St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Musculoskeletal malignancy & pathol fracture d/t muscskel malig

Facility

$69,769.91

Service Code	APR-DRG 3433
Min. Negotiated Rate	$18,591.00
Max. Negotiated Rate	$69,769.91
Rate for Payer: Affinity Essential Plan 1&2	$69,769.91
Rate for Payer: Affinity Essential Plan 3&4	$69,769.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,008.85
Rate for Payer: Amida Care Medicaid	$31,008.85
Rate for Payer: EmblemHealth Essential Plan 1&2	$69,769.91
Rate for Payer: EmblemHealth Essential Plan 3&4	$31,008.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,008.85
Rate for Payer: Fidelis Qualified Health Plan	$37,210.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,008.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,008.85
Rate for Payer: Healthfirst Commercial	$31,629.00
Rate for Payer: Healthfirst Essential Plan	$69,769.91
Rate for Payer: Healthfirst QHP	$18,591.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,008.85
Rate for Payer: SOMOS Essential	$69,769.91
Rate for Payer: United Healthcare Essential Plan 1&2	$69,769.91
Rate for Payer: United Healthcare Essential Plan 3&4	$69,769.91
Rate for Payer: United Healthcare Medicaid	$31,008.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,008.85

Musculoskeletal & other procedures for multiple significant trauma

Facility

$165,269.83

Service Code	APR-DRG 9124
Min. Negotiated Rate	$73,453.26
Max. Negotiated Rate	$165,269.83
Rate for Payer: Affinity Essential Plan 1&2	$165,269.83
Rate for Payer: Affinity Essential Plan 3&4	$165,269.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$73,453.26
Rate for Payer: Amida Care Medicaid	$73,453.26
Rate for Payer: EmblemHealth Essential Plan 1&2	$165,269.83
Rate for Payer: EmblemHealth Essential Plan 3&4	$73,453.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$73,453.26
Rate for Payer: Fidelis Qualified Health Plan	$88,143.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$73,453.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$73,453.26
Rate for Payer: Healthfirst Commercial	$127,779.00
Rate for Payer: Healthfirst Essential Plan	$165,269.83
Rate for Payer: Healthfirst QHP	$84,831.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$73,453.26
Rate for Payer: SOMOS Essential	$165,269.83
Rate for Payer: United Healthcare Essential Plan 1&2	$165,269.83
Rate for Payer: United Healthcare Essential Plan 3&4	$165,269.83
Rate for Payer: United Healthcare Medicaid	$73,453.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$73,453.26

Musculoskeletal & other procedures for multiple significant trauma

Facility

$73,593.43

Service Code	APR-DRG 9121
Min. Negotiated Rate	$28,028.00
Max. Negotiated Rate	$73,593.43
Rate for Payer: Affinity Essential Plan 1&2	$73,593.43
Rate for Payer: Affinity Essential Plan 3&4	$73,593.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,708.19
Rate for Payer: Amida Care Medicaid	$32,708.19
Rate for Payer: EmblemHealth Essential Plan 1&2	$73,593.43
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,708.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,708.19
Rate for Payer: Fidelis Qualified Health Plan	$39,249.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,708.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,708.19
Rate for Payer: Healthfirst Commercial	$45,055.00
Rate for Payer: Healthfirst Essential Plan	$73,593.43
Rate for Payer: Healthfirst QHP	$28,028.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,708.19
Rate for Payer: SOMOS Essential	$73,593.43
Rate for Payer: United Healthcare Essential Plan 1&2	$73,593.43
Rate for Payer: United Healthcare Essential Plan 3&4	$73,593.43
Rate for Payer: United Healthcare Medicaid	$32,708.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,708.19

