St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Laparoscopic cholecystectomy

Facility

$96,557.38

Service Code	APR-DRG 2634
Min. Negotiated Rate	$32,717.00
Max. Negotiated Rate	$96,557.38
Rate for Payer: Affinity Essential Plan 1&2	$96,557.38
Rate for Payer: Affinity Essential Plan 3&4	$96,557.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$42,914.39
Rate for Payer: Amida Care Medicaid	$42,914.39
Rate for Payer: EmblemHealth Essential Plan 1&2	$96,557.38
Rate for Payer: EmblemHealth Essential Plan 3&4	$42,914.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,914.39
Rate for Payer: Fidelis Qualified Health Plan	$51,497.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,914.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,914.39
Rate for Payer: Healthfirst Commercial	$60,260.00
Rate for Payer: Healthfirst Essential Plan	$96,557.38
Rate for Payer: Healthfirst QHP	$32,717.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,914.39
Rate for Payer: SOMOS Essential	$96,557.38
Rate for Payer: United Healthcare Essential Plan 1&2	$96,557.38
Rate for Payer: United Healthcare Essential Plan 3&4	$96,557.38
Rate for Payer: United Healthcare Medicaid	$42,914.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,914.39

Laparoscopic cholecystectomy

Facility

$60,427.46

Service Code	APR-DRG 2633
Min. Negotiated Rate	$17,197.00
Max. Negotiated Rate	$60,427.46
Rate for Payer: Affinity Essential Plan 1&2	$60,427.46
Rate for Payer: Affinity Essential Plan 3&4	$60,427.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,856.65
Rate for Payer: Amida Care Medicaid	$26,856.65
Rate for Payer: EmblemHealth Essential Plan 1&2	$60,427.46
Rate for Payer: EmblemHealth Essential Plan 3&4	$26,856.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,856.65
Rate for Payer: Fidelis Qualified Health Plan	$32,227.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,856.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,856.65
Rate for Payer: Healthfirst Commercial	$28,725.00
Rate for Payer: Healthfirst Essential Plan	$60,427.46
Rate for Payer: Healthfirst QHP	$17,197.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,856.65
Rate for Payer: SOMOS Essential	$60,427.46
Rate for Payer: United Healthcare Essential Plan 1&2	$60,427.46
Rate for Payer: United Healthcare Essential Plan 3&4	$60,427.46
Rate for Payer: United Healthcare Medicaid	$26,856.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,856.65

LASER EYE PROCEDURES

Facility

$940.77

Service Code	EAPG 00232
Min. Negotiated Rate	$682.72
Max. Negotiated Rate	$940.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$682.72
Rate for Payer: Healthfirst Commercial	$940.77

LATANOPROST 0.005 % OP SOLN

Facility

$3.64

Service Code	NDC 7006942103
Hospital Charge Code	7006942103
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$1.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.82

LATANOPROST 0.005 % OP SOLN

Facility

$38.00

Service Code	NDC 6131454701
Hospital Charge Code	6131454701
Hospital Revenue Code	250
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$19.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.00

LATANOPROST 0.005 % OP SOLN

Facility

$126.86

Service Code	NDC 0013830304
Hospital Charge Code	0013830304
Hospital Revenue Code	250
Min. Negotiated Rate	$63.43
Max. Negotiated Rate	$63.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.43

LATANOPROST 0.005 % OP SOLN

Facility

$38.00

Service Code	NDC 6131454701
Hospital Charge Code	6131454701
Hospital Revenue Code	250
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$30.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.00
Rate for Payer: Aetna Government	$19.00
Rate for Payer: Brighton Health Commercial	$28.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.84
Rate for Payer: EmblemHealth Commercial	$19.00
Rate for Payer: Group Health Inc Commercial	$19.00
Rate for Payer: Group Health Inc Medicare	$13.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.00
Rate for Payer: Hamaspik Choice Inc Medicare	$19.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.70

LATANOPROST 0.005 % OP SOLN

Facility

$38.11

Service Code	NDC 5976203332
Hospital Charge Code	5976203332
Hospital Revenue Code	250
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.05

LATANOPROST 0.005 % OP SOLN

Facility

$9.75

Service Code	NDC 2420846325
Hospital Charge Code	2420846325
Hospital Revenue Code	250
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$7.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.88
Rate for Payer: Aetna Government	$4.88
Rate for Payer: Brighton Health Commercial	$7.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.63
Rate for Payer: EmblemHealth Commercial	$4.88
Rate for Payer: Group Health Inc Commercial	$4.88
Rate for Payer: Group Health Inc Medicare	$3.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.88
Rate for Payer: Hamaspik Choice Inc Medicare	$4.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.34

LATANOPROST 0.005 % OP SOLN

Facility

$126.86

Service Code	NDC 0013830304
Hospital Charge Code	0013830304
Hospital Revenue Code	250
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$101.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.43
Rate for Payer: Aetna Government	$63.43
Rate for Payer: Brighton Health Commercial	$95.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$101.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.26
Rate for Payer: EmblemHealth Commercial	$63.43
Rate for Payer: Group Health Inc Commercial	$63.43
Rate for Payer: Group Health Inc Medicare	$44.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.43
Rate for Payer: Hamaspik Choice Inc Medicare	$63.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$82.46

LATANOPROST 0.005 % OP SOLN

Facility

$9.75

Service Code	NDC 2420846325
Hospital Charge Code	2420846325
Hospital Revenue Code	250
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$4.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.88

