St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Intracranial hemorrhage

Facility

$80,886.96

Service Code	APR-DRG 0444
Min. Negotiated Rate	$29,368.00
Max. Negotiated Rate	$80,886.96
Rate for Payer: Affinity Essential Plan 1&2	$80,886.96
Rate for Payer: Affinity Essential Plan 3&4	$80,886.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,949.76
Rate for Payer: Amida Care Medicaid	$35,949.76
Rate for Payer: EmblemHealth Essential Plan 1&2	$80,886.96
Rate for Payer: EmblemHealth Essential Plan 3&4	$35,949.76
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,949.76
Rate for Payer: Fidelis Qualified Health Plan	$43,139.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,949.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,949.76
Rate for Payer: Healthfirst Commercial	$49,052.00
Rate for Payer: Healthfirst Essential Plan	$80,886.96
Rate for Payer: Healthfirst QHP	$29,368.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,949.76
Rate for Payer: SOMOS Essential	$80,886.96
Rate for Payer: United Healthcare Essential Plan 1&2	$80,886.96
Rate for Payer: United Healthcare Essential Plan 3&4	$80,886.96
Rate for Payer: United Healthcare Medicaid	$35,949.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,949.76

INTRACRANIAL HEMORRHAGE

Facility

$175.89

Service Code	EAPG 00539
Min. Negotiated Rate	$175.89
Max. Negotiated Rate	$175.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$175.89

IODINE STRONG 5 % PO SOLN

Facility

$2.76

Service Code	NDC 4843323015
Hospital Charge Code	4843323015
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38

IODINE STRONG 5 % PO SOLN

Facility

$2.76

Service Code	NDC 4843323015
Hospital Charge Code	4843323015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.38
Rate for Payer: Aetna Government	$1.38
Rate for Payer: Brighton Health Commercial	$2.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.88
Rate for Payer: EmblemHealth Commercial	$1.38
Rate for Payer: Group Health Inc Commercial	$1.38
Rate for Payer: Group Health Inc Medicare	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.80

IODIXANOL 270 MG/ML IV SOLN

Facility

$1.14

Service Code	HCPCS Q9966
Hospital Charge Code	0407222217
Hospital Revenue Code	258
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.34
Rate for Payer: Aetna Government	$0.34
Rate for Payer: Brighton Health Commercial	$0.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: EmblemHealth Commercial	$0.57
Rate for Payer: Group Health Inc Commercial	$0.57
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57
Rate for Payer: Hamaspik Choice Inc Medicare	$0.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.74

IODIXANOL 270 MG/ML IV SOLN

Facility

$1.14

Service Code	HCPCS Q9966
Hospital Charge Code	0407222217
Hospital Revenue Code	258
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57

IODIXANOL 320 MG/ML IV SOLN

Facility

$1.19

Service Code	HCPCS Q9967
Hospital Charge Code	0407222319
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.81
Rate for Payer: EmblemHealth Commercial	$0.60
Rate for Payer: Group Health Inc Commercial	$0.60
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60
Rate for Payer: Hamaspik Choice Inc Medicare	$0.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.78

IODIXANOL 320 MG/ML IV SOLN

Facility

$1.11

Service Code	HCPCS Q9967
Hospital Charge Code	0407222323
Hospital Revenue Code	258
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56

IODIXANOL 320 MG/ML IV SOLN

Facility

$1.27

Service Code	HCPCS Q9967
Hospital Charge Code	0407222317
Hospital Revenue Code	258
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.64

IODIXANOL 320 MG/ML IV SOLN

Facility

$1.27

Service Code	HCPCS Q9967
Hospital Charge Code	0407222317
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$1.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: EmblemHealth Commercial	$0.64
Rate for Payer: Group Health Inc Commercial	$0.64
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.64
Rate for Payer: Hamaspik Choice Inc Medicare	$0.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.83

IODIXANOL 320 MG/ML IV SOLN

Facility

$1.27

Service Code	HCPCS Q9967
Hospital Charge Code	0407222316
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$1.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: EmblemHealth Commercial	$0.64
Rate for Payer: Group Health Inc Commercial	$0.64
Rate for Payer: Group Health Inc Medicare	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.64
Rate for Payer: Hamaspik Choice Inc Medicare	$0.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.83

