St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ATROPINE SULFATE 1 % OP SOLN

Facility

$23.82

Service Code	NDC 0065081702
Hospital Charge Code	0065081702
Hospital Revenue Code	250
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$19.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.91
Rate for Payer: Aetna Government	$11.91
Rate for Payer: Brighton Health Commercial	$17.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.20
Rate for Payer: EmblemHealth Commercial	$11.91
Rate for Payer: Group Health Inc Commercial	$11.91
Rate for Payer: Group Health Inc Medicare	$8.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.91
Rate for Payer: Hamaspik Choice Inc Medicare	$11.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.48

ATROPINE SULFATE (PF) 0.4 MG/ML IJ SOLN

Facility

$9.60

Service Code	NDC 0517040125
Hospital Charge Code	0517040125
Hospital Revenue Code	250
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$7.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.80
Rate for Payer: Aetna Government	$4.80
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.53
Rate for Payer: EmblemHealth Commercial	$4.80
Rate for Payer: Group Health Inc Commercial	$4.80
Rate for Payer: Group Health Inc Medicare	$3.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.80
Rate for Payer: Hamaspik Choice Inc Medicare	$4.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.24

ATROPINE SULFATE (PF) 0.4 MG/ML IJ SOLN

Facility

$9.60

Service Code	NDC 0517040125
Hospital Charge Code	0517040125
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.80

ATROPINE SULFATE (PF) 1 MG/ML IJ SOLN

Facility

$15.07

Service Code	HCPCS J0461
Hospital Charge Code	0517101025
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$12.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$11.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.25
Rate for Payer: EmblemHealth Commercial	$7.54
Rate for Payer: Group Health Inc Commercial	$7.54
Rate for Payer: Group Health Inc Medicare	$5.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.54
Rate for Payer: Hamaspik Choice Inc Medicare	$7.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.80

ATROPINE SULFATE (PF) 1 MG/ML IJ SOLN

Facility

$15.07

Service Code	HCPCS J0461
Hospital Charge Code	5009045240
Hospital Revenue Code	250
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$7.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.54

ATROPINE SULFATE (PF) 1 MG/ML IJ SOLN

Facility

$15.07

Service Code	HCPCS J0461
Hospital Charge Code	5009045240
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$12.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$11.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.25
Rate for Payer: EmblemHealth Commercial	$7.54
Rate for Payer: Group Health Inc Commercial	$7.54
Rate for Payer: Group Health Inc Medicare	$5.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.54
Rate for Payer: Hamaspik Choice Inc Medicare	$7.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.80

ATROPINE SULFATE (PF) 1 MG/ML IJ SOLN

Facility

$15.07

Service Code	HCPCS J0461
Hospital Charge Code	0517101025
Hospital Revenue Code	250
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$7.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.54

AUDIOMETRY

Facility

$134.25

Service Code	EAPG 00257
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$134.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$97.20
Rate for Payer: Healthfirst Commercial	$134.25

AVACOPAN 10 MG PO CAPS

Facility

$107.12

Service Code	NDC 7355616801
Hospital Charge Code	7355616801
Hospital Revenue Code	250
Min. Negotiated Rate	$53.56
Max. Negotiated Rate	$53.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.56

AVACOPAN 10 MG PO CAPS

Facility

$107.12

Service Code	NDC 7355616801
Hospital Charge Code	7355616801
Hospital Revenue Code	250
Min. Negotiated Rate	$37.49
Max. Negotiated Rate	$85.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$53.56
Rate for Payer: Aetna Government	$53.56
Rate for Payer: Brighton Health Commercial	$80.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.84
Rate for Payer: EmblemHealth Commercial	$53.56
Rate for Payer: Group Health Inc Commercial	$53.56
Rate for Payer: Group Health Inc Medicare	$37.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.56
Rate for Payer: Hamaspik Choice Inc Medicare	$53.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.63