LATANOPROST 0.005 % OP SOLN

Facility

$3.64

Service Code	NDC 7006942103
Hospital Charge Code	7006942103
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$2.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.82
Rate for Payer: Aetna Government	$1.82
Rate for Payer: Brighton Health Commercial	$2.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.47
Rate for Payer: EmblemHealth Commercial	$1.82
Rate for Payer: Group Health Inc Commercial	$1.82
Rate for Payer: Group Health Inc Medicare	$1.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.36

LATANOPROST 0.005 % OP SOLN

Facility

$38.00

Service Code	NDC 6498051625
Hospital Charge Code	6498051625
Hospital Revenue Code	250
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$19.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.00

LATANOPROST 0.005 % OP SOLN

Facility

$38.00

Service Code	NDC 7006942101
Hospital Charge Code	7006942101
Hospital Revenue Code	250
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$19.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.00

LATANOPROST 0.005 % OP SOLN

Facility

$38.11

Service Code	NDC 5976203332
Hospital Charge Code	5976203332
Hospital Revenue Code	250
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$30.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.05
Rate for Payer: Aetna Government	$19.05
Rate for Payer: Brighton Health Commercial	$28.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.91
Rate for Payer: EmblemHealth Commercial	$19.05
Rate for Payer: Group Health Inc Commercial	$19.05
Rate for Payer: Group Health Inc Medicare	$13.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.05
Rate for Payer: Hamaspik Choice Inc Medicare	$19.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.77

LATANOPROST 0.005 % OP SOLN

Facility

$38.00

Service Code	NDC 7006942101
Hospital Charge Code	7006942101
Hospital Revenue Code	250
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$30.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.00
Rate for Payer: Aetna Government	$19.00
Rate for Payer: Brighton Health Commercial	$28.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.84
Rate for Payer: EmblemHealth Commercial	$19.00
Rate for Payer: Group Health Inc Commercial	$19.00
Rate for Payer: Group Health Inc Medicare	$13.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.00
Rate for Payer: Hamaspik Choice Inc Medicare	$19.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.70

LATANOPROST 0.005 % OP SOLN

Facility

$38.00

Service Code	NDC 6498051625
Hospital Charge Code	6498051625
Hospital Revenue Code	250
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$30.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.00
Rate for Payer: Aetna Government	$19.00
Rate for Payer: Brighton Health Commercial	$28.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.84
Rate for Payer: EmblemHealth Commercial	$19.00
Rate for Payer: Group Health Inc Commercial	$19.00
Rate for Payer: Group Health Inc Medicare	$13.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.00
Rate for Payer: Hamaspik Choice Inc Medicare	$19.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.70

LETROZOLE 2.5 MG PO TABS

Facility

$18.05

Service Code	NDC 1672903415
Hospital Charge Code	1672903415
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$14.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.03
Rate for Payer: Aetna Government	$9.03
Rate for Payer: Brighton Health Commercial	$13.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.28
Rate for Payer: EmblemHealth Commercial	$9.03
Rate for Payer: Group Health Inc Commercial	$9.03
Rate for Payer: Group Health Inc Medicare	$6.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.03
Rate for Payer: Hamaspik Choice Inc Medicare	$9.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.73

LETROZOLE 2.5 MG PO TABS

Facility

$18.05

Service Code	NDC 5026847615
Hospital Charge Code	5026847615
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$14.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.03
Rate for Payer: Aetna Government	$9.03
Rate for Payer: Brighton Health Commercial	$13.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.28
Rate for Payer: EmblemHealth Commercial	$9.03
Rate for Payer: Group Health Inc Commercial	$9.03
Rate for Payer: Group Health Inc Medicare	$6.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.03
Rate for Payer: Hamaspik Choice Inc Medicare	$9.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.73

LETROZOLE 2.5 MG PO TABS

Facility

$18.05

Service Code	NDC 5026847615
Hospital Charge Code	5026847615
Hospital Revenue Code	250
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$9.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.03

LETROZOLE 2.5 MG PO TABS

Facility

$18.05

Service Code	NDC 1672903415
Hospital Charge Code	1672903415
Hospital Revenue Code	250
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$9.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.03

LETROZOLE 2.5 MG PO TABS

Facility

$18.14

Service Code	NDC 5965118030
Hospital Charge Code	5965118030
Hospital Revenue Code	250
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$14.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.07
Rate for Payer: Aetna Government	$9.07
Rate for Payer: Brighton Health Commercial	$13.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.33
Rate for Payer: EmblemHealth Commercial	$9.07
Rate for Payer: Group Health Inc Commercial	$9.07
Rate for Payer: Group Health Inc Medicare	$6.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.07
Rate for Payer: Hamaspik Choice Inc Medicare	$9.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.79

LETROZOLE 2.5 MG PO TABS

Facility

$18.05

Service Code	NDC 5026847611
Hospital Charge Code	5026847611
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$14.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.03
Rate for Payer: Aetna Government	$9.03
Rate for Payer: Brighton Health Commercial	$13.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.28
Rate for Payer: EmblemHealth Commercial	$9.03
Rate for Payer: Group Health Inc Commercial	$9.03
Rate for Payer: Group Health Inc Medicare	$6.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.03
Rate for Payer: Hamaspik Choice Inc Medicare	$9.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.73

LETROZOLE 2.5 MG PO TABS

Facility

$18.14

Service Code	NDC 5965118030
Hospital Charge Code	5965118030
Hospital Revenue Code	250
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$9.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.07

LETROZOLE 2.5 MG PO TABS

Facility

$18.12

Service Code	NDC 5199175933
Hospital Charge Code	5199175933
Hospital Revenue Code	250
Min. Negotiated Rate	$9.06
Max. Negotiated Rate	$9.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.06

Know your out-of-pocket cost for care.

All Charges