St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Lymphoma, myeloma & non-acute leukemia

Facility

$58,116.46

Service Code	APR-DRG 6912
Min. Negotiated Rate	$15,881.00
Max. Negotiated Rate	$58,116.46
Rate for Payer: Affinity Essential Plan 1&2	$58,116.46
Rate for Payer: Affinity Essential Plan 3&4	$58,116.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,829.54
Rate for Payer: Amida Care Medicaid	$25,829.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$58,116.46
Rate for Payer: EmblemHealth Essential Plan 3&4	$25,829.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,829.54
Rate for Payer: Fidelis Qualified Health Plan	$30,995.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,829.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,829.54
Rate for Payer: Healthfirst Commercial	$25,363.00
Rate for Payer: Healthfirst Essential Plan	$58,116.46
Rate for Payer: Healthfirst QHP	$15,881.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,829.54
Rate for Payer: SOMOS Essential	$58,116.46
Rate for Payer: United Healthcare Essential Plan 1&2	$58,116.46
Rate for Payer: United Healthcare Essential Plan 3&4	$58,116.46
Rate for Payer: United Healthcare Medicaid	$25,829.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,829.54

Lymphoma, myeloma & non-acute leukemia

Facility

$76,208.69

Service Code	APR-DRG 6913
Min. Negotiated Rate	$26,441.00
Max. Negotiated Rate	$76,208.69
Rate for Payer: Affinity Essential Plan 1&2	$76,208.69
Rate for Payer: Affinity Essential Plan 3&4	$76,208.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,870.53
Rate for Payer: Amida Care Medicaid	$33,870.53
Rate for Payer: EmblemHealth Essential Plan 1&2	$76,208.69
Rate for Payer: EmblemHealth Essential Plan 3&4	$33,870.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,870.53
Rate for Payer: Fidelis Qualified Health Plan	$40,644.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,870.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,870.53
Rate for Payer: Healthfirst Commercial	$44,809.00
Rate for Payer: Healthfirst Essential Plan	$76,208.69
Rate for Payer: Healthfirst QHP	$26,441.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,870.53
Rate for Payer: SOMOS Essential	$76,208.69
Rate for Payer: United Healthcare Essential Plan 1&2	$76,208.69
Rate for Payer: United Healthcare Essential Plan 3&4	$76,208.69
Rate for Payer: United Healthcare Medicaid	$33,870.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,870.53

Lymphoma, myeloma & non-acute leukemia

Facility

$143,394.55

Service Code	APR-DRG 6914
Min. Negotiated Rate	$57,238.00
Max. Negotiated Rate	$143,394.55
Rate for Payer: Affinity Essential Plan 1&2	$143,394.55
Rate for Payer: Affinity Essential Plan 3&4	$143,394.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$63,730.91
Rate for Payer: Amida Care Medicaid	$63,730.91
Rate for Payer: EmblemHealth Essential Plan 1&2	$143,394.55
Rate for Payer: EmblemHealth Essential Plan 3&4	$63,730.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$63,730.91
Rate for Payer: Fidelis Qualified Health Plan	$76,477.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$63,730.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$63,730.91
Rate for Payer: Healthfirst Commercial	$105,299.00
Rate for Payer: Healthfirst Essential Plan	$143,394.55
Rate for Payer: Healthfirst QHP	$57,238.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63,730.91
Rate for Payer: SOMOS Essential	$143,394.55
Rate for Payer: United Healthcare Essential Plan 1&2	$143,394.55
Rate for Payer: United Healthcare Essential Plan 3&4	$143,394.55
Rate for Payer: United Healthcare Medicaid	$63,730.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63,730.91

Lymphoma, myeloma & non-acute leukemia

Facility

$50,003.37

Service Code	APR-DRG 6911
Min. Negotiated Rate	$10,891.00
Max. Negotiated Rate	$50,003.37
Rate for Payer: Affinity Essential Plan 1&2	$50,003.37
Rate for Payer: Affinity Essential Plan 3&4	$50,003.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,223.72
Rate for Payer: Amida Care Medicaid	$22,223.72
Rate for Payer: EmblemHealth Essential Plan 1&2	$50,003.37
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,223.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,223.72
Rate for Payer: Fidelis Qualified Health Plan	$26,668.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,223.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,223.72
Rate for Payer: Healthfirst Commercial	$18,425.00
Rate for Payer: Healthfirst Essential Plan	$50,003.37
Rate for Payer: Healthfirst QHP	$10,891.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,223.72
Rate for Payer: SOMOS Essential	$50,003.37
Rate for Payer: United Healthcare Essential Plan 1&2	$50,003.37
Rate for Payer: United Healthcare Essential Plan 3&4	$50,003.37
Rate for Payer: United Healthcare Medicaid	$22,223.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,223.72

MACROSCOPIC EXAMINATION; ARTHROPOD (NOT BY MICROSCOPE)

