St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GABAPENTIN 400 MG PO CAPS

Facility

$0.25

Service Code	NDC 0904666761
Hospital Charge Code	0904666761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: EmblemHealth Commercial	$0.12
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN

Facility

$6.81

Service Code	HCPCS A9577
Hospital Charge Code	0270516414
Hospital Revenue Code	258
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.40

GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN

Facility

$6.81

Service Code	HCPCS A9577
Hospital Charge Code	0270516414
Hospital Revenue Code	258
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$5.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.87
Rate for Payer: Aetna Government	$1.87
Rate for Payer: Brighton Health Commercial	$5.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.63
Rate for Payer: EmblemHealth Commercial	$3.40
Rate for Payer: Group Health Inc Commercial	$3.40
Rate for Payer: Group Health Inc Medicare	$2.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.40
Rate for Payer: Hamaspik Choice Inc Medicare	$3.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.43

GADOBUTROL 10 MMOL/10ML IV SOSY

Facility

$10.68

Service Code	HCPCS A9579
Hospital Charge Code	5041932528
Hospital Revenue Code	258
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$8.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$8.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.26
Rate for Payer: EmblemHealth Commercial	$5.34
Rate for Payer: Group Health Inc Commercial	$5.34
Rate for Payer: Group Health Inc Medicare	$3.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.34
Rate for Payer: Hamaspik Choice Inc Medicare	$5.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.94

GADOBUTROL 10 MMOL/10ML IV SOSY

Facility

$10.68

Service Code	HCPCS A9579
Hospital Charge Code	5041932528
Hospital Revenue Code	258
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.34

GADOBUTROL 1 MMOL/ML IV SOLN

Facility

$6.97

Service Code	HCPCS A9585
Hospital Charge Code	6521928110
Hospital Revenue Code	258
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$3.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.49

GADOBUTROL 1 MMOL/ML IV SOLN

Facility

$6.97

Service Code	HCPCS A9585
Hospital Charge Code	6521928110
Hospital Revenue Code	258
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$5.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$5.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.74
Rate for Payer: EmblemHealth Commercial	$3.49
Rate for Payer: Group Health Inc Commercial	$3.49
Rate for Payer: Group Health Inc Medicare	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.49
Rate for Payer: Hamaspik Choice Inc Medicare	$3.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.53

GADOBUTROL 1 MMOL/ML IV SOLN

Facility

$9.96

Service Code	HCPCS A9585
Hospital Charge Code	5041932512
Hospital Revenue Code	258
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$4.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.98

GADOBUTROL 1 MMOL/ML IV SOLN

Facility

$9.96

Service Code	HCPCS A9585
Hospital Charge Code	5041932512
Hospital Revenue Code	258
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$7.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$7.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.77
Rate for Payer: EmblemHealth Commercial	$4.98
Rate for Payer: Group Health Inc Commercial	$4.98
Rate for Payer: Group Health Inc Medicare	$3.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.98
Rate for Payer: Hamaspik Choice Inc Medicare	$4.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.47

GADOXETATE DISODIUM 0.25 MMOL/ML IV SOLN

Facility

$17.04

Service Code	HCPCS A9581
Hospital Charge Code	5041932005
Hospital Revenue Code	258
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$14.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.73
Rate for Payer: Aetna Government	$14.73
Rate for Payer: Brighton Health Commercial	$12.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.58
Rate for Payer: EmblemHealth Commercial	$8.52
Rate for Payer: Group Health Inc Commercial	$8.52
Rate for Payer: Group Health Inc Medicare	$5.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.52
Rate for Payer: Hamaspik Choice Inc Medicare	$8.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.07

GADOXETATE DISODIUM 0.25 MMOL/ML IV SOLN

Facility

$17.04

Service Code	HCPCS A9581
Hospital Charge Code	5041932005
Hospital Revenue Code	258
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$8.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.52

GALLBLADDER AND BILIARY TRACT DIAGNOSES

Facility

$204.16

Service Code	EAPG 00637
Min. Negotiated Rate	$148.12
Max. Negotiated Rate	$204.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$148.12
Rate for Payer: Healthfirst Commercial	$204.16

GANCICLOVIR SODIUM 500 MG IV SOLR

Facility

$101.57

Service Code	HCPCS J1570
Hospital Charge Code	7043608955
Hospital Revenue Code	258
Min. Negotiated Rate	$50.78
Max. Negotiated Rate	$50.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.78

