St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

INCIDENTAL SKIN SUBSTITUTES

Facility

$1,495.04

Service Code	EAPG 02010
Min. Negotiated Rate	$1,495.04
Max. Negotiated Rate	$1,495.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,495.04

INCLISIRAN SODIUM 284 MG/1.5ML SC SOSY

Facility

$2.00

Service Code	HCPCS J1306
Hospital Charge Code	0078100060
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

INCLISIRAN SODIUM 284 MG/1.5ML SC SOSY

Facility

$2.00

Service Code	HCPCS J1306
Hospital Charge Code	0078100060
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1,206.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.32
Rate for Payer: Aetna Government	$12.32
Rate for Payer: Affinity Essential Plan 1&2	$27.14
Rate for Payer: Affinity Essential Plan 3&4	$27.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.06
Rate for Payer: Amida Care Medicaid	$12.06
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Elderplan Medicare Advantage	$12.32
Rate for Payer: EmblemHealth Commercial	$12.32
Rate for Payer: EmblemHealth Essential Plan 1&2	$27.14
Rate for Payer: EmblemHealth Essential Plan 3&4	$12.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12.06
Rate for Payer: Fidelis Essential Plan Aliesa	$27.14
Rate for Payer: Fidelis Essential Plan QHP	$27.14
Rate for Payer: Fidelis Medicare Advantage	$12.32
Rate for Payer: Fidelis Qualified Health Plan	$12.66
Rate for Payer: Group Health Inc Commercial	$12.32
Rate for Payer: Group Health Inc Medicare	$12.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.06
Rate for Payer: Hamaspik Choice Inc Medicare	$12.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,206.00
Rate for Payer: Healthfirst Essential Plan	$27.14
Rate for Payer: Healthfirst Medicare Advantage	$10.47
Rate for Payer: Healthfirst QHP	$19.66
Rate for Payer: Humana Medicare	$12.57
Rate for Payer: Senior Whole Health Medicare Advantage	$12.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.06
Rate for Payer: SOMOS Essential	$27.14
Rate for Payer: United Healthcare Essential Plan 1&2	$27.14
Rate for Payer: United Healthcare Essential Plan 3&4	$13.27
Rate for Payer: United Healthcare Medicaid	$12.06
Rate for Payer: United Healthcare Medicare Advantage	$12.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.06
Rate for Payer: Wellcare Medicare	$11.70

INDIGOTINDISULFONATE SODIUM 8 MG/ML IJ SOLN

Facility

$45.22

Service Code	NDC 0517037505
Hospital Charge Code	0517037505
Hospital Revenue Code	250
Min. Negotiated Rate	$22.61
Max. Negotiated Rate	$22.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.61

INDIGOTINDISULFONATE SODIUM 8 MG/ML IJ SOLN

Facility

$45.22

Service Code	NDC 0517037505
Hospital Charge Code	0517037505
Hospital Revenue Code	250
Min. Negotiated Rate	$15.83
Max. Negotiated Rate	$36.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.61
Rate for Payer: Aetna Government	$22.61
Rate for Payer: Brighton Health Commercial	$33.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.75
Rate for Payer: EmblemHealth Commercial	$22.61
Rate for Payer: Group Health Inc Commercial	$22.61
Rate for Payer: Group Health Inc Medicare	$15.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.61
Rate for Payer: Hamaspik Choice Inc Medicare	$22.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.39

INDIUM IN 111 OXYQUINOLINE 1 MCI/ML IV SOLN

Facility

$4.00

Service Code	HCPCS A9547
Hospital Charge Code	1715602101
Hospital Revenue Code	258
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$788.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$772.64
Rate for Payer: Aetna Government	$772.64
Rate for Payer: Affinity Essential Plan 1&2	$540.85
Rate for Payer: Affinity Essential Plan 3&4	$540.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$540.85
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$772.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Elderplan Medicare Advantage	$772.64
Rate for Payer: EmblemHealth Commercial	$772.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$695.38
Rate for Payer: Fidelis Essential Plan Aliesa	$656.74
Rate for Payer: Fidelis Essential Plan QHP	$687.65
Rate for Payer: Fidelis Medicare Advantage	$772.64
Rate for Payer: Fidelis Qualified Health Plan	$687.65
Rate for Payer: Group Health Inc Commercial	$772.64
Rate for Payer: Group Health Inc Medicare	$772.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$772.64
Rate for Payer: Hamaspik Choice Inc Medicare	$772.64
Rate for Payer: Healthfirst Medicare Advantage	$656.74
Rate for Payer: Healthfirst QHP	$772.64
Rate for Payer: Humana Medicare	$788.09
Rate for Payer: Senior Whole Health Medicare Advantage	$772.64
Rate for Payer: United Healthcare Medicare Advantage	$772.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$734.01
Rate for Payer: Wellcare Medicare	$734.01

INDIUM IN 111 OXYQUINOLINE 1 MCI/ML IV SOLN

Facility

$4.00

Service Code	HCPCS A9547
Hospital Charge Code	1715602101
Hospital Revenue Code	258
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00

INDIVIDUAL COMPREHENSIVE PSYCHOTHERAPY

Facility

$263.83

Service Code	EAPG 00316
Min. Negotiated Rate	$192.09
Max. Negotiated Rate	$263.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$192.09
Rate for Payer: Healthfirst Commercial	$263.83

INDOCYANINE GREEN 25 MG IJ SOLR

Facility

$357.29

Service Code	NDC 7010082502
Hospital Charge Code	7010082502
Hospital Revenue Code	250
Min. Negotiated Rate	$178.65
Max. Negotiated Rate	$178.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.65