AVELUMAB 200 MG/10ML IV SOLN

Facility

$225.56

Service Code	HCPCS J9023
Hospital Charge Code	4408735351
Hospital Revenue Code	258
Min. Negotiated Rate	$70.06
Max. Negotiated Rate	$180.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$100.09
Rate for Payer: Aetna Government	$100.09
Rate for Payer: Affinity Essential Plan 1&2	$70.06
Rate for Payer: Affinity Essential Plan 3&4	$70.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$70.06
Rate for Payer: Brighton Health Commercial	$169.17
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$100.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.38
Rate for Payer: Elderplan Medicare Advantage	$100.09
Rate for Payer: EmblemHealth Commercial	$100.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$90.08
Rate for Payer: Fidelis Essential Plan Aliesa	$85.08
Rate for Payer: Fidelis Essential Plan QHP	$89.08
Rate for Payer: Fidelis Medicare Advantage	$100.09
Rate for Payer: Fidelis Qualified Health Plan	$89.08
Rate for Payer: Group Health Inc Commercial	$100.09
Rate for Payer: Group Health Inc Medicare	$100.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.09
Rate for Payer: Hamaspik Choice Inc Medicare	$100.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$100.09
Rate for Payer: Healthfirst Medicare Advantage	$85.08
Rate for Payer: Healthfirst QHP	$100.09
Rate for Payer: Humana Medicare	$102.09
Rate for Payer: Senior Whole Health Medicare Advantage	$100.09
Rate for Payer: United Healthcare Medicare Advantage	$100.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$146.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$95.09
Rate for Payer: Wellcare Medicare	$95.09

AVELUMAB 200 MG/10ML IV SOLN

Facility

$225.56

Service Code	HCPCS J9023
Hospital Charge Code	4408735351
Hospital Revenue Code	258
Min. Negotiated Rate	$112.78
Max. Negotiated Rate	$112.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.78

AZACITIDINE 100 MG IJ SUSR

Facility

$54.00

Service Code	HCPCS J9025
Hospital Charge Code	7128811530
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.00

AZACITIDINE 100 MG IJ SUSR

Facility

$54.00

Service Code	HCPCS J9025
Hospital Charge Code	7128811530
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$43.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.93
Rate for Payer: Aetna Government	$0.93
Rate for Payer: Brighton Health Commercial	$40.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.72
Rate for Payer: EmblemHealth Commercial	$27.00
Rate for Payer: Group Health Inc Commercial	$27.00
Rate for Payer: Group Health Inc Medicare	$18.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.00
Rate for Payer: Hamaspik Choice Inc Medicare	$27.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.10

AZACITIDINE 100 MG IJ SUSR

Facility

$120.00

Service Code	HCPCS J9025
Hospital Charge Code	4359814362
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$96.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.93
Rate for Payer: Aetna Government	$0.93
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.60
Rate for Payer: EmblemHealth Commercial	$60.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

AZACITIDINE 100 MG IJ SUSR

Facility

$240.00

Service Code	HCPCS J9025
Hospital Charge Code	4359830562
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$192.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.93
Rate for Payer: Aetna Government	$0.93
Rate for Payer: Brighton Health Commercial	$180.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.20
Rate for Payer: EmblemHealth Commercial	$120.00
Rate for Payer: Group Health Inc Commercial	$120.00
Rate for Payer: Group Health Inc Medicare	$84.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.00
Rate for Payer: Hamaspik Choice Inc Medicare	$120.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$156.00

AZACITIDINE 100 MG IJ SUSR

Facility

$120.00

Service Code	HCPCS J9025
Hospital Charge Code	4359814362
Hospital Revenue Code	250
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00

AZACITIDINE 100 MG IJ SUSR

Facility

$240.00

Service Code	HCPCS J9025
Hospital Charge Code	4359830562
Hospital Revenue Code	250
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.00

AZATHIOPRINE 50 MG PO TABS

Facility

$0.85

Service Code	HCPCS J7500
Hospital Charge Code	6808422911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$6.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.58
Rate for Payer: Aetna Government	$6.58
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

AZATHIOPRINE 50 MG PO TABS

Facility

$6.81

Service Code	HCPCS J7500
Hospital Charge Code	6021910761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$6.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.58
Rate for Payer: Aetna Government	$6.58
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	$3.41
Rate for Payer: Group Health Inc Commercial	$3.41
Rate for Payer: Group Health Inc Medicare	$2.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.41
Rate for Payer: Hamaspik Choice Inc Medicare	$3.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.43

AZATHIOPRINE 50 MG PO TABS

Facility

$0.85

Service Code	HCPCS J7500
Hospital Charge Code	6808422901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$6.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.58
Rate for Payer: Aetna Government	$6.58
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

AZATHIOPRINE 50 MG PO TABS

Facility

$0.85

Service Code	HCPCS J7500
Hospital Charge Code	6808422911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

AZATHIOPRINE 50 MG PO TABS

Facility

$0.85

Service Code	HCPCS J7500
Hospital Charge Code	6808422901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

AZATHIOPRINE 50 MG PO TABS

Facility

$6.81

Service Code	HCPCS J7500
Hospital Charge Code	6021910761
Hospital Revenue Code	250
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$3.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.41

AZITHROMYCIN 100 MG/5ML PO SUSR

Facility

$2.33

Service Code	NDC 0093202723
Hospital Charge Code	0093202723
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16

Know your out-of-pocket cost for care.

All Charges