St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Mastectomy procedures

Facility

$83,085.39

Service Code	APR-DRG 3624
Min. Negotiated Rate	$26,089.00
Max. Negotiated Rate	$83,085.39
Rate for Payer: Affinity Essential Plan 1&2	$83,085.39
Rate for Payer: Affinity Essential Plan 3&4	$83,085.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$36,926.84
Rate for Payer: Amida Care Medicaid	$36,926.84
Rate for Payer: EmblemHealth Essential Plan 1&2	$83,085.39
Rate for Payer: EmblemHealth Essential Plan 3&4	$36,926.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,926.84
Rate for Payer: Fidelis Qualified Health Plan	$44,312.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,926.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,926.84
Rate for Payer: Healthfirst Commercial	$39,995.00
Rate for Payer: Healthfirst Essential Plan	$83,085.39
Rate for Payer: Healthfirst QHP	$26,089.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,926.84
Rate for Payer: SOMOS Essential	$83,085.39
Rate for Payer: United Healthcare Essential Plan 1&2	$83,085.39
Rate for Payer: United Healthcare Essential Plan 3&4	$83,085.39
Rate for Payer: United Healthcare Medicaid	$36,926.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,926.84

Mastectomy procedures

Facility

$63,767.32

Service Code	APR-DRG 3622
Min. Negotiated Rate	$16,753.00
Max. Negotiated Rate	$63,767.32
Rate for Payer: Affinity Essential Plan 1&2	$63,767.32
Rate for Payer: Affinity Essential Plan 3&4	$63,767.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,341.03
Rate for Payer: Amida Care Medicaid	$28,341.03
Rate for Payer: EmblemHealth Essential Plan 1&2	$63,767.32
Rate for Payer: EmblemHealth Essential Plan 3&4	$28,341.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,341.03
Rate for Payer: Fidelis Qualified Health Plan	$34,009.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,341.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,341.03
Rate for Payer: Healthfirst Commercial	$28,536.00
Rate for Payer: Healthfirst Essential Plan	$63,767.32
Rate for Payer: Healthfirst QHP	$16,753.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,341.03
Rate for Payer: SOMOS Essential	$63,767.32
Rate for Payer: United Healthcare Essential Plan 1&2	$63,767.32
Rate for Payer: United Healthcare Essential Plan 3&4	$63,767.32
Rate for Payer: United Healthcare Medicaid	$28,341.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,341.03

MEASLES, MUMPS & RUBELLA VAC IJ SOLR

Facility

$110.54

Service Code	HCPCS 90710
Hospital Charge Code	0006468101
Hospital Revenue Code	250
Min. Negotiated Rate	$38.69
Max. Negotiated Rate	$254.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$254.51
Rate for Payer: Aetna Government	$254.51
Rate for Payer: Brighton Health Commercial	$82.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$88.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$75.17
Rate for Payer: EmblemHealth Commercial	$55.27
Rate for Payer: Group Health Inc Commercial	$55.27
Rate for Payer: Group Health Inc Medicare	$38.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.27
Rate for Payer: Hamaspik Choice Inc Medicare	$55.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$71.85

MEASLES, MUMPS & RUBELLA VAC IJ SOLR

Facility

$110.54

Service Code	HCPCS 90710
Hospital Charge Code	0006468101
Hospital Revenue Code	250
Min. Negotiated Rate	$55.27
Max. Negotiated Rate	$55.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.27

MEASLES, MUMPS & RUBELLA VAC IJ SOLR

Facility

$110.54

Service Code	HCPCS 90710
Hospital Charge Code	0006468100
Hospital Revenue Code	250
Min. Negotiated Rate	$38.69
Max. Negotiated Rate	$254.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$254.51
Rate for Payer: Aetna Government	$254.51
Rate for Payer: Brighton Health Commercial	$82.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$88.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$75.17
Rate for Payer: EmblemHealth Commercial	$55.27
Rate for Payer: Group Health Inc Commercial	$55.27
Rate for Payer: Group Health Inc Medicare	$38.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.27
Rate for Payer: Hamaspik Choice Inc Medicare	$55.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$71.85

MEASLES, MUMPS & RUBELLA VAC IJ SOLR

Facility

$110.54

Service Code	HCPCS 90710
Hospital Charge Code	0006468100
Hospital Revenue Code	250
Min. Negotiated Rate	$55.27
Max. Negotiated Rate	$55.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.27

MEASLES-MUMPS-RUBELLA-VARICELL SC SUSR

Facility

$323.58

Service Code	NDC 0006417100
Hospital Charge Code	0006417100
Hospital Revenue Code	250
Min. Negotiated Rate	$161.79
Max. Negotiated Rate	$161.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.79

MEASLES-MUMPS-RUBELLA-VARICELL SC SUSR

Facility

$323.58

Service Code	NDC 0006417100
Hospital Charge Code	0006417100
Hospital Revenue Code	250
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$258.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$177.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$161.79
Rate for Payer: Aetna Government	$161.79
Rate for Payer: Brighton Health Commercial	$242.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$258.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$220.03
Rate for Payer: EmblemHealth Commercial	$161.79
Rate for Payer: Group Health Inc Commercial	$161.79
Rate for Payer: Group Health Inc Medicare	$113.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.79
Rate for Payer: Hamaspik Choice Inc Medicare	$161.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$210.33

MECLIZINE HCL 12.5 MG PO TABS

Facility

$0.53

Service Code	NDC 0904737561
Hospital Charge Code	0904737561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
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	$0.26
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

MECLIZINE HCL 12.5 MG PO TABS

Facility

$0.53

Service Code	NDC 0904737561
Hospital Charge Code	0904737561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26

MECLIZINE HCL 12.5 MG PO TABS

Facility

$0.33

Service Code	NDC 6516244110
Hospital Charge Code	6516244110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16

MECLIZINE HCL 12.5 MG PO TABS

Facility

$0.33

Service Code	NDC 6516244110
Hospital Charge Code	6516244110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.22
Rate for Payer: EmblemHealth Commercial	$0.16
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.21

MECLIZINE HCL 25 MG PO TABS

Facility

$0.86

Service Code	NDC 6068773011
Hospital Charge Code	6068773011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.43

MECLIZINE HCL 25 MG PO TABS

Facility

$0.84

Service Code	NDC 5026852311
Hospital Charge Code	5026852311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

MECLIZINE HCL 25 MG PO TABS

Facility

$0.40

Service Code	NDC 6516244210
Hospital Charge Code	6516244210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

MECLIZINE HCL 25 MG PO TABS

Facility

$0.40

Service Code	NDC 6516244210
Hospital Charge Code	6516244210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

MECLIZINE HCL 25 MG PO TABS

Facility

$0.56

Service Code	NDC 0904737661
Hospital Charge Code	0904737661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: EmblemHealth Commercial	$0.28
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.36

MECLIZINE HCL 25 MG PO TABS

Facility

$0.56

Service Code	NDC 0904737661
Hospital Charge Code	0904737661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28

MECLIZINE HCL 25 MG PO TABS

Facility

$0.84

Service Code	NDC 6068773065
Hospital Charge Code	6068773065
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

MECLIZINE HCL 25 MG PO TABS

Facility

$0.84

Service Code	NDC 5026852311
Hospital Charge Code	5026852311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

MECLIZINE HCL 25 MG PO TABS

Facility

$0.86

Service Code	NDC 6068773011
Hospital Charge Code	6068773011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.43
Rate for Payer: Aetna Government	$0.43
Rate for Payer: Brighton Health Commercial	$0.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: EmblemHealth Commercial	$0.43
Rate for Payer: Group Health Inc Commercial	$0.43
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.43
Rate for Payer: Hamaspik Choice Inc Medicare	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.56

MECLIZINE HCL 25 MG PO TABS

Facility

$0.40

Service Code	NDC 7071011621
Hospital Charge Code	7071011621
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

MECLIZINE HCL 25 MG PO TABS

Facility

$0.84

Service Code	NDC 5026852315
Hospital Charge Code	5026852315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

MECLIZINE HCL 25 MG PO TABS

Facility

$0.84

Service Code	NDC 5026852315
Hospital Charge Code	5026852315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

MECLIZINE HCL 25 MG PO TABS

Facility

$0.84

Service Code	NDC 6068773065
Hospital Charge Code	6068773065
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

Know your out-of-pocket cost for care.

All Charges