St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ICE IT REUSABLE COLD/C-PACK MISC

Facility

$7.57

Service Code	NDC 3870310120
Hospital Charge Code	3870310120
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$6.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.79
Rate for Payer: Aetna Government	$3.79
Rate for Payer: Brighton Health Commercial	$5.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.15
Rate for Payer: EmblemHealth Commercial	$3.79
Rate for Payer: Group Health Inc Commercial	$3.79
Rate for Payer: Group Health Inc Medicare	$2.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.79
Rate for Payer: Hamaspik Choice Inc Medicare	$3.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.92

ICE IT REUSABLE COLD/C-PACK MISC

Facility

$7.79

Service Code	NDC 3870310050
Hospital Charge Code	3870310050
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$6.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.90
Rate for Payer: Aetna Government	$3.90
Rate for Payer: Brighton Health Commercial	$5.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.30
Rate for Payer: EmblemHealth Commercial	$3.90
Rate for Payer: Group Health Inc Commercial	$3.90
Rate for Payer: Group Health Inc Medicare	$2.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.90
Rate for Payer: Hamaspik Choice Inc Medicare	$3.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.06

ICE IT REUSABLE COLD/C-PACK MISC

Facility

$7.79

Service Code	NDC 3870310050
Hospital Charge Code	3870310050
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.90

IDARUCIZUMAB 2.5 GM/50ML IV SOLN

Facility

$58.87

Service Code	HCPCS J3490
Hospital Charge Code	0597019705
Hospital Revenue Code	258
Min. Negotiated Rate	$20.61
Max. Negotiated Rate	$47.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.44
Rate for Payer: Aetna Government	$29.44
Rate for Payer: Brighton Health Commercial	$44.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.03
Rate for Payer: EmblemHealth Commercial	$29.44
Rate for Payer: Group Health Inc Commercial	$29.44
Rate for Payer: Group Health Inc Medicare	$20.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.44
Rate for Payer: Hamaspik Choice Inc Medicare	$29.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.27

IDARUCIZUMAB 2.5 GM/50ML IV SOLN

Facility

$58.87

Service Code	HCPCS J3490
Hospital Charge Code	0597019705
Hospital Revenue Code	258
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$29.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.44

IFOSFAMIDE 1 G IV SOLR

Facility

$44.09

Service Code	HCPCS J9208
Hospital Charge Code	1001992582
Hospital Revenue Code	258
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$22.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.05

IFOSFAMIDE 1 G IV SOLR

Facility

$44.09

Service Code	HCPCS J9208
Hospital Charge Code	1001992582
Hospital Revenue Code	258
Min. Negotiated Rate	$15.43
Max. Negotiated Rate	$35.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.76
Rate for Payer: Aetna Government	$26.76
Rate for Payer: Brighton Health Commercial	$33.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.98
Rate for Payer: EmblemHealth Commercial	$22.05
Rate for Payer: Group Health Inc Commercial	$22.05
Rate for Payer: Group Health Inc Medicare	$15.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.05
Rate for Payer: Hamaspik Choice Inc Medicare	$22.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.66

IFOSFAMIDE 3 G IV SOLR

Facility

$129.05

Service Code	HCPCS J9208
Hospital Charge Code	1001992616
Hospital Revenue Code	258
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$103.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.76
Rate for Payer: Aetna Government	$26.76
Rate for Payer: Brighton Health Commercial	$96.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.75
Rate for Payer: EmblemHealth Commercial	$64.53
Rate for Payer: Group Health Inc Commercial	$64.53
Rate for Payer: Group Health Inc Medicare	$45.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.53
Rate for Payer: Hamaspik Choice Inc Medicare	$64.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.88

IFOSFAMIDE 3 G IV SOLR

Facility

$125.56

Service Code	HCPCS J9208
Hospital Charge Code	0338399301
Hospital Revenue Code	258
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$100.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.76
Rate for Payer: Aetna Government	$26.76
Rate for Payer: Brighton Health Commercial	$94.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$100.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.38
Rate for Payer: EmblemHealth Commercial	$62.78
Rate for Payer: Group Health Inc Commercial	$62.78
Rate for Payer: Group Health Inc Medicare	$43.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.78
Rate for Payer: Hamaspik Choice Inc Medicare	$62.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.61

IFOSFAMIDE 3 G IV SOLR

Facility

$129.05

Service Code	HCPCS J9208
Hospital Charge Code	1001992616
Hospital Revenue Code	258
Min. Negotiated Rate	$64.53
Max. Negotiated Rate	$64.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.53

IFOSFAMIDE 3 G IV SOLR

Facility

$129.05

Service Code	HCPCS J9208
Hospital Charge Code	1001992602
Hospital Revenue Code	258
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$103.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.76
Rate for Payer: Aetna Government	$26.76
Rate for Payer: Brighton Health Commercial	$96.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.75
Rate for Payer: EmblemHealth Commercial	$64.53
Rate for Payer: Group Health Inc Commercial	$64.53
Rate for Payer: Group Health Inc Medicare	$45.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.53
Rate for Payer: Hamaspik Choice Inc Medicare	$64.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.88

IFOSFAMIDE 3 G IV SOLR

Facility

$129.05

Service Code	HCPCS J9208
Hospital Charge Code	1001992602
Hospital Revenue Code	258
Min. Negotiated Rate	$64.53
Max. Negotiated Rate	$64.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.53

IFOSFAMIDE 3 G IV SOLR

Facility

$125.56

Service Code	HCPCS J9208
Hospital Charge Code	0338399301
Hospital Revenue Code	258
Min. Negotiated Rate	$62.78
Max. Negotiated Rate	$62.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.78

IMIPENEM-CILASTATIN 250 MG IV SOLR

Facility

$17.99

Service Code	HCPCS J0743
Hospital Charge Code	6332334925
Hospital Revenue Code	258
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$14.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.61
Rate for Payer: Aetna Government	$7.61
Rate for Payer: Brighton Health Commercial	$13.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.23
Rate for Payer: EmblemHealth Commercial	$8.99
Rate for Payer: Group Health Inc Commercial	$8.99
Rate for Payer: Group Health Inc Medicare	$6.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.99
Rate for Payer: Hamaspik Choice Inc Medicare	$8.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.69

IMIPENEM-CILASTATIN 250 MG IV SOLR

Facility

$17.99

Service Code	HCPCS J0743
Hospital Charge Code	6332334925
Hospital Revenue Code	258
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$8.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.99

IMIPENEM-CILASTATIN 500 MG IV SOLR

Facility

$39.18

Service Code	HCPCS J0743
Hospital Charge Code	0006351659
Hospital Revenue Code	258
Min. Negotiated Rate	$7.61
Max. Negotiated Rate	$31.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.61
Rate for Payer: Aetna Government	$7.61
Rate for Payer: Brighton Health Commercial	$29.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.64
Rate for Payer: EmblemHealth Commercial	$19.59
Rate for Payer: Group Health Inc Commercial	$19.59
Rate for Payer: Group Health Inc Medicare	$13.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.59
Rate for Payer: Hamaspik Choice Inc Medicare	$19.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.47

IMIPENEM-CILASTATIN 500 MG IV SOLR

Facility

$32.82

Service Code	HCPCS J0743
Hospital Charge Code	4456770501
Hospital Revenue Code	258
Min. Negotiated Rate	$7.61
Max. Negotiated Rate	$26.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.61
Rate for Payer: Aetna Government	$7.61
Rate for Payer: Brighton Health Commercial	$24.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.32
Rate for Payer: EmblemHealth Commercial	$16.41
Rate for Payer: Group Health Inc Commercial	$16.41
Rate for Payer: Group Health Inc Medicare	$11.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.41
Rate for Payer: Hamaspik Choice Inc Medicare	$16.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.33

IMIPENEM-CILASTATIN 500 MG IV SOLR

Facility

$39.18

Service Code	HCPCS J0743
Hospital Charge Code	0006351659
Hospital Revenue Code	258
Min. Negotiated Rate	$19.59
Max. Negotiated Rate	$19.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.59

IMIPENEM-CILASTATIN 500 MG IV SOLR

Facility

$32.82

Service Code	HCPCS J0743
Hospital Charge Code	4456770510
Hospital Revenue Code	258
Min. Negotiated Rate	$7.61
Max. Negotiated Rate	$26.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.61
Rate for Payer: Aetna Government	$7.61
Rate for Payer: Brighton Health Commercial	$24.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.32
Rate for Payer: EmblemHealth Commercial	$16.41
Rate for Payer: Group Health Inc Commercial	$16.41
Rate for Payer: Group Health Inc Medicare	$11.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.41
Rate for Payer: Hamaspik Choice Inc Medicare	$16.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.33

IMIPENEM-CILASTATIN 500 MG IV SOLR

Facility

$32.82

Service Code	HCPCS J0743
Hospital Charge Code	4456770510
Hospital Revenue Code	258
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$16.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.41

IMIPENEM-CILASTATIN 500 MG IV SOLR

Facility

$32.82

Service Code	HCPCS J0743
Hospital Charge Code	4456770501
Hospital Revenue Code	258
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$16.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.41

IMIPRAMINE HCL 25 MG PO TABS

Facility

$0.72

Service Code	NDC 4988405501
Hospital Charge Code	4988405501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

IMIPRAMINE HCL 25 MG PO TABS

Facility

$0.72

Service Code	NDC 4988405501
Hospital Charge Code	4988405501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

IMIPRAMINE HCL 50 MG PO TABS

Facility

$1.22

Service Code	NDC 4988405601
Hospital Charge Code	4988405601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.61
Rate for Payer: Aetna Government	$0.61
Rate for Payer: Brighton Health Commercial	$0.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.83
Rate for Payer: EmblemHealth Commercial	$0.61
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.79

IMIPRAMINE HCL 50 MG PO TABS

Facility

$1.22

Service Code	NDC 4988405601
Hospital Charge Code	4988405601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61

Know your out-of-pocket cost for care.

All Charges