St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ADENOSINE

Facility

$1.00

Service Code	HCPCS J0153
Hospital Charge Code	41655637
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.59
Rate for Payer: SOMOS Essential	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

ADENOSINE

Facility

$1.00

Service Code	HCPCS J0153
Hospital Charge Code	41645637
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

ADENOSINE 6 MG/2ML IV SOLN [38703]

Facility

$3.75

Service Code	HCPCS J0153
Hospital Charge Code	67457085500
Hospital Revenue Code	278
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$3.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.16
Rate for Payer: EmblemHealth Commercial	$1.88
Rate for Payer: Fidelis Medicare Advantage	$3.94
Rate for Payer: Group Health Inc Commercial	$1.88
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.44

ADENOSINE 6 MG/2ML IV SOLN [38703]

Facility

$6.57

Service Code	HCPCS J0153
Hospital Charge Code	63323065102
Hospital Revenue Code	278
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$6.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$3.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.78
Rate for Payer: EmblemHealth Commercial	$3.28
Rate for Payer: Fidelis Medicare Advantage	$6.90
Rate for Payer: Group Health Inc Commercial	$3.28
Rate for Payer: Group Health Inc Medicare	$2.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.28
Rate for Payer: Hamaspik Choice Inc Medicare	$3.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.27

ADENOSINE 6 MG/2ML IV SOLN [38703]

Facility

$9.60

Service Code	HCPCS J0153
Hospital Charge Code	25021030167
Hospital Revenue Code	278
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$10.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$5.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.52
Rate for Payer: EmblemHealth Commercial	$4.80
Rate for Payer: Fidelis Medicare Advantage	$10.08
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

ADENOSINE 6 MG/2ML IV SOLN [38703]

Facility

$9.54

Service Code	HCPCS J0153
Hospital Charge Code	63323065189
Hospital Revenue Code	278
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$10.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$5.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.49
Rate for Payer: EmblemHealth Commercial	$4.77
Rate for Payer: Fidelis Medicare Advantage	$10.02
Rate for Payer: Group Health Inc Commercial	$4.77
Rate for Payer: Group Health Inc Medicare	$3.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.77
Rate for Payer: Hamaspik Choice Inc Medicare	$4.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.20

ADENOSINE 6 MG/2ML IV SOLN [38703]

Facility

$3.75

Service Code	HCPCS J0153
Hospital Charge Code	67457085502
Hospital Revenue Code	278
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$3.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.16
Rate for Payer: EmblemHealth Commercial	$1.88
Rate for Payer: Fidelis Medicare Advantage	$3.94
Rate for Payer: Group Health Inc Commercial	$1.88
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.44

ADENOSINE 6 MG/2ML IV SOLN [38703]

Facility

$3.75

Service Code	HCPCS J0153
Hospital Charge Code	67457085502
Hospital Revenue Code	278
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1.88

ADENOSINE 6 MG/2ML IV SOLN [38703]

Facility

$9.54

Service Code	HCPCS J0153
Hospital Charge Code	63323065189
Hospital Revenue Code	278
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$4.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.77
Rate for Payer: Hamaspik Choice Inc Medicare	$4.77

ADENOSINE 6 MG/2ML IV SOLN [38703]

Facility

$6.57

Service Code	HCPCS J0153
Hospital Charge Code	63323065102
Hospital Revenue Code	278
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.28
Rate for Payer: Hamaspik Choice Inc Medicare	$3.28

ADENOSINE 6 MG/2ML IV SOLN [38703]

Facility

$9.60

Service Code	HCPCS J0153
Hospital Charge Code	25021030167
Hospital Revenue Code	278
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.80
Rate for Payer: Hamaspik Choice Inc Medicare	$4.80

ADENOSINE 6 MG/2ML IV SOLN [38703]

Facility

$3.75

Service Code	HCPCS J0153
Hospital Charge Code	67457085500
Hospital Revenue Code	278
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1.88