GANCICLOVIR SODIUM 500 MG IV SOLR

Facility

$101.57

Service Code	HCPCS J1570
Hospital Charge Code	7043608955
Hospital Revenue Code	258
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$81.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$49.40
Rate for Payer: Aetna Government	$49.40
Rate for Payer: Brighton Health Commercial	$76.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.07
Rate for Payer: EmblemHealth Commercial	$50.78
Rate for Payer: Group Health Inc Commercial	$50.78
Rate for Payer: Group Health Inc Medicare	$35.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.78
Rate for Payer: Hamaspik Choice Inc Medicare	$50.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.02

GASTROINTESTINAL AND PERITONEAL INFECTION DIAGNOSES

Facility

$171.26

Service Code	EAPG 00619
Min. Negotiated Rate	$171.26
Max. Negotiated Rate	$171.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$171.26

GASTROINTESTINAL HEMORRHAGE DIAGNOSES

Facility

$173.57

Service Code	EAPG 00617
Min. Negotiated Rate	$173.57
Max. Negotiated Rate	$173.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$173.57

Gastrointestinal vascular insufficiency

Facility

$82,167.32

Service Code	APR-DRG 2464
Min. Negotiated Rate	$28,900.00
Max. Negotiated Rate	$82,167.32
Rate for Payer: Affinity Essential Plan 1&2	$82,167.32
Rate for Payer: Affinity Essential Plan 3&4	$82,167.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$36,518.81
Rate for Payer: Amida Care Medicaid	$36,518.81
Rate for Payer: EmblemHealth Essential Plan 1&2	$82,167.32
Rate for Payer: EmblemHealth Essential Plan 3&4	$36,518.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,518.81
Rate for Payer: Fidelis Qualified Health Plan	$43,822.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,518.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,518.81
Rate for Payer: Healthfirst Commercial	$33,793.00
Rate for Payer: Healthfirst Essential Plan	$82,167.32
Rate for Payer: Healthfirst QHP	$28,900.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,518.81
Rate for Payer: SOMOS Essential	$82,167.32
Rate for Payer: United Healthcare Essential Plan 1&2	$82,167.32
Rate for Payer: United Healthcare Essential Plan 3&4	$82,167.32
Rate for Payer: United Healthcare Medicaid	$36,518.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,518.81

Gastrointestinal vascular insufficiency

Facility

$54,751.97

Service Code	APR-DRG 2463
Min. Negotiated Rate	$13,382.00
Max. Negotiated Rate	$54,751.97
Rate for Payer: Affinity Essential Plan 1&2	$54,751.97
Rate for Payer: Affinity Essential Plan 3&4	$54,751.97
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,334.21
Rate for Payer: Amida Care Medicaid	$24,334.21
Rate for Payer: EmblemHealth Essential Plan 1&2	$54,751.97
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,334.21
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,334.21
Rate for Payer: Fidelis Qualified Health Plan	$29,201.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,334.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,334.21
Rate for Payer: Healthfirst Commercial	$22,584.00
Rate for Payer: Healthfirst Essential Plan	$54,751.97
Rate for Payer: Healthfirst QHP	$13,382.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,334.21
Rate for Payer: SOMOS Essential	$54,751.97
Rate for Payer: United Healthcare Essential Plan 1&2	$54,751.97
Rate for Payer: United Healthcare Essential Plan 3&4	$54,751.97
Rate for Payer: United Healthcare Medicaid	$24,334.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,334.21

Gastrointestinal vascular insufficiency

Facility

$42,975.40

Service Code	APR-DRG 2461
Min. Negotiated Rate	$7,141.00
Max. Negotiated Rate	$42,975.40
Rate for Payer: Affinity Essential Plan 1&2	$42,975.40
Rate for Payer: Affinity Essential Plan 3&4	$42,975.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,100.18
Rate for Payer: Amida Care Medicaid	$19,100.18
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,975.40
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,100.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,100.18
Rate for Payer: Fidelis Qualified Health Plan	$22,920.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,100.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,100.18
Rate for Payer: Healthfirst Commercial	$11,984.00
Rate for Payer: Healthfirst Essential Plan	$42,975.40
Rate for Payer: Healthfirst QHP	$7,141.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,100.18
Rate for Payer: SOMOS Essential	$42,975.40
Rate for Payer: United Healthcare Essential Plan 1&2	$42,975.40
Rate for Payer: United Healthcare Essential Plan 3&4	$42,975.40
Rate for Payer: United Healthcare Medicaid	$19,100.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,100.18

