St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Infections of upper respiratory tract

Facility

$38,842.36

Service Code	APR-DRG 1131
Min. Negotiated Rate	$4,662.00
Max. Negotiated Rate	$38,842.36
Rate for Payer: Affinity Essential Plan 1&2	$38,842.36
Rate for Payer: Affinity Essential Plan 3&4	$38,842.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,263.27
Rate for Payer: Amida Care Medicaid	$17,263.27
Rate for Payer: EmblemHealth Essential Plan 1&2	$38,842.36
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,263.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,263.27
Rate for Payer: Fidelis Qualified Health Plan	$20,715.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,263.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,263.27
Rate for Payer: Healthfirst Commercial	$8,277.00
Rate for Payer: Healthfirst Essential Plan	$38,842.36
Rate for Payer: Healthfirst QHP	$4,662.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,263.27
Rate for Payer: SOMOS Essential	$38,842.36
Rate for Payer: United Healthcare Essential Plan 1&2	$38,842.36
Rate for Payer: United Healthcare Essential Plan 3&4	$38,842.36
Rate for Payer: United Healthcare Medicaid	$17,263.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,263.27

Infections of upper respiratory tract

Facility

$45,710.26

Service Code	APR-DRG 1133
Min. Negotiated Rate	$8,262.00
Max. Negotiated Rate	$45,710.26
Rate for Payer: Affinity Essential Plan 1&2	$45,710.26
Rate for Payer: Affinity Essential Plan 3&4	$45,710.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,315.67
Rate for Payer: Amida Care Medicaid	$20,315.67
Rate for Payer: EmblemHealth Essential Plan 1&2	$45,710.26
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,315.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,315.67
Rate for Payer: Fidelis Qualified Health Plan	$24,378.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,315.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,315.67
Rate for Payer: Healthfirst Commercial	$14,110.00
Rate for Payer: Healthfirst Essential Plan	$45,710.26
Rate for Payer: Healthfirst QHP	$8,262.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,315.67
Rate for Payer: SOMOS Essential	$45,710.26
Rate for Payer: United Healthcare Essential Plan 1&2	$45,710.26
Rate for Payer: United Healthcare Essential Plan 3&4	$45,710.26
Rate for Payer: United Healthcare Medicaid	$20,315.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,315.67

Infections of upper respiratory tract

Facility

$40,764.67

Service Code	APR-DRG 1132
Min. Negotiated Rate	$5,616.00
Max. Negotiated Rate	$40,764.67
Rate for Payer: Affinity Essential Plan 1&2	$40,764.67
Rate for Payer: Affinity Essential Plan 3&4	$40,764.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,117.63
Rate for Payer: Amida Care Medicaid	$18,117.63
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,764.67
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,117.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,117.63
Rate for Payer: Fidelis Qualified Health Plan	$21,741.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,117.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,117.63
Rate for Payer: Healthfirst Commercial	$9,871.00
Rate for Payer: Healthfirst Essential Plan	$40,764.67
Rate for Payer: Healthfirst QHP	$5,616.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,117.63
Rate for Payer: SOMOS Essential	$40,764.67
Rate for Payer: United Healthcare Essential Plan 1&2	$40,764.67
Rate for Payer: United Healthcare Essential Plan 3&4	$40,764.67
Rate for Payer: United Healthcare Medicaid	$18,117.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,117.63

INFECTIONS OF UPPER RESPIRATORY TRACT & OTITIS MEDIA

Facility

$204.89

Service Code	EAPG 00562
Min. Negotiated Rate	$148.12
Max. Negotiated Rate	$204.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$148.12
Rate for Payer: Healthfirst Commercial	$204.89

Infectious & parasitic diseases including HIV w O.R. procedure

Facility

$143,176.45

Service Code	APR-DRG 7104
Min. Negotiated Rate	$63,633.98
Max. Negotiated Rate	$143,176.45
Rate for Payer: Affinity Essential Plan 1&2	$143,176.45
Rate for Payer: Affinity Essential Plan 3&4	$143,176.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$63,633.98
Rate for Payer: Amida Care Medicaid	$63,633.98
Rate for Payer: EmblemHealth Essential Plan 1&2	$143,176.45
Rate for Payer: EmblemHealth Essential Plan 3&4	$63,633.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$63,633.98
Rate for Payer: Fidelis Qualified Health Plan	$76,360.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$63,633.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$63,633.98
Rate for Payer: Healthfirst Commercial	$118,890.00
Rate for Payer: Healthfirst Essential Plan	$143,176.45
Rate for Payer: Healthfirst QHP	$73,404.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63,633.98
Rate for Payer: SOMOS Essential	$143,176.45
Rate for Payer: United Healthcare Essential Plan 1&2	$143,176.45
Rate for Payer: United Healthcare Essential Plan 3&4	$143,176.45
Rate for Payer: United Healthcare Medicaid	$63,633.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63,633.98