IODIXANOL 320 MG/ML IV SOLN

Facility

$1.27

Service Code	HCPCS Q9967
Hospital Charge Code	0407222316
Hospital Revenue Code	258
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.64

IODIXANOL 320 MG/ML IV SOLN

Facility

$1.11

Service Code	HCPCS Q9967
Hospital Charge Code	0407222323
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.76
Rate for Payer: EmblemHealth Commercial	$0.56
Rate for Payer: Group Health Inc Commercial	$0.56
Rate for Payer: Group Health Inc Medicare	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56
Rate for Payer: Hamaspik Choice Inc Medicare	$0.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.72

IODIXANOL 320 MG/ML IV SOLN

Facility

$1.19

Service Code	HCPCS Q9967
Hospital Charge Code	0407222319
Hospital Revenue Code	258
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60

IOHEXOL 12 MG/ML PO SOLN

Facility

$0.03

Service Code	NDC 0407141612
Hospital Charge Code	0407141612
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

IOHEXOL 12 MG/ML PO SOLN

Facility

$0.03

Service Code	NDC 0407141612
Hospital Charge Code	0407141612
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

IOHEXOL 180 MG/ML IJ SOLN

Facility

$4.81

Service Code	HCPCS Q9965
Hospital Charge Code	0407141110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$3.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.27
Rate for Payer: EmblemHealth Commercial	$2.40
Rate for Payer: Group Health Inc Commercial	$2.40
Rate for Payer: Group Health Inc Medicare	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.12

IOHEXOL 180 MG/ML IJ SOLN

Facility

$4.81

Service Code	HCPCS Q9965
Hospital Charge Code	0407141110
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40

IOHEXOL 240 MG/ML IJ SOLN

Facility

$0.94

Service Code	HCPCS Q9966
Hospital Charge Code	0407141230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.34
Rate for Payer: Aetna Government	$0.34
Rate for Payer: Brighton Health Commercial	$0.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.64
Rate for Payer: EmblemHealth Commercial	$0.47
Rate for Payer: Group Health Inc Commercial	$0.47
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.61

IOHEXOL 240 MG/ML IJ SOLN

Facility

$2.76

Service Code	HCPCS Q9966
Hospital Charge Code	0407141220
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$2.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.34
Rate for Payer: Aetna Government	$0.34
Rate for Payer: Brighton Health Commercial	$2.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.88
Rate for Payer: EmblemHealth Commercial	$1.38
Rate for Payer: Group Health Inc Commercial	$1.38
Rate for Payer: Group Health Inc Medicare	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.79

IOHEXOL 240 MG/ML IJ SOLN

Facility

$2.76

Service Code	HCPCS Q9966
Hospital Charge Code	0407141220
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38

IOHEXOL 240 MG/ML IJ SOLN

Facility

$0.94

Service Code	HCPCS Q9966
Hospital Charge Code	0407141230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47

IOHEXOL 300 MG/ML IJ SOLN

Facility

$1.06

Service Code	HCPCS Q9967
Hospital Charge Code	0407141365
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.72
Rate for Payer: EmblemHealth Commercial	$0.53
Rate for Payer: Group Health Inc Commercial	$0.53
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53
Rate for Payer: Hamaspik Choice Inc Medicare	$0.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.69

IOHEXOL 300 MG/ML IJ SOLN

Facility

$1.06

Service Code	HCPCS Q9967
Hospital Charge Code	0407141365
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53

IOHEXOL 300 MG/ML IJ SOLN

Facility

$1.11

Service Code	HCPCS Q9967
Hospital Charge Code	0407141361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.76
Rate for Payer: EmblemHealth Commercial	$0.56
Rate for Payer: Group Health Inc Commercial	$0.56
Rate for Payer: Group Health Inc Medicare	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56
Rate for Payer: Hamaspik Choice Inc Medicare	$0.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.72

Know your out-of-pocket cost for care.

All Charges