Gastrointestinal vascular insufficiency

Facility

$45,815.78

Service Code	APR-DRG 2462
Min. Negotiated Rate	$8,891.00
Max. Negotiated Rate	$45,815.78
Rate for Payer: Affinity Essential Plan 1&2	$45,815.78
Rate for Payer: Affinity Essential Plan 3&4	$45,815.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,362.57
Rate for Payer: Amida Care Medicaid	$20,362.57
Rate for Payer: EmblemHealth Essential Plan 1&2	$45,815.78
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,362.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,362.57
Rate for Payer: Fidelis Qualified Health Plan	$24,435.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,362.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,362.57
Rate for Payer: Healthfirst Commercial	$14,665.00
Rate for Payer: Healthfirst Essential Plan	$45,815.78
Rate for Payer: Healthfirst QHP	$8,891.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,362.57
Rate for Payer: SOMOS Essential	$45,815.78
Rate for Payer: United Healthcare Essential Plan 1&2	$45,815.78
Rate for Payer: United Healthcare Essential Plan 3&4	$45,815.78
Rate for Payer: United Healthcare Medicaid	$20,362.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,362.57

GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$185.14

Service Code	EAPG 00642
Min. Negotiated Rate	$185.14
Max. Negotiated Rate	$185.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$185.14

GEMCITABINE HCL 1 GM/26.3ML IV SOLN

Facility

$1.83

Service Code	HCPCS J9201
Hospital Charge Code	6745761730
Hospital Revenue Code	258
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$828.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.82
Rate for Payer: Aetna Government	$3.82
Rate for Payer: Affinity Essential Plan 1&2	$18.63
Rate for Payer: Affinity Essential Plan 3&4	$18.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.28
Rate for Payer: Amida Care Medicaid	$8.28
Rate for Payer: Brighton Health Commercial	$1.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.25
Rate for Payer: EmblemHealth Commercial	$0.92
Rate for Payer: EmblemHealth Essential Plan 1&2	$18.63
Rate for Payer: EmblemHealth Essential Plan 3&4	$8.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$8.28
Rate for Payer: Fidelis Essential Plan Aliesa	$18.63
Rate for Payer: Fidelis Essential Plan QHP	$18.63
Rate for Payer: Fidelis Qualified Health Plan	$8.69
Rate for Payer: Group Health Inc Commercial	$0.92
Rate for Payer: Group Health Inc Medicare	$0.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$828.00
Rate for Payer: Healthfirst Essential Plan	$18.63
Rate for Payer: Healthfirst QHP	$13.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.28
Rate for Payer: SOMOS Essential	$18.63
Rate for Payer: United Healthcare Essential Plan 1&2	$18.63
Rate for Payer: United Healthcare Essential Plan 3&4	$9.11
Rate for Payer: United Healthcare Medicaid	$8.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.28

GEMCITABINE HCL 1 GM/26.3ML IV SOLN

Facility

$1.83

Service Code	HCPCS J9201
Hospital Charge Code	6745761730
Hospital Revenue Code	258
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.92

GEMCITABINE HCL 1 GM/26.3ML IV SOLN

Facility

$2.07

Service Code	HCPCS J9201
Hospital Charge Code	0409018101
Hospital Revenue Code	258
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.03

GEMCITABINE HCL 1 GM/26.3ML IV SOLN

Facility

$2.07

Service Code	HCPCS J9201
Hospital Charge Code	0409018101
Hospital Revenue Code	258
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$828.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.82
Rate for Payer: Aetna Government	$3.82
Rate for Payer: Affinity Essential Plan 1&2	$18.63
Rate for Payer: Affinity Essential Plan 3&4	$18.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.28
Rate for Payer: Amida Care Medicaid	$8.28
Rate for Payer: Brighton Health Commercial	$1.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.41
Rate for Payer: EmblemHealth Commercial	$1.03
Rate for Payer: EmblemHealth Essential Plan 1&2	$18.63
Rate for Payer: EmblemHealth Essential Plan 3&4	$8.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$8.28
Rate for Payer: Fidelis Essential Plan Aliesa	$18.63
Rate for Payer: Fidelis Essential Plan QHP	$18.63
Rate for Payer: Fidelis Qualified Health Plan	$8.69
Rate for Payer: Group Health Inc Commercial	$1.03
Rate for Payer: Group Health Inc Medicare	$0.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.28
Rate for Payer: Hamaspik Choice Inc Medicare	$1.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$828.00
Rate for Payer: Healthfirst Essential Plan	$18.63
Rate for Payer: Healthfirst QHP	$13.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.28
Rate for Payer: SOMOS Essential	$18.63
Rate for Payer: United Healthcare Essential Plan 1&2	$18.63
Rate for Payer: United Healthcare Essential Plan 3&4	$9.11
Rate for Payer: United Healthcare Medicaid	$8.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.28

Know your out-of-pocket cost for care.

All Charges