St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GENTAMICIN 60 MG/100 ML PREMIX

Facility

$4.00

Service Code	HCPCS J1580
Hospital Charge Code	41653095
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$2.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
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	$2.60

GENTAMICIN 60 MG/100 ML PREMIX

Facility

$4.00

Service Code	HCPCS J1580
Hospital Charge Code	41653095
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00

GENTAMICIN 60 MG/100 ML PREMIX

Facility

$4.00

Service Code	HCPCS J1580
Hospital Charge Code	41643095
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$2.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
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	$2.60

GENTAMICIN 60 MG/100 ML PREMIX

Facility

$4.00

Service Code	HCPCS J1580
Hospital Charge Code	41643095
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00

GENTAMICIN 60 MG/50 ML PREMIX

Facility

$3.02

Service Code	HCPCS J1580
Hospital Charge Code	41650062
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$1.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.74
Rate for Payer: Group Health Inc Commercial	$1.51
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51
Rate for Payer: Hamaspik Choice Inc Medicare	$1.51
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	$1.96

GENTAMICIN 60 MG/50 ML PREMIX

Facility

$3.02

Service Code	HCPCS J1580
Hospital Charge Code	41640062
Hospital Revenue Code	636
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51
Rate for Payer: Hamaspik Choice Inc Medicare	$1.51

GENTAMICIN 60 MG/50 ML PREMIX

Facility

$3.02

Service Code	HCPCS J1580
Hospital Charge Code	41650062
Hospital Revenue Code	636
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51
Rate for Payer: Hamaspik Choice Inc Medicare	$1.51

GENTAMICIN 60 MG/50 ML PREMIX

Facility

$3.02

Service Code	HCPCS J1580
Hospital Charge Code	41640062
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$1.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.74
Rate for Payer: Group Health Inc Commercial	$1.51
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51
Rate for Payer: Hamaspik Choice Inc Medicare	$1.51
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	$1.96

GENTAMICIN 80 MG/100 ML PREMIX

Facility

$2.90

Service Code	HCPCS J1580
Hospital Charge Code	41653080
Hospital Revenue Code	636
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$1.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.67
Rate for Payer: Group Health Inc Commercial	$1.45
Rate for Payer: Group Health Inc Medicare	$1.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1.45
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	$1.88

GENTAMICIN 80 MG/100 ML PREMIX

Facility

$2.90

Service Code	HCPCS J1580
Hospital Charge Code	41653080
Hospital Revenue Code	636
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1.45

GENTAMICIN 80 MG/100 ML PREMIX

Facility

$2.90

Service Code	HCPCS J1580
Hospital Charge Code	41643080
Hospital Revenue Code	636
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$1.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.67
Rate for Payer: Group Health Inc Commercial	$1.45
Rate for Payer: Group Health Inc Medicare	$1.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1.45
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	$1.88

GENTAMICIN 80 MG/100 ML PREMIX

Facility

$2.90

Service Code	HCPCS J1580
Hospital Charge Code	41643080
Hospital Revenue Code	636
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1.45

GENTAMICIN IN SALINE 0.8-0.9 MG/ML-% IV SOLN [15906]

Facility

$0.05

Service Code	HCPCS J1580
Hospital Charge Code	00338050348
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02

GENTAMICIN IN SALINE 0.8-0.9 MG/ML-% IV SOLN [15906]

Facility

$0.05

Service Code	HCPCS J1580
Hospital Charge Code	00338050348
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$1.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.05
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

GENTAMICIN IN SALINE 1-0.9 MG/ML-% IV SOLN [15908]

Facility

$0.05

Service Code	HCPCS J1580
Hospital Charge Code	00338050548
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03

GENTAMICIN IN SALINE 1-0.9 MG/ML-% IV SOLN [15908]

Facility

$0.05

Service Code	HCPCS J1580
Hospital Charge Code	00338050548
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$1.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Fidelis Medicare Advantage	$0.05
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	$0.03

GENTAMICIN IN SALINE 1.2-0.9 MG/ML-% IV SOLN [15909]

Facility

$0.09

Service Code	HCPCS J1580
Hospital Charge Code	00338050741
Hospital Revenue Code	278
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05