Infectious & parasitic diseases including HIV w O.R. procedure

Facility

$61,319.14

Service Code	APR-DRG 7102
Min. Negotiated Rate	$20,918.00
Max. Negotiated Rate	$61,319.14
Rate for Payer: Affinity Essential Plan 1&2	$61,319.14
Rate for Payer: Affinity Essential Plan 3&4	$61,319.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,252.95
Rate for Payer: Amida Care Medicaid	$27,252.95
Rate for Payer: EmblemHealth Essential Plan 1&2	$61,319.14
Rate for Payer: EmblemHealth Essential Plan 3&4	$27,252.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,252.95
Rate for Payer: Fidelis Qualified Health Plan	$32,703.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,252.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,252.95
Rate for Payer: Healthfirst Commercial	$32,101.00
Rate for Payer: Healthfirst Essential Plan	$61,319.14
Rate for Payer: Healthfirst QHP	$20,918.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,252.95
Rate for Payer: SOMOS Essential	$61,319.14
Rate for Payer: United Healthcare Essential Plan 1&2	$61,319.14
Rate for Payer: United Healthcare Essential Plan 3&4	$61,319.14
Rate for Payer: United Healthcare Medicaid	$27,252.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,252.95

Infectious & parasitic diseases including HIV w O.R. procedure

Facility

$84,349.91

Service Code	APR-DRG 7103
Min. Negotiated Rate	$34,007.00
Max. Negotiated Rate	$84,349.91
Rate for Payer: Affinity Essential Plan 1&2	$84,349.91
Rate for Payer: Affinity Essential Plan 3&4	$84,349.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$37,488.85
Rate for Payer: Amida Care Medicaid	$37,488.85
Rate for Payer: EmblemHealth Essential Plan 1&2	$84,349.91
Rate for Payer: EmblemHealth Essential Plan 3&4	$37,488.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,488.85
Rate for Payer: Fidelis Qualified Health Plan	$44,986.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,488.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,488.85
Rate for Payer: Healthfirst Commercial	$57,396.00
Rate for Payer: Healthfirst Essential Plan	$84,349.91
Rate for Payer: Healthfirst QHP	$34,007.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,488.85
Rate for Payer: SOMOS Essential	$84,349.91
Rate for Payer: United Healthcare Essential Plan 1&2	$84,349.91
Rate for Payer: United Healthcare Essential Plan 3&4	$84,349.91
Rate for Payer: United Healthcare Medicaid	$37,488.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,488.85

Infectious & parasitic diseases including HIV w O.R. procedure

Facility

$51,079.72

Service Code	APR-DRG 7101
Min. Negotiated Rate	$13,829.00
Max. Negotiated Rate	$51,079.72
Rate for Payer: Affinity Essential Plan 1&2	$51,079.72
Rate for Payer: Affinity Essential Plan 3&4	$51,079.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,702.10
Rate for Payer: Amida Care Medicaid	$22,702.10
Rate for Payer: EmblemHealth Essential Plan 1&2	$51,079.72
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,702.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,702.10
Rate for Payer: Fidelis Qualified Health Plan	$27,242.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,702.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,702.10
Rate for Payer: Healthfirst Commercial	$21,135.00
Rate for Payer: Healthfirst Essential Plan	$51,079.72
Rate for Payer: Healthfirst QHP	$13,829.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,702.10
Rate for Payer: SOMOS Essential	$51,079.72
Rate for Payer: United Healthcare Essential Plan 1&2	$51,079.72
Rate for Payer: United Healthcare Essential Plan 3&4	$51,079.72
Rate for Payer: United Healthcare Medicaid	$22,702.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,702.10

Inflammatory bowel disease

Facility

$45,655.74

Service Code	APR-DRG 2452
Min. Negotiated Rate	$8,753.00
Max. Negotiated Rate	$45,655.74
Rate for Payer: Affinity Essential Plan 1&2	$45,655.74
Rate for Payer: Affinity Essential Plan 3&4	$45,655.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,291.44
Rate for Payer: Amida Care Medicaid	$20,291.44
Rate for Payer: EmblemHealth Essential Plan 1&2	$45,655.74
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,291.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,291.44
Rate for Payer: Fidelis Qualified Health Plan	$24,349.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,291.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,291.44
Rate for Payer: Healthfirst Commercial	$14,401.00
Rate for Payer: Healthfirst Essential Plan	$45,655.74
Rate for Payer: Healthfirst QHP	$8,753.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,291.44
Rate for Payer: SOMOS Essential	$45,655.74
Rate for Payer: United Healthcare Essential Plan 1&2	$45,655.74
Rate for Payer: United Healthcare Essential Plan 3&4	$45,655.74
Rate for Payer: United Healthcare Medicaid	$20,291.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,291.44

