St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

IOHEXOL 300 MG/ML IJ SOLN

Facility

$1.11

Service Code	HCPCS Q9967
Hospital Charge Code	0407141361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56

IOHEXOL 300 MG/ML IJ SOLN

Facility

$1.09

Service Code	HCPCS Q9967
Hospital Charge Code	0407141363
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.74
Rate for Payer: EmblemHealth Commercial	$0.54
Rate for Payer: Group Health Inc Commercial	$0.54
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54
Rate for Payer: Hamaspik Choice Inc Medicare	$0.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

IOHEXOL 300 MG/ML IJ SOLN

Facility

$1.09

Service Code	HCPCS Q9967
Hospital Charge Code	0407141363
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54

IOHEXOL 350 MG/ML IV SOLN

Facility

$1.11

Service Code	HCPCS Q9967
Hospital Charge Code	0407141493
Hospital Revenue Code	258
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56

IOHEXOL 350 MG/ML IV SOLN

Facility

$1.03

Service Code	HCPCS Q9967
Hospital Charge Code	0407141472
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.70
Rate for Payer: EmblemHealth Commercial	$0.52
Rate for Payer: Group Health Inc Commercial	$0.52
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52
Rate for Payer: Hamaspik Choice Inc Medicare	$0.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.67

IOHEXOL 350 MG/ML IV SOLN

Facility

$1.21

Service Code	HCPCS Q9967
Hospital Charge Code	0407141491
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.82
Rate for Payer: EmblemHealth Commercial	$0.61
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.79

IOHEXOL 350 MG/ML IV SOLN

Facility

$1.21

Service Code	HCPCS Q9967
Hospital Charge Code	0407141489
Hospital Revenue Code	258
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61

IOHEXOL 350 MG/ML IV SOLN

Facility

$1.21

Service Code	HCPCS Q9967
Hospital Charge Code	0407141491
Hospital Revenue Code	258
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61

IOHEXOL 350 MG/ML IV SOLN

Facility

$1.21

Service Code	HCPCS Q9967
Hospital Charge Code	0407141489
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.82
Rate for Payer: EmblemHealth Commercial	$0.61
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.79

IOHEXOL 350 MG/ML IV SOLN

Facility

$1.03

Service Code	HCPCS Q9967
Hospital Charge Code	0407141472
Hospital Revenue Code	258
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52

IOHEXOL 350 MG/ML IV SOLN

Facility

$1.11

Service Code	HCPCS Q9967
Hospital Charge Code	0407141493
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	$0.84
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

IPILIMUMAB 200 MG/40ML IV SOLN

Facility

$1.00

Service Code	HCPCS J9228
Hospital Charge Code	0003232822
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

IPILIMUMAB 200 MG/40ML IV SOLN

Facility

$1.00

Service Code	HCPCS J9228
Hospital Charge Code	0003232822
Hospital Revenue Code	258
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$187.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$183.48
Rate for Payer: Aetna Government	$183.48
Rate for Payer: Affinity Essential Plan 1&2	$128.44
Rate for Payer: Affinity Essential Plan 3&4	$128.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$128.44
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$183.48
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	$183.48
Rate for Payer: EmblemHealth Commercial	$183.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$165.13
Rate for Payer: Fidelis Essential Plan Aliesa	$155.96
Rate for Payer: Fidelis Essential Plan QHP	$163.30
Rate for Payer: Fidelis Medicare Advantage	$183.48
Rate for Payer: Fidelis Qualified Health Plan	$163.30
Rate for Payer: Group Health Inc Commercial	$183.48
Rate for Payer: Group Health Inc Medicare	$183.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$183.48
Rate for Payer: Hamaspik Choice Inc Medicare	$183.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$183.48
Rate for Payer: Healthfirst Medicare Advantage	$155.96
Rate for Payer: Healthfirst QHP	$183.48
Rate for Payer: Humana Medicare	$187.15
Rate for Payer: Senior Whole Health Medicare Advantage	$183.48
Rate for Payer: United Healthcare Medicare Advantage	$183.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$174.31
Rate for Payer: Wellcare Medicare	$174.31

IPILIMUMAB 50 MG/10ML IV SOLN

Facility

$1.00

Service Code	HCPCS J9228
Hospital Charge Code	0003232711
Hospital Revenue Code	258
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$187.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$183.48
Rate for Payer: Aetna Government	$183.48
Rate for Payer: Affinity Essential Plan 1&2	$128.44
Rate for Payer: Affinity Essential Plan 3&4	$128.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$128.44
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$183.48
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	$183.48
Rate for Payer: EmblemHealth Commercial	$183.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$165.13
Rate for Payer: Fidelis Essential Plan Aliesa	$155.96
Rate for Payer: Fidelis Essential Plan QHP	$163.30
Rate for Payer: Fidelis Medicare Advantage	$183.48
Rate for Payer: Fidelis Qualified Health Plan	$163.30
Rate for Payer: Group Health Inc Commercial	$183.48
Rate for Payer: Group Health Inc Medicare	$183.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$183.48
Rate for Payer: Hamaspik Choice Inc Medicare	$183.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$183.48
Rate for Payer: Healthfirst Medicare Advantage	$155.96
Rate for Payer: Healthfirst QHP	$183.48
Rate for Payer: Humana Medicare	$187.15
Rate for Payer: Senior Whole Health Medicare Advantage	$183.48
Rate for Payer: United Healthcare Medicare Advantage	$183.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$174.31
Rate for Payer: Wellcare Medicare	$174.31

IPILIMUMAB 50 MG/10ML IV SOLN

Facility

$1.00

Service Code	HCPCS J9228
Hospital Charge Code	0003232711
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN

Facility

$0.73

Service Code	HCPCS J7620
Hospital Charge Code	6909717353
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.50
Rate for Payer: EmblemHealth Commercial	$0.37
Rate for Payer: Group Health Inc Commercial	$0.37
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37
Rate for Payer: Hamaspik Choice Inc Medicare	$0.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN

Facility

$0.77

Service Code	HCPCS J7620
Hospital Charge Code	0378967193
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38

IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN

Facility

$0.70

Service Code	HCPCS J7620
Hospital Charge Code	6909717364
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: EmblemHealth Commercial	$0.35
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN

Facility

$0.77

Service Code	HCPCS J7620
Hospital Charge Code	7620460001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38

IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN

Facility

$0.26

Service Code	HCPCS J7620
Hospital Charge Code	6068740583
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN

Facility

$0.73

Service Code	HCPCS J7620
Hospital Charge Code	4733575649
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.50
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN

Facility

$0.77

Service Code	HCPCS J7620
Hospital Charge Code	0378967193
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: EmblemHealth Commercial	$0.38
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.50

IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN

Facility

$0.77

Service Code	HCPCS J7620
Hospital Charge Code	7620460001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: EmblemHealth Commercial	$0.38
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.50

IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN

Facility

$0.73

Service Code	HCPCS J7620
Hospital Charge Code	7620460060
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN

Facility

$0.73

Service Code	HCPCS J7620
Hospital Charge Code	7620460030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.50
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

Know your out-of-pocket cost for care.

All Charges