Musculoskeletal & other procedures for multiple significant trauma

Facility

$101,232.13

Service Code	APR-DRG 9123
Min. Negotiated Rate	$44,992.06
Max. Negotiated Rate	$101,232.13
Rate for Payer: Affinity Essential Plan 1&2	$101,232.13
Rate for Payer: Affinity Essential Plan 3&4	$101,232.13
Rate for Payer: Affinity Medicaid/CHP/HARP	$44,992.06
Rate for Payer: Amida Care Medicaid	$44,992.06
Rate for Payer: EmblemHealth Essential Plan 1&2	$101,232.13
Rate for Payer: EmblemHealth Essential Plan 3&4	$44,992.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$44,992.06
Rate for Payer: Fidelis Qualified Health Plan	$53,990.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$44,992.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44,992.06
Rate for Payer: Healthfirst Commercial	$71,751.00
Rate for Payer: Healthfirst Essential Plan	$101,232.13
Rate for Payer: Healthfirst QHP	$46,869.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44,992.06
Rate for Payer: SOMOS Essential	$101,232.13
Rate for Payer: United Healthcare Essential Plan 1&2	$101,232.13
Rate for Payer: United Healthcare Essential Plan 3&4	$101,232.13
Rate for Payer: United Healthcare Medicaid	$44,992.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44,992.06

Musculoskeletal & other procedures for multiple significant trauma

Facility

$73,625.09

Service Code	APR-DRG 9122
Min. Negotiated Rate	$28,073.00
Max. Negotiated Rate	$73,625.09
Rate for Payer: Affinity Essential Plan 1&2	$73,625.09
Rate for Payer: Affinity Essential Plan 3&4	$73,625.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,722.26
Rate for Payer: Amida Care Medicaid	$32,722.26
Rate for Payer: EmblemHealth Essential Plan 1&2	$73,625.09
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,722.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,722.26
Rate for Payer: Fidelis Qualified Health Plan	$39,266.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,722.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,722.26
Rate for Payer: Healthfirst Commercial	$45,055.00
Rate for Payer: Healthfirst Essential Plan	$73,625.09
Rate for Payer: Healthfirst QHP	$28,073.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,722.26
Rate for Payer: SOMOS Essential	$73,625.09
Rate for Payer: United Healthcare Essential Plan 1&2	$73,625.09
Rate for Payer: United Healthcare Essential Plan 3&4	$73,625.09
Rate for Payer: United Healthcare Medicaid	$32,722.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,722.26

MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR

Facility

$9.06

Service Code	HCPCS J7517
Hospital Charge Code	0527516082
Hospital Revenue Code	250
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$4.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.53

MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR

Facility

$9.06

Service Code	HCPCS J7517
Hospital Charge Code	0527516082
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$7.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$6.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.16
Rate for Payer: EmblemHealth Commercial	$4.53
Rate for Payer: Group Health Inc Commercial	$4.53
Rate for Payer: Group Health Inc Medicare	$3.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.53
Rate for Payer: Hamaspik Choice Inc Medicare	$4.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.89

MYCOPHENOLATE MOFETIL 250 MG PO CAPS

Facility

$0.78

Service Code	HCPCS J7517
Hospital Charge Code	6068788511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39

MYCOPHENOLATE MOFETIL 250 MG PO CAPS

Facility

$0.78

Service Code	HCPCS J7517
Hospital Charge Code	6068788511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: EmblemHealth Commercial	$0.39
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.51

MYCOPHENOLATE MOFETIL 250 MG PO CAPS

Facility

$3.99

Service Code	HCPCS J7517
Hospital Charge Code	6787726601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00

MYCOPHENOLATE MOFETIL 250 MG PO CAPS

Facility

$3.99

Service Code	HCPCS J7517
Hospital Charge Code	6787726601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: EmblemHealth Commercial	$2.00
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: Healthfirst CHP/FHP/Medicaid	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

MYELOGRAPHY AND DISCOGRAPHY IMAGING PROCEDURES

Facility

$1,036.94

Service Code	EAPG 00284
Min. Negotiated Rate	$752.15
Max. Negotiated Rate	$1,036.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$752.15
Rate for Payer: Healthfirst Commercial	$1,036.94

