St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS

Facility

$15.53

Service Code	NDC 3172250660
Hospital Charge Code	3172250660
Hospital Revenue Code	250
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$12.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.76
Rate for Payer: Aetna Government	$7.76
Rate for Payer: Brighton Health Commercial	$11.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.56
Rate for Payer: EmblemHealth Commercial	$7.76
Rate for Payer: Group Health Inc Commercial	$7.76
Rate for Payer: Group Health Inc Medicare	$5.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.76
Rate for Payer: Hamaspik Choice Inc Medicare	$7.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.09

LAMOTRIGINE 100 MG PO TABS

Facility

$4.75

Service Code	NDC 6586222801
Hospital Charge Code	6586222801
Hospital Revenue Code	250
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$2.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.38

LAMOTRIGINE 100 MG PO TABS

Facility

$0.17

Service Code	NDC 0904700861
Hospital Charge Code	0904700861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

LAMOTRIGINE 100 MG PO TABS

Facility

$0.17

Service Code	NDC 0904700861
Hospital Charge Code	0904700861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

LAMOTRIGINE 100 MG PO TABS

Facility

$0.23

Service Code	NDC 6808431901
Hospital Charge Code	6808431901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: EmblemHealth Commercial	$0.12
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

LAMOTRIGINE 100 MG PO TABS

Facility

$4.75

Service Code	NDC 6586222801
Hospital Charge Code	6586222801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$3.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.38
Rate for Payer: Aetna Government	$2.38
Rate for Payer: Brighton Health Commercial	$3.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.23
Rate for Payer: EmblemHealth Commercial	$2.38
Rate for Payer: Group Health Inc Commercial	$2.38
Rate for Payer: Group Health Inc Medicare	$1.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.38
Rate for Payer: Hamaspik Choice Inc Medicare	$2.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.09

LAMOTRIGINE 100 MG PO TABS

Facility

$0.23

Service Code	NDC 6808431901
Hospital Charge Code	6808431901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12

LAMOTRIGINE 200 MG PO TABS

Facility

$0.53

Service Code	NDC 6068770411
Hospital Charge Code	6068770411
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

LAMOTRIGINE 200 MG PO TABS

Facility

$0.53

Service Code	NDC 6068770411
Hospital Charge Code	6068770411
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

LAMOTRIGINE 200 MG PO TABS

Facility

$5.67

Service Code	NDC 6586223060
Hospital Charge Code	6586223060
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$4.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.83
Rate for Payer: Aetna Government	$2.83
Rate for Payer: Brighton Health Commercial	$4.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.85
Rate for Payer: EmblemHealth Commercial	$2.83
Rate for Payer: Group Health Inc Commercial	$2.83
Rate for Payer: Group Health Inc Medicare	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83
Rate for Payer: Hamaspik Choice Inc Medicare	$2.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.68

LAMOTRIGINE 200 MG PO TABS

Facility

$6.14

Service Code	NDC 5167241334
Hospital Charge Code	5167241334
Hospital Revenue Code	250
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$4.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.07
Rate for Payer: Aetna Government	$3.07
Rate for Payer: Brighton Health Commercial	$4.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.17
Rate for Payer: EmblemHealth Commercial	$3.07
Rate for Payer: Group Health Inc Commercial	$3.07
Rate for Payer: Group Health Inc Medicare	$2.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.07
Rate for Payer: Hamaspik Choice Inc Medicare	$3.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.99

LAMOTRIGINE 200 MG PO TABS

Facility

$6.14

Service Code	NDC 5167241334
Hospital Charge Code	5167241334
Hospital Revenue Code	250
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$3.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.07

LAMOTRIGINE 200 MG PO TABS

Facility

$5.67

Service Code	NDC 6586223060
Hospital Charge Code	6586223060
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83

LAMOTRIGINE 25 MG PO TABS

Facility

$4.50

Service Code	NDC 5167241301
Hospital Charge Code	5167241301
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.25

LAMOTRIGINE 25 MG PO TABS

Facility

$0.22

Service Code	NDC 6808431801
Hospital Charge Code	6808431801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

LAMOTRIGINE 25 MG PO TABS

Facility

$4.16

Service Code	NDC 6586222701
Hospital Charge Code	6586222701
Hospital Revenue Code	250
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$3.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.08
Rate for Payer: Aetna Government	$2.08
Rate for Payer: Brighton Health Commercial	$3.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.83
Rate for Payer: EmblemHealth Commercial	$2.08
Rate for Payer: Group Health Inc Commercial	$2.08
Rate for Payer: Group Health Inc Medicare	$1.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.08
Rate for Payer: Hamaspik Choice Inc Medicare	$2.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.70