Inflammatory bowel disease

Facility

$53,439.95

Service Code	APR-DRG 2453
Min. Negotiated Rate	$13,359.00
Max. Negotiated Rate	$53,439.95
Rate for Payer: Affinity Essential Plan 1&2	$53,439.95
Rate for Payer: Affinity Essential Plan 3&4	$53,439.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,751.09
Rate for Payer: Amida Care Medicaid	$23,751.09
Rate for Payer: EmblemHealth Essential Plan 1&2	$53,439.95
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,751.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,751.09
Rate for Payer: Fidelis Qualified Health Plan	$28,501.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,751.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,751.09
Rate for Payer: Healthfirst Commercial	$21,124.00
Rate for Payer: Healthfirst Essential Plan	$53,439.95
Rate for Payer: Healthfirst QHP	$13,359.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,751.09
Rate for Payer: SOMOS Essential	$53,439.95
Rate for Payer: United Healthcare Essential Plan 1&2	$53,439.95
Rate for Payer: United Healthcare Essential Plan 3&4	$53,439.95
Rate for Payer: United Healthcare Medicaid	$23,751.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,751.09

Inflammatory bowel disease

Facility

$69,924.69

Service Code	APR-DRG 2454
Min. Negotiated Rate	$21,928.00
Max. Negotiated Rate	$69,924.69
Rate for Payer: Affinity Essential Plan 1&2	$69,924.69
Rate for Payer: Affinity Essential Plan 3&4	$69,924.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,077.64
Rate for Payer: Amida Care Medicaid	$31,077.64
Rate for Payer: EmblemHealth Essential Plan 1&2	$69,924.69
Rate for Payer: EmblemHealth Essential Plan 3&4	$31,077.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,077.64
Rate for Payer: Fidelis Qualified Health Plan	$37,293.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,077.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,077.64
Rate for Payer: Healthfirst Commercial	$38,546.00
Rate for Payer: Healthfirst Essential Plan	$69,924.69
Rate for Payer: Healthfirst QHP	$21,928.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,077.64
Rate for Payer: SOMOS Essential	$69,924.69
Rate for Payer: United Healthcare Essential Plan 1&2	$69,924.69
Rate for Payer: United Healthcare Essential Plan 3&4	$69,924.69
Rate for Payer: United Healthcare Medicaid	$31,077.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,077.64

Inflammatory bowel disease

Facility

$43,003.55

Service Code	APR-DRG 2451
Min. Negotiated Rate	$7,251.00
Max. Negotiated Rate	$43,003.55
Rate for Payer: Affinity Essential Plan 1&2	$43,003.55
Rate for Payer: Affinity Essential Plan 3&4	$43,003.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,112.69
Rate for Payer: Amida Care Medicaid	$19,112.69
Rate for Payer: EmblemHealth Essential Plan 1&2	$43,003.55
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,112.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,112.69
Rate for Payer: Fidelis Qualified Health Plan	$22,935.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,112.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,112.69
Rate for Payer: Healthfirst Commercial	$12,482.00
Rate for Payer: Healthfirst Essential Plan	$43,003.55
Rate for Payer: Healthfirst QHP	$7,251.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,112.69
Rate for Payer: SOMOS Essential	$43,003.55
Rate for Payer: United Healthcare Essential Plan 1&2	$43,003.55
Rate for Payer: United Healthcare Essential Plan 3&4	$43,003.55
Rate for Payer: United Healthcare Medicaid	$19,112.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,112.69

INFLAMMATORY BOWEL DISEASE

Facility

$196.51

Service Code	EAPG 00626
Min. Negotiated Rate	$143.49
Max. Negotiated Rate	$196.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$143.49
Rate for Payer: Healthfirst Commercial	$196.51

INFLIXIMAB 100 MG IV SOLR

Facility

$570.00

Service Code	HCPCS J1745
Hospital Charge Code	5789416001
Hospital Revenue Code	258
Min. Negotiated Rate	$285.00
Max. Negotiated Rate	$285.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$285.00