NAFCILLIN SODIUM 1 G IJ SOLR

Facility

$13.70

Service Code	NDC 6785003110
Hospital Charge Code	6785003110
Hospital Revenue Code	250
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$10.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.85
Rate for Payer: Aetna Government	$6.85
Rate for Payer: Brighton Health Commercial	$10.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.32
Rate for Payer: EmblemHealth Commercial	$6.85
Rate for Payer: Group Health Inc Commercial	$6.85
Rate for Payer: Group Health Inc Medicare	$4.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.85
Rate for Payer: Hamaspik Choice Inc Medicare	$6.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.90

NAFCILLIN SODIUM 1 G IJ SOLR

Facility

$13.70

Service Code	NDC 6785003100
Hospital Charge Code	6785003100
Hospital Revenue Code	250
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$6.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.85

NAFCILLIN SODIUM 1 G IJ SOLR

Facility

$17.87

Service Code	NDC 6332332710
Hospital Charge Code	6332332710
Hospital Revenue Code	250
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$14.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.93
Rate for Payer: Aetna Government	$8.93
Rate for Payer: Brighton Health Commercial	$13.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.15
Rate for Payer: EmblemHealth Commercial	$8.93
Rate for Payer: Group Health Inc Commercial	$8.93
Rate for Payer: Group Health Inc Medicare	$6.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.93
Rate for Payer: Hamaspik Choice Inc Medicare	$8.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.61

NAFCILLIN SODIUM 1 G IJ SOLR

Facility

$13.70

Service Code	NDC 6785003110
Hospital Charge Code	6785003110
Hospital Revenue Code	250
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$6.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.85

NAFCILLIN SODIUM 1 G IJ SOLR

Facility

$13.70

Service Code	NDC 6785003100
Hospital Charge Code	6785003100
Hospital Revenue Code	250
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$10.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.85
Rate for Payer: Aetna Government	$6.85
Rate for Payer: Brighton Health Commercial	$10.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.32
Rate for Payer: EmblemHealth Commercial	$6.85
Rate for Payer: Group Health Inc Commercial	$6.85
Rate for Payer: Group Health Inc Medicare	$4.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.85
Rate for Payer: Hamaspik Choice Inc Medicare	$6.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.90

NAFCILLIN SODIUM 1 G IJ SOLR

Facility

$2.90

Service Code	NDC 2315590631
Hospital Charge Code	2315590631
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.45
Rate for Payer: Aetna Government	$1.45
Rate for Payer: Brighton Health Commercial	$2.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.97
Rate for Payer: EmblemHealth Commercial	$1.45
Rate for Payer: Group Health Inc Commercial	$1.45
Rate for Payer: Group Health Inc Medicare	$1.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.89

NAFCILLIN SODIUM 1 G IJ SOLR

Facility

$14.50

Service Code	NDC 5515012215
Hospital Charge Code	5515012215
Hospital Revenue Code	250
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$7.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.25

NAFCILLIN SODIUM 1 G IJ SOLR

Facility

$17.87

Service Code	NDC 6332332710
Hospital Charge Code	6332332710
Hospital Revenue Code	250
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$8.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.93

NAFCILLIN SODIUM 1 G IJ SOLR

Facility

$14.50

Service Code	NDC 5515012215
Hospital Charge Code	5515012215
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$11.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.25
Rate for Payer: Aetna Government	$7.25
Rate for Payer: Brighton Health Commercial	$10.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.86
Rate for Payer: EmblemHealth Commercial	$7.25
Rate for Payer: Group Health Inc Commercial	$7.25
Rate for Payer: Group Health Inc Medicare	$5.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.43

NAFCILLIN SODIUM 1 G IJ SOLR

Facility

$2.90

Service Code	NDC 2315590631
Hospital Charge Code	2315590631
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45

NAFCILLIN SODIUM 2 G IJ SOLR

Facility

$15.00

Service Code	NDC 5515012315
Hospital Charge Code	5515012315
Hospital Revenue Code	250
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50

NAFCILLIN SODIUM 2 G IJ SOLR

Facility

$15.00

Service Code	NDC 5515012315
Hospital Charge Code	5515012315
Hospital Revenue Code	250
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$12.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.50
Rate for Payer: Aetna