ADENOSINE DEAMINASE,PLEURAL FI

Facility

$20.25

Service Code	HCPCS 84311
Hospital Charge Code	40609117
Hospital Revenue Code	300
Rate for Payer: Cash Price	$8.10

ADENOSINE DEAMINASE,PLEURAL FI

Facility

$20.25

Service Code	HCPCS 84311
Hospital Charge Code	40609117
Hospital Revenue Code	300
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$15.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.10
Rate for Payer: Aetna Government	$8.10
Rate for Payer: Affinity Essential Plan 1&2	$5.67
Rate for Payer: Affinity Essential Plan 3&4	$5.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.67
Rate for Payer: Brighton Health Commercial	$15.19
Rate for Payer: Cash Price	$8.10
Rate for Payer: Cash Price	$8.10
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.39
Rate for Payer: Elderplan Medicare Advantage	$8.10
Rate for Payer: EmblemHealth Commercial	$8.10
Rate for Payer: Fidelis Essential Plan Aliesa	$6.88
Rate for Payer: Fidelis Essential Plan QHP	$7.21
Rate for Payer: Fidelis Medicare Advantage	$8.10
Rate for Payer: Fidelis Qualified Health Plan	$7.21
Rate for Payer: Group Health Inc Commercial	$8.10
Rate for Payer: Group Health Inc Medicare	$8.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.12
Rate for Payer: Hamaspik Choice Inc Medicare	$8.10
Rate for Payer: Healthfirst Medicare Advantage	$8.10
Rate for Payer: Healthfirst QHP	$8.10
Rate for Payer: Humana Medicare	$8.26
Rate for Payer: Senior Whole Health Medicare Advantage	$8.10
Rate for Payer: United Healthcare Commercial	$8.85
Rate for Payer: United Healthcare Medicare Advantage	$8.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.48
Rate for Payer: Wellcare Medicare	$7.29

ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN [15330]

Facility

$7.15

Service Code	HCPCS J0153
Hospital Charge Code	55150019301
Hospital Revenue Code	278
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$7.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$4.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.11
Rate for Payer: EmblemHealth Commercial	$3.58
Rate for Payer: Fidelis Medicare Advantage	$7.51
Rate for Payer: Group Health Inc Commercial	$3.58
Rate for Payer: Group Health Inc Medicare	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.58
Rate for Payer: Hamaspik Choice Inc Medicare	$3.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.65

ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN [15330]

Facility

$7.15

Service Code	HCPCS J0153
Hospital Charge Code	55150019301
Hospital Revenue Code	278
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$3.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.58
Rate for Payer: Hamaspik Choice Inc Medicare	$3.58

ADENOSINE INJ 1 MG

Facility

$5.57

Service Code	HCPCS J0153
Hospital Charge Code	41653431
Hospital Revenue Code	636
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$3.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$3.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.20
Rate for Payer: Group Health Inc Commercial	$2.78
Rate for Payer: Group Health Inc Medicare	$1.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.78
Rate for Payer: Hamaspik Choice Inc Medicare	$2.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.59
Rate for Payer: SOMOS Essential	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.62

ADENOSINE INJ 1 MG

Facility

$5.57

Service Code	HCPCS J0153
Hospital Charge Code	41653431
Hospital Revenue Code	636
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$2.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.78
Rate for Payer: Hamaspik Choice Inc Medicare	$2.78

ADENOSINE INJ, 1 MG

Facility

$5.57

Service Code	HCPCS J0153
Hospital Charge Code	41643431
Hospital Revenue Code	636
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$2.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.78
Rate for Payer: Hamaspik Choice Inc Medicare	$2.78

ADENOSINE INJ, 1 MG

Facility

$5.57

Service Code	HCPCS J0153
Hospital Charge Code	41643431
Hospital Revenue Code	636
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$3.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$3.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.20
Rate for Payer: Group Health Inc Commercial	$2.78
Rate for Payer: Group Health Inc Medicare	$1.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.78
Rate for Payer: Hamaspik Choice Inc Medicare	$2.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.59
Rate for Payer: SOMOS Essential	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.62