GENTAMICIN IN SALINE 1.2-0.9 MG/ML-% IV SOLN [15909]

Facility

$0.09

Service Code	HCPCS J1580
Hospital Charge Code	00338050741
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$1.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Fidelis Medicare Advantage	$0.10
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

GENTAMICIN IN SALINE 1.2-0.9 MG/ML-% IV SOLN [15909]

Facility

$0.05

Service Code	HCPCS J1580
Hospital Charge Code	00338050748
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03

GENTAMICIN IN SALINE 1.2-0.9 MG/ML-% IV SOLN [15909]

Facility

$0.05

Service Code	HCPCS J1580
Hospital Charge Code	00338050748
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$1.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Fidelis Medicare Advantage	$0.05
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	$0.03

GENTAMICIN PEAK.

Facility

$40.95

Service Code	HCPCS 80170
Hospital Charge Code	40602575
Hospital Revenue Code	301
Rate for Payer: Cash Price	$16.38

GENTAMICIN PEAK.

Facility

$40.95

Service Code	HCPCS 80170
Hospital Charge Code	40602575
Hospital Revenue Code	301
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$30.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.38
Rate for Payer: Aetna Government	$16.38
Rate for Payer: Affinity Essential Plan 1&2	$11.47
Rate for Payer: Affinity Essential Plan 3&4	$11.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.47
Rate for Payer: Brighton Health Commercial	$30.71
Rate for Payer: Cash Price	$16.38
Rate for Payer: Cash Price	$16.38
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.06
Rate for Payer: Elderplan Medicare Advantage	$16.38
Rate for Payer: EmblemHealth Commercial	$16.38
Rate for Payer: Fidelis Essential Plan Aliesa	$13.92
Rate for Payer: Fidelis Essential Plan QHP	$14.58
Rate for Payer: Fidelis Medicare Advantage	$16.38
Rate for Payer: Fidelis Qualified Health Plan	$14.58
Rate for Payer: Group Health Inc Commercial	$16.38
Rate for Payer: Group Health Inc Medicare	$16.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.48
Rate for Payer: Hamaspik Choice Inc Medicare	$16.38
Rate for Payer: Healthfirst Medicare Advantage	$16.38
Rate for Payer: Healthfirst QHP	$16.38
Rate for Payer: Humana Medicare	$16.71
Rate for Payer: Senior Whole Health Medicare Advantage	$16.38
Rate for Payer: United Healthcare Commercial	$20.76
Rate for Payer: United Healthcare Medicare Advantage	$16.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.10
Rate for Payer: Wellcare Medicare	$14.74

GENTAMICIN SULFATE 0.3 % OP SOLN [3428]

Facility

$4.34

Service Code	NDC 61314063305
Hospital Charge Code	61314063305
Hospital Revenue Code	250
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$3.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.17
Rate for Payer: Aetna Government	$2.17
Rate for Payer: Brighton Health Commercial	$3.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.95
Rate for Payer: Group Health Inc Commercial	$2.17
Rate for Payer: Group Health Inc Medicare	$1.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.17
Rate for Payer: Hamaspik Choice Inc Medicare	$2.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.82

GENTAMICIN SULFATE 0.3 % OP SOLN [3428]

Facility

$3.84

Service Code	NDC 60758018805
Hospital Charge Code	60758018805
Hospital Revenue Code	250
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$3.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.92
Rate for Payer: Aetna Government	$1.92
Rate for Payer: Brighton Health Commercial	$2.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.61
Rate for Payer: Group Health Inc Commercial	$1.92
Rate for Payer: Group Health Inc Medicare	$1.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.92
Rate for Payer: Hamaspik Choice Inc Medicare	$1.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.49

GENTAMICIN SULFATE 10 MG/ML IJ SOLN [3425]

Facility

$3.25

Service Code	HCPCS J1580
Hospital Charge Code	63323017302
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$2.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.21
Rate for Payer: Group Health Inc Commercial	$1.62
Rate for Payer: Group Health Inc Medicare	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1.62
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2.73
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$2.90
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$2.90
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$2.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.11

Know your out-of-pocket cost for care.

All Charges