INFLIXIMAB 100 MG IV SOLR

Facility

$570.00

Service Code	HCPCS J1745
Hospital Charge Code	5789416001
Hospital Revenue Code	258
Min. Negotiated Rate	$26.43
Max. Negotiated Rate	$7,766.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$313.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.09
Rate for Payer: Aetna Government	$31.09
Rate for Payer: Affinity Essential Plan 1&2	$174.74
Rate for Payer: Affinity Essential Plan 3&4	$174.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$77.66
Rate for Payer: Amida Care Medicaid	$77.66
Rate for Payer: Brighton Health Commercial	$427.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$31.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$456.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$387.60
Rate for Payer: Elderplan Medicare Advantage	$31.09
Rate for Payer: EmblemHealth Commercial	$31.09
Rate for Payer: EmblemHealth Essential Plan 1&2	$174.74
Rate for Payer: EmblemHealth Essential Plan 3&4	$77.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$77.66
Rate for Payer: Fidelis Essential Plan Aliesa	$174.74
Rate for Payer: Fidelis Essential Plan QHP	$174.74
Rate for Payer: Fidelis Medicare Advantage	$31.09
Rate for Payer: Fidelis Qualified Health Plan	$81.54
Rate for Payer: Group Health Inc Commercial	$31.09
Rate for Payer: Group Health Inc Medicare	$31.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.66
Rate for Payer: Hamaspik Choice Inc Medicare	$31.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7,766.00
Rate for Payer: Healthfirst Essential Plan	$174.74
Rate for Payer: Healthfirst Medicare Advantage	$26.43
Rate for Payer: Healthfirst QHP	$126.59
Rate for Payer: Humana Medicare	$31.71
Rate for Payer: Senior Whole Health Medicare Advantage	$31.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.66
Rate for Payer: SOMOS Essential	$174.74
Rate for Payer: United Healthcare Essential Plan 1&2	$174.74
Rate for Payer: United Healthcare Essential Plan 3&4	$85.43
Rate for Payer: United Healthcare Medicaid	$77.66
Rate for Payer: United Healthcare Medicare Advantage	$31.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$370.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$77.66
Rate for Payer: Wellcare Medicare	$29.54

INFLIXIMAB-ABDA 100 MG IV SOLR

Facility

$904.07

Service Code	HCPCS Q5104
Hospital Charge Code	7820616201
Hospital Revenue Code	258
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$723.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$497.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.00
Rate for Payer: Aetna Government	$27.00
Rate for Payer: Affinity Essential Plan 1&2	$18.90
Rate for Payer: Affinity Essential Plan 3&4	$18.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$18.90
Rate for Payer: Brighton Health Commercial	$678.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$723.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$614.77
Rate for Payer: Elderplan Medicare Advantage	$27.00
Rate for Payer: EmblemHealth Commercial	$27.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24.30
Rate for Payer: Fidelis Essential Plan Aliesa	$22.95
Rate for Payer: Fidelis Essential Plan QHP	$24.03
Rate for Payer: Fidelis Medicare Advantage	$27.00
Rate for Payer: Fidelis Qualified Health Plan	$24.03
Rate for Payer: Group Health Inc Commercial	$27.00
Rate for Payer: Group Health Inc Medicare	$27.00
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	$27.00
Rate for Payer: Healthfirst Medicare Advantage	$22.95
Rate for Payer: Healthfirst QHP	$27.00
Rate for Payer: Humana Medicare	$27.54
Rate for Payer: Senior Whole Health Medicare Advantage	$27.00
Rate for Payer: United Healthcare Medicare Advantage	$27.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$587.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25.65
Rate for Payer: Wellcare Medicare	$25.65

INFLIXIMAB-ABDA 100 MG IV SOLR

Facility

$904.07

Service Code	HCPCS Q5104
Hospital Charge Code	7820616201
Hospital Revenue Code	258
Min. Negotiated Rate	$452.04
Max. Negotiated Rate	$452.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$452.04

INFLIXIMAB-AXXQ 100 MG IV SOLR

Facility

$600.00

Service Code	HCPCS Q5121
Hospital Charge Code	5551367001
Hospital Revenue Code	258
Min. Negotiated Rate	$14.29
Max. Negotiated Rate	$480.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$330.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.41
Rate for Payer: Aetna Government	$20.41
Rate for Payer: Affinity Essential Plan 1&2	$14.29
Rate for Payer: Affinity Essential Plan 3&4	$14.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.29
Rate for Payer: Brighton Health Commercial	$450.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$480.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$408.00
Rate for Payer: Elderplan Medicare Advantage	$20.41
Rate for Payer: EmblemHealth Commercial	$20.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.37
Rate for Payer: Fidelis Essential Plan Aliesa	$17.35
Rate for Payer: Fidelis Essential Plan QHP	$18.16
Rate for Payer: Fidelis Medicare Advantage	$20.41
Rate for Payer: Fidelis Qualified Health Plan	$18.16
Rate for Payer: Group Health Inc Commercial	$20.41
Rate for Payer: Group Health Inc Medicare	$20.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.41
Rate for Payer: Hamaspik Choice Inc Medicare	$20.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.41
Rate for Payer: Healthfirst Medicare Advantage	$17.35
Rate for Payer: Healthfirst QHP	$20.41
Rate for Payer: Humana Medicare	$20.82
Rate for Payer: Senior Whole Health Medicare Advantage	$20.41
Rate for Payer: United Healthcare Medicare Advantage	$20.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$390.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.39
Rate for Payer: Wellcare Medicare	$19.39