LAMOTRIGINE 25 MG PO TABS

Facility

$4.50

Service Code	NDC 5167241301
Hospital Charge Code	5167241301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$3.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.25
Rate for Payer: Aetna Government	$2.25
Rate for Payer: Brighton Health Commercial	$3.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.06
Rate for Payer: EmblemHealth Commercial	$2.25
Rate for Payer: Group Health Inc Commercial	$2.25
Rate for Payer: Group Health Inc Medicare	$1.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.93

LAMOTRIGINE 25 MG PO TABS

Facility

$4.16

Service Code	NDC 6586222701
Hospital Charge Code	6586222701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$2.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.08

LAMOTRIGINE 25 MG PO TABS

Facility

$0.22

Service Code	NDC 6808431801
Hospital Charge Code	6808431801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: EmblemHealth Commercial	$0.11
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

LAMOTRIGINE 25 MG PO TABS

Facility

$0.20

Service Code	NDC 0904700761
Hospital Charge Code	0904700761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

LAMOTRIGINE 25 MG PO TABS

Facility

$0.20

Service Code	NDC 0904700761
Hospital Charge Code	0904700761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN

Facility

$22.00

Service Code	HCPCS J1930
Hospital Charge Code	1505411204
Hospital Revenue Code	250
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$34.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.05
Rate for Payer: Aetna Government	$34.05
Rate for Payer: Affinity Essential Plan 1&2	$23.84
Rate for Payer: Affinity Essential Plan 3&4	$23.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$23.84
Rate for Payer: Brighton Health Commercial	$16.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$34.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.96
Rate for Payer: Elderplan Medicare Advantage	$34.05
Rate for Payer: EmblemHealth Commercial	$34.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30.64
Rate for Payer: Fidelis Essential Plan Aliesa	$28.94
Rate for Payer: Fidelis Essential Plan QHP	$30.30
Rate for Payer: Fidelis Medicare Advantage	$34.05
Rate for Payer: Fidelis Qualified Health Plan	$30.30
Rate for Payer: Group Health Inc Commercial	$34.05
Rate for Payer: Group Health Inc Medicare	$34.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.05
Rate for Payer: Hamaspik Choice Inc Medicare	$34.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34.05
Rate for Payer: Healthfirst Medicare Advantage	$28.94
Rate for Payer: Healthfirst QHP	$34.05
Rate for Payer: Humana Medicare	$34.73
Rate for Payer: Senior Whole Health Medicare Advantage	$34.05
Rate for Payer: United Healthcare Medicare Advantage	$34.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32.35
Rate for Payer: Wellcare Medicare	$32.35

LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN

Facility

$22.00

Service Code	HCPCS J1930
Hospital Charge Code	1505411204
Hospital Revenue Code	250
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$11.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.00

Laparoscopic cholecystectomy

Facility

$52,623.90

Service Code	APR-DRG 2632
Min. Negotiated Rate	$12,231.00
Max. Negotiated Rate	$52,623.90
Rate for Payer: Affinity Essential Plan 1&2	$52,623.90
Rate for Payer: Affinity Essential Plan 3&4	$52,623.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,388.40
Rate for Payer: Amida Care Medicaid	$23,388.40
Rate for Payer: EmblemHealth Essential Plan 1&2	$52,623.90
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,388.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,388.40
Rate for Payer: Fidelis Qualified Health Plan	$28,066.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,388.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,388.40
Rate for Payer: Healthfirst Commercial	$20,581.00
Rate for Payer: Healthfirst Essential Plan	$52,623.90
Rate for Payer: Healthfirst QHP	$12,231.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,388.40
Rate for Payer: SOMOS Essential	$52,623.90
Rate for Payer: United Healthcare Essential Plan 1&2	$52,623.90
Rate for Payer: United Healthcare Essential Plan 3&4	$52,623.90
Rate for Payer: United Healthcare Medicaid	$23,388.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,388.40

Laparoscopic cholecystectomy

Facility

$47,574.54

Service Code	APR-DRG 2631
Min. Negotiated Rate	$9,474.00
Max. Negotiated Rate	$47,574.54
Rate for Payer: Affinity Essential Plan 1&2	$47,574.54
Rate for Payer: Affinity Essential Plan 3&4	$47,574.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,144.24
Rate for Payer: Amida Care Medicaid	$21,144.24
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,574.54
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,144.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,144.24
Rate for Payer: Fidelis Qualified Health Plan	$25,373.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,144.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,144.24
Rate for Payer: Healthfirst Commercial	$15,949.00
Rate for Payer: Healthfirst Essential Plan	$47,574.54
Rate for Payer: Healthfirst QHP	$9,474.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,144.24
Rate for Payer: SOMOS Essential	$47,574.54
Rate for Payer: United Healthcare Essential Plan 1&2	$47,574.54
Rate for Payer: United Healthcare Essential Plan 3&4	$47,574.54
Rate for Payer: United Healthcare Medicaid	$21,144.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,144.24

Know your out-of-pocket cost for care.

All Charges