ADENOVIRUS AG IF

Facility

$36.08

Service Code	HCPCS 87260
Hospital Charge Code	40613065
Hospital Revenue Code	300
Rate for Payer: Cash Price	$14.43

ADENOVIRUS AG IF

Facility

$36.08

Service Code	HCPCS 87260
Hospital Charge Code	40613065
Hospital Revenue Code	300
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$27.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.43
Rate for Payer: Aetna Government	$14.43
Rate for Payer: Affinity Essential Plan 1&2	$10.10
Rate for Payer: Affinity Essential Plan 3&4	$10.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.10
Rate for Payer: Brighton Health Commercial	$27.06
Rate for Payer: Cash Price	$14.43
Rate for Payer: Cash Price	$14.43
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$14.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.13
Rate for Payer: Elderplan Medicare Advantage	$14.43
Rate for Payer: EmblemHealth Commercial	$14.43
Rate for Payer: Fidelis Essential Plan Aliesa	$12.27
Rate for Payer: Fidelis Essential Plan QHP	$12.84
Rate for Payer: Fidelis Medicare Advantage	$14.43
Rate for Payer: Fidelis Qualified Health Plan	$12.84
Rate for Payer: Group Health Inc Commercial	$14.43
Rate for Payer: Group Health Inc Medicare	$14.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.04
Rate for Payer: Hamaspik Choice Inc Medicare	$14.43
Rate for Payer: Healthfirst Medicare Advantage	$14.43
Rate for Payer: Healthfirst QHP	$14.43
Rate for Payer: Humana Medicare	$14.72
Rate for Payer: Senior Whole Health Medicare Advantage	$14.43
Rate for Payer: United Healthcare Commercial	$15.19
Rate for Payer: United Healthcare Medicare Advantage	$14.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.54
Rate for Payer: Wellcare Medicare	$12.99

ADENOVIRUS VACCINE TYPE 4

Facility

$25.30

Service Code	HCPCS 90476
Hospital Charge Code	30101227
Hospital Revenue Code	636
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$357.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.00
Rate for Payer: Aetna Government	$46.00
Rate for Payer: Affinity Essential Plan 1&2	$32.20
Rate for Payer: Affinity Essential Plan 3&4	$32.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$32.20
Rate for Payer: Brighton Health Commercial	$15.18
Rate for Payer: Cash Price	$46.00
Rate for Payer: Cash Price	$46.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$46.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.55
Rate for Payer: Elderplan Medicare Advantage	$46.00
Rate for Payer: EmblemHealth Commercial	$46.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$46.00
Rate for Payer: Fidelis Essential Plan Aliesa	$46.00
Rate for Payer: Fidelis Essential Plan QHP	$48.30
Rate for Payer: Fidelis Medicare Advantage	$46.00
Rate for Payer: Fidelis Qualified Health Plan	$48.30
Rate for Payer: Group Health Inc Commercial	$46.00
Rate for Payer: Group Health Inc Medicare	$46.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.65
Rate for Payer: Hamaspik Choice Inc Medicare	$12.65
Rate for Payer: Healthfirst Medicare Advantage	$39.10
Rate for Payer: Healthfirst QHP	$46.00
Rate for Payer: Humana Medicare	$46.92
Rate for Payer: Senior Whole Health Medicare Advantage	$46.00
Rate for Payer: United Healthcare Commercial	$357.98
Rate for Payer: United Healthcare Medicare Advantage	$46.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36.80
Rate for Payer: Wellcare Medicare	$43.70

ADENOVIRUS VACCINE TYPE 4

Facility

$25.30

Service Code	HCPCS 90476
Hospital Charge Code	30101227
Hospital Revenue Code	636
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$12.65
Rate for Payer: Cash Price	$46.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.65
Rate for Payer: Hamaspik Choice Inc Medicare	$12.65

ADH

Facility

$84.85

Service Code	HCPCS 84588
Hospital Charge Code	40609128
Hospital Revenue Code	300
Rate for Payer: Cash Price	$33.94

Know your out-of-pocket cost for care.

All Charges