INFLIXIMAB-AXXQ 100 MG IV SOLR

Facility

$600.00

Service Code	HCPCS Q5121
Hospital Charge Code	5551367001
Hospital Revenue Code	258
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$300.00

INFLIXIMAB-DYYB 100 MG IV SOLR

Facility

$1.00

Service Code	HCPCS Q5103
Hospital Charge Code	0069080901
Hospital Revenue Code	258
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$20.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.99
Rate for Payer: Aetna Government	$19.99
Rate for Payer: Affinity Essential Plan 1&2	$13.99
Rate for Payer: Affinity Essential Plan 3&4	$13.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$13.99
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$19.99
Rate for Payer: EmblemHealth Commercial	$19.99
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17.99
Rate for Payer: Fidelis Essential Plan Aliesa	$16.99
Rate for Payer: Fidelis Essential Plan QHP	$17.79
Rate for Payer: Fidelis Medicare Advantage	$19.99
Rate for Payer: Fidelis Qualified Health Plan	$17.79
Rate for Payer: Group Health Inc Commercial	$19.99
Rate for Payer: Group Health Inc Medicare	$19.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.99
Rate for Payer: Hamaspik Choice Inc Medicare	$19.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19.99
Rate for Payer: Healthfirst Medicare Advantage	$16.99
Rate for Payer: Healthfirst QHP	$19.99
Rate for Payer: Humana Medicare	$20.39
Rate for Payer: Senior Whole Health Medicare Advantage	$19.99
Rate for Payer: United Healthcare Medicare Advantage	$19.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.99
Rate for Payer: Wellcare Medicare	$18.99

INFLIXIMAB-DYYB 100 MG IV SOLR

Facility

$1.00

Service Code	HCPCS Q5103
Hospital Charge Code	0069080901
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

INFLUENZA VAC A&B SURF ANT ADJ 0.5 ML IM SUSY

Facility

$63.56

Service Code	HCPCS 90653
Hospital Charge Code	7046102503
Hospital Revenue Code	250
Min. Negotiated Rate	$31.78
Max. Negotiated Rate	$31.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.78

INFLUENZA VAC A&B SURF ANT ADJ 0.5 ML IM SUSY

Facility

$63.56

Service Code	HCPCS 90653
Hospital Charge Code	7046102503
Hospital Revenue Code	250
Min. Negotiated Rate	$22.25
Max. Negotiated Rate	$98.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.02
Rate for Payer: Aetna Government	$54.02
Rate for Payer: Brighton Health Commercial	$47.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.22
Rate for Payer: EmblemHealth Commercial	$31.78
Rate for Payer: Group Health Inc Commercial	$31.78
Rate for Payer: Group Health Inc Medicare	$22.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.78
Rate for Payer: Hamaspik Choice Inc Medicare	$31.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$98.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.32

INFLUENZA VAC A&B SURF ANT ADJ 0.5 ML IM SUSY

Facility

$63.56

Service Code	HCPCS 90653
Hospital Charge Code	7046102504
Hospital Revenue Code	250
Min. Negotiated Rate	$22.25
Max. Negotiated Rate	$98.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.02
Rate for Payer: Aetna Government	$54.02
Rate for Payer: Brighton Health Commercial	$47.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.22
Rate for Payer: EmblemHealth Commercial	$31.78
Rate for Payer: Group Health Inc Commercial	$31.78
Rate for Payer: Group Health Inc Medicare	$22.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.78
Rate for Payer: Hamaspik Choice Inc Medicare	$31.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$98.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.32

INFLUENZA VAC A&B SURF ANT ADJ 0.5 ML IM SUSY

Facility

$63.56

Service Code	HCPCS 90653
Hospital Charge Code	7046102504
Hospital Revenue Code	250
Min. Negotiated Rate	$31.78
Max. Negotiated Rate	$31.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.78

Know your out-of-pocket cost for care.

All Charges