.68

Service Code	NDC 4928151105
Hospital Charge Code	4928151105
Hospital Revenue Code	250
Min. Negotiated Rate	$47.84
Max. Negotiated Rate	$109.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.34
Rate for Payer: Aetna Government	$68.34
Rate for Payer: Brighton Health Commercial	$102.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$109.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.94
Rate for Payer: EmblemHealth Commercial	$68.34
Rate for Payer: Group Health Inc Commercial	$68.34
Rate for Payer: Group Health Inc Medicare	$47.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.34
Rate for Payer: Hamaspik Choice Inc Medicare	$68.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.84

DTAP-IPV-HIB VACCINE IM SUSR

Facility

$136.68

Service Code	NDC 4928151105
Hospital Charge Code	4928151105
Hospital Revenue Code	250
Min. Negotiated Rate	$68.34
Max. Negotiated Rate	$68.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.34

DTAP-IPV VACCINE 0.5 ML IM SUSY

Facility

$145.39

Service Code	NDC 5816081252
Hospital Charge Code	5816081252
Hospital Revenue Code	250
Min. Negotiated Rate	$72.69
Max. Negotiated Rate	$72.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.69

DTAP-IPV VACCINE 0.5 ML IM SUSY

Facility

$145.39

Service Code	NDC 5816081243
Hospital Charge Code	5816081243
Hospital Revenue Code	250
Min. Negotiated Rate	$72.69
Max. Negotiated Rate	$72.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.69

DTAP-IPV VACCINE 0.5 ML IM SUSY

Facility

$145.39

Service Code	NDC 5816081243
Hospital Charge Code	5816081243
Hospital Revenue Code	250
Min. Negotiated Rate	$50.89
Max. Negotiated Rate	$116.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.69
Rate for Payer: Aetna Government	$72.69
Rate for Payer: Brighton Health Commercial	$109.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$116.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.87
Rate for Payer: EmblemHealth Commercial	$72.69
Rate for Payer: Group Health Inc Commercial	$72.69
Rate for Payer: Group Health Inc Medicare	$50.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.69
Rate for Payer: Hamaspik Choice Inc Medicare	$72.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.50

DTAP-IPV VACCINE 0.5 ML IM SUSY

Facility

$145.39

Service Code	NDC 5816081252
Hospital Charge Code	5816081252
Hospital Revenue Code	250
Min. Negotiated Rate	$50.89
Max. Negotiated Rate	$116.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.69
Rate for Payer: Aetna Government	$72.69
Rate for Payer: Brighton Health Commercial	$109.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$116.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.87
Rate for Payer: EmblemHealth Commercial	$72.69
Rate for Payer: Group Health Inc Commercial	$72.69
Rate for Payer: Group Health Inc Medicare	$50.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.69
Rate for Payer: Hamaspik Choice Inc Medicare	$72.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.50

Know your out-of-pocket cost for care.

All Charges