Facility

$14.00

Service Code	CPT 87168
Hospital Charge Code	3008716801
Hospital Revenue Code	300
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$10.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.27
Rate for Payer: Aetna Government	$4.27
Rate for Payer: Affinity Essential Plan 1&2	$2.99
Rate for Payer: Affinity Essential Plan 3&4	$2.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.99
Rate for Payer: Brighton Health Commercial	$10.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.11
Rate for Payer: Elderplan Medicare Advantage	$4.27
Rate for Payer: EmblemHealth Commercial	$4.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.84
Rate for Payer: Fidelis Essential Plan Aliesa	$3.63
Rate for Payer: Fidelis Essential Plan QHP	$3.80
Rate for Payer: Fidelis Medicare Advantage	$4.27
Rate for Payer: Fidelis Qualified Health Plan	$3.80
Rate for Payer: Group Health Inc Commercial	$4.27
Rate for Payer: Group Health Inc Medicare	$4.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.27
Rate for Payer: Hamaspik Choice Inc Medicare	$4.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.27
Rate for Payer: Healthfirst Medicare Advantage	$4.27
Rate for Payer: Healthfirst QHP	$4.27
Rate for Payer: Humana Medicare	$4.36
Rate for Payer: Senior Whole Health Medicare Advantage	$4.27
Rate for Payer: United Healthcare Commercial	$5.41
Rate for Payer: United Healthcare Medicare Advantage	$4.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.06
Rate for Payer: Wellcare Medicare	$3.84

MACROSCOPIC EXAMINATION; ARTHROPOD (NOT BY MICROSCOPE)

Facility

$14.00

Service Code	CPT 87168
Hospital Charge Code	3008716801
Hospital Revenue Code	300
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00

MAGIC MOUTHWASH - COMPOUNDED (LIDO/BENADRYL/MAALOX)

Facility

$0.19

Service Code	NDC 9999123466
Hospital Charge Code	9999123466
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

MAGIC MOUTHWASH - COMPOUNDED (LIDO/BENADRYL/MAALOX)

Facility

$0.19

Service Code	NDC 9999123466
Hospital Charge Code	9999123466
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
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	$0.12

MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN

Facility

$0.01

Service Code	NDC 0904678744
Hospital Charge Code	0904678744
Hospital Revenue Code	250
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN

Facility

$0.01

Service Code	NDC 0904678744
Hospital Charge Code	0904678744
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

MAGNESIUM HYDROXIDE 2400 MG/10ML PO SUSP

Facility

$0.35

Service Code	NDC 0121094010
Hospital Charge Code	0121094010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

MAGNESIUM HYDROXIDE 2400 MG/10ML PO SUSP

Facility

$0.35

Service Code	NDC 0121094010
Hospital Charge Code	0121094010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

MAGNESIUM HYDROXIDE 2400 MG/10ML PO SUSP

Facility

$0.35

Service Code	NDC 0121094000
Hospital Charge Code	0121094000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

MAGNESIUM HYDROXIDE 2400 MG/10ML PO SUSP

Facility

$0.35

Service Code	NDC 0121094000
Hospital Charge Code	0121094000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP

Facility

$0.08

Service Code	NDC 0121043130
Hospital Charge Code	0121043130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP

Facility

$0.08

Service Code	NDC 0121043130
Hospital Charge Code	0121043130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP

Facility

$0.09

Service Code	NDC 6933915317
Hospital Charge Code	6933915317
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP

Facility

$0.09

Service Code	NDC 6933915317
Hospital Charge Code	6933915317
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

MAGNESIUM OXIDE -MG SUPPLEMENT 400 (240 MG) MG PO TABS

Facility

$0.06

Service Code	NDC 1000673038
Hospital Charge Code	1000673038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

MAGNESIUM OXIDE -MG SUPPLEMENT 400 (240 MG) MG PO TABS

Facility

$0.09

Service Code	NDC 6498033912
Hospital Charge Code	6498033912
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

MAGNESIUM OXIDE -MG SUPPLEMENT 400 (240 MG) MG PO TABS

Facility

$0.09

Service Code	NDC 6498033912
Hospital Charge Code	6498033912
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

MAGNESIUM OXIDE -MG SUPPLEMENT 400 (240 MG) MG PO TABS

Facility

$0.09

Service Code	NDC 6954321712
Hospital Charge Code	6954321712
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

MAGNESIUM OXIDE -MG SUPPLEMENT 400 (240 MG) MG PO TABS

Facility

$0.09

Service Code	NDC 1000670028
Hospital Charge Code	1000670028
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

MAGNESIUM OXIDE -MG SUPPLEMENT 400 (240 MG) MG PO TABS

Facility

$0.09

Service Code	NDC 6954321712
Hospital Charge Code	6954321712
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

MAGNESIUM OXIDE -MG SUPPLEMENT 400 (240 MG) MG PO TABS

Facility

$0.09

Service Code	NDC 1000670028
Hospital Charge Code	1000670028
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

Know your out-of-pocket cost for care.

All Charges