INDOCYANINE GREEN 25 MG IJ SOLR

Facility

$357.29

Service Code	NDC 7010082502
Hospital Charge Code	7010082502
Hospital Revenue Code	250
Min. Negotiated Rate	$125.05
Max. Negotiated Rate	$285.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$178.65
Rate for Payer: Aetna Government	$178.65
Rate for Payer: Brighton Health Commercial	$267.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$285.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$242.96
Rate for Payer: EmblemHealth Commercial	$178.65
Rate for Payer: Group Health Inc Commercial	$178.65
Rate for Payer: Group Health Inc Medicare	$125.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.65
Rate for Payer: Hamaspik Choice Inc Medicare	$178.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$232.24

INDOCYANINE GREEN 25 MG IV SOLR

Facility

$169.79

Service Code	NDC 7010042402
Hospital Charge Code	7010042402
Hospital Revenue Code	258
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$84.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.90

INDOCYANINE GREEN 25 MG IV SOLR

Facility

$169.79

Service Code	NDC 7010042402
Hospital Charge Code	7010042402
Hospital Revenue Code	258
Min. Negotiated Rate	$59.43
Max. Negotiated Rate	$135.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$84.90
Rate for Payer: Aetna Government	$84.90
Rate for Payer: Brighton Health Commercial	$127.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.46
Rate for Payer: EmblemHealth Commercial	$84.90
Rate for Payer: Group Health Inc Commercial	$84.90
Rate for Payer: Group Health Inc Medicare	$59.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.90
Rate for Payer: Hamaspik Choice Inc Medicare	$84.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$110.36

INDOMETHACIN 25 MG PO CAPS

Facility

$0.40

Service Code	NDC 6846240601
Hospital Charge Code	6846240601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

INDOMETHACIN 25 MG PO CAPS

Facility

$0.43

Service Code	NDC 5026843015
Hospital Charge Code	5026843015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22

INDOMETHACIN 25 MG PO CAPS

Facility

$0.43

Service Code	NDC 5026843015
Hospital Charge Code	5026843015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: EmblemHealth Commercial	$0.22
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

INDOMETHACIN 25 MG PO CAPS

Facility

$0.43

Service Code	NDC 5026843011
Hospital Charge Code	5026843011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22

INDOMETHACIN 25 MG PO CAPS

Facility

$0.43

Service Code	NDC 5026843011
Hospital Charge Code	5026843011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: EmblemHealth Commercial	$0.22
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

INDOMETHACIN 25 MG PO CAPS

Facility

$0.40

Service Code	NDC 6846240601
Hospital Charge Code	6846240601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

INDOMETHACIN 50 MG PO CAPS

Facility

$0.66

Service Code	NDC 5026843111
Hospital Charge Code	5026843111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

INDOMETHACIN 50 MG PO CAPS

Facility

$0.66

Service Code	NDC 5026843111
Hospital Charge Code	5026843111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

INDOMETHACIN 50 MG PO CAPS

Facility

$0.64

Service Code	NDC 3172254301
Hospital Charge Code	3172254301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32

INDOMETHACIN 50 MG PO CAPS

Facility

$0.64

Service Code	NDC 3172254301
Hospital Charge Code	3172254301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.43
Rate for Payer: EmblemHealth Commercial	$0.32
Rate for Payer: Group Health Inc Commercial	$0.32
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32
Rate for Payer: Hamaspik Choice Inc Medicare	$0.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.41

INDOMETHACIN SODIUM 1 MG IV SOLR

Facility

$634.73

Service Code	NDC 6332365903
Hospital Charge Code	6332365903
Hospital Revenue Code	258
Min. Negotiated Rate	$317.37
Max. Negotiated Rate	$317.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$317.37

INDOMETHACIN SODIUM 1 MG IV SOLR

Facility

$634.73

Service Code	NDC 6332365903
Hospital Charge Code	6332365903
Hospital Revenue Code	258
Min. Negotiated Rate	$222.16
Max. Negotiated Rate	$507.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$349.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$317.37
Rate for Payer: Aetna Government	$317.37
Rate for Payer: Brighton Health Commercial	$476.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$507.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$431.62
Rate for Payer: EmblemHealth Commercial	$317.37
Rate for Payer: Group Health Inc Commercial	$317.37
Rate for Payer: Group Health Inc Medicare	$222.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$317.37
Rate for Payer: Hamaspik Choice Inc Medicare	$317.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$412.57

Infections of upper respiratory tract

Facility

$68,711.15

Service Code	APR-DRG 1134
Min. Negotiated Rate	$18,819.00
Max. Negotiated Rate	$68,711.15
Rate for Payer: Affinity Essential Plan 1&2	$68,711.15
Rate for Payer: Affinity Essential Plan 3&4	$68,711.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,538.29
Rate for Payer: Amida Care Medicaid	$30,538.29
Rate for Payer: EmblemHealth Essential Plan 1&2	$68,711.15
Rate for Payer: EmblemHealth Essential Plan 3&4	$30,538.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,538.29
Rate for Payer: Fidelis Qualified Health Plan	$36,645.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,538.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,538.29
Rate for Payer: Healthfirst Commercial	$33,274.00
Rate for Payer: Healthfirst Essential Plan	$68,711.15
Rate for Payer: Healthfirst QHP	$18,819.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,538.29
Rate for Payer: SOMOS Essential	$68,711.15
Rate for Payer: United Healthcare Essential Plan 1&2	$68,711.15
Rate for Payer: United Healthcare Essential Plan 3&4	$68,711.15
Rate for Payer: United Healthcare Medicaid	$30,538.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,538.29

Know your out-of-pocket cost for care.

All Charges