St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GENTAMICIN 0.3% OPHTHALMIC SOLN

Facility

$3.00

Hospital Charge Code	41643234
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

GENTAMICIN 100 MG/100 ML PREMIX

Facility

$2.31

Service Code	HCPCS J1580
Hospital Charge Code	41653077
Hospital Revenue Code	636
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1.16

GENTAMICIN 100 MG/100 ML PREMIX

Facility

$2.31

Service Code	HCPCS J1580
Hospital Charge Code	41643077
Hospital Revenue Code	636
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1.16

GENTAMICIN 100 MG/100 ML PREMIX

Facility

$2.31

Service Code	HCPCS J1580
Hospital Charge Code	41643077
Hospital Revenue Code	636
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$1.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.33
Rate for Payer: Group Health Inc Commercial	$1.16
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.90
Rate for Payer: SOMOS Essential	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.50

GENTAMICIN 100 MG/100 ML PREMIX

Facility

$2.31

Service Code	HCPCS J1580
Hospital Charge Code	41653077
Hospital Revenue Code	636
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$1.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.33
Rate for Payer: Group Health Inc Commercial	$1.16
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.90
Rate for Payer: SOMOS Essential	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.50

GENTAMICIN 10 MG/ML INJ PEDIATRIC

Facility

$12.81

Service Code	HCPCS J1580
Hospital Charge Code	41644874
Hospital Revenue Code	636
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$6.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.40
Rate for Payer: Hamaspik Choice Inc Medicare	$6.40

GENTAMICIN 10 MG/ML INJ PEDIATRIC

Facility

$12.81

Service Code	HCPCS J1580
Hospital Charge Code	41644874
Hospital Revenue Code	636
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$8.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$7.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.37
Rate for Payer: Group Health Inc Commercial	$6.40
Rate for Payer: Group Health Inc Medicare	$4.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.40
Rate for Payer: Hamaspik Choice Inc Medicare	$6.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.90
Rate for Payer: SOMOS Essential	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.33

GENTAMICIN 10 MG/ML INJ PEDIATRIC

Facility

$12.81

Service Code	HCPCS J1580
Hospital Charge Code	41654874
Hospital Revenue Code	636
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$8.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$7.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.37
Rate for Payer: Group Health Inc Commercial	$6.40
Rate for Payer: Group Health Inc Medicare	$4.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.40
Rate for Payer: Hamaspik Choice Inc Medicare	$6.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.90
Rate for Payer: SOMOS Essential	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.33

GENTAMICIN 10 MG/ML INJ PEDIATRIC

Facility

$12.81

Service Code	HCPCS J1580
Hospital Charge Code	41654874
Hospital Revenue Code	636
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$6.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.40
Rate for Payer: Hamaspik Choice Inc Medicare	$6.40

GENTAMICIN 120 MG/100 ML PREMIX

Facility

$2.01

Service Code	HCPCS J1580
Hospital Charge Code	41653078
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$1.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.16
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.90
Rate for Payer: SOMOS Essential	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.31

GENTAMICIN 120 MG/100 ML PREMIX

Facility

$2.01

Service Code	HCPCS J1580
Hospital Charge Code	41653078
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

GENTAMICIN 120 MG/100 ML PREMIX

Facility

$2.01

Service Code	HCPCS J1580
Hospital Charge Code	41643078
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$1.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.16
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.90
Rate for Payer: SOMOS Essential	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.31

GENTAMICIN 120 MG/100 ML PREMIX

Facility

$2.01

Service Code	HCPCS J1580
Hospital Charge Code	41643078
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

GENTAMICIN 40 MG/50 ML PREMIX

Facility

$6.00

Service Code	HCPCS J1580
Hospital Charge Code	41643083
Hospital Revenue Code	636
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$3.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.45
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.90
Rate for Payer: SOMOS Essential	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

GENTAMICIN 40 MG/50 ML PREMIX

Facility

$6.00

Service Code	HCPCS J1580
Hospital Charge Code	41653083
Hospital Revenue Code	636
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$3.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.45
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.90
Rate for Payer: SOMOS Essential	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

GENTAMICIN 40 MG/50 ML PREMIX

Facility

$6.00

Service Code	HCPCS J1580
Hospital Charge Code	41643083
Hospital Revenue Code	636
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00

GENTAMICIN 40 MG/50 ML PREMIX

Facility

$6.00

Service Code	HCPCS J1580
Hospital Charge Code	41653083
Hospital Revenue Code	636
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00

GENTAMICIN 40MG/ML, 20ML MDV

Facility

$4.48

Service Code	HCPCS J1580
Hospital Charge Code	41656649
Hospital Revenue Code	636
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$2.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$2.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.58
Rate for Payer: Group Health Inc Commercial	$2.24
Rate for Payer: Group Health Inc Medicare	$1.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.24
Rate for Payer: Hamaspik Choice Inc Medicare	$2.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.90
Rate for Payer: SOMOS Essential	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.91

GENTAMICIN 40MG/ML, 20ML MDV

Facility

$4.48

Service Code	HCPCS J1580
Hospital Charge Code	41646649
Hospital Revenue Code	636
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.24
Rate for Payer: Hamaspik Choice Inc Medicare	$2.24

GENTAMICIN 40MG/ML, 20ML MDV

Facility

$4.48

Service Code	HCPCS J1580
Hospital Charge Code	41656649
Hospital Revenue Code	636
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.24
Rate for Payer: Hamaspik Choice Inc Medicare	$2.24

GENTAMICIN 40MG/ML, 20ML MDV

Facility

$4.48

Service Code	HCPCS J1580
Hospital Charge Code	41646649
Hospital Revenue Code	636
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$2.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$2.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.58
Rate for Payer: Group Health Inc Commercial	$2.24
Rate for Payer: Group Health Inc Medicare	$1.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.24
Rate for Payer: Hamaspik Choice Inc Medicare	$2.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.90
Rate for Payer: SOMOS Essential	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.91

GENTAMICIN 40 MG/ML INJ 2 ML

Facility

$1.37

Service Code	HCPCS J1580
Hospital Charge Code	41654245
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.79
Rate for Payer: Group Health Inc Commercial	$0.69
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69
Rate for Payer: Hamaspik Choice Inc Medicare	$0.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.90
Rate for Payer: SOMOS Essential	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

GENTAMICIN 40 MG/ML INJ 2 ML

Facility

$1.37

Service Code	HCPCS J1580
Hospital Charge Code	41644245
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.79
Rate for Payer: Group Health Inc Commercial	$0.69
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69
Rate for Payer: Hamaspik Choice Inc Medicare	$0.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.90
Rate for Payer: SOMOS Essential	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

GENTAMICIN 40 MG/ML INJ 2 ML

Facility

$1.37

Service Code	HCPCS J1580
Hospital Charge Code	41644245
Hospital Revenue Code	636
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69
Rate for Payer: Hamaspik Choice Inc Medicare	$0.69

GENTAMICIN 40 MG/ML INJ 2 ML

Facility

$1.37

Service Code	HCPCS J1580
Hospital Charge Code	41654245
Hospital Revenue Code	636
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69
Rate for Payer: Hamaspik Choice Inc Medicare	$0.69

Know your out-of-pocket cost for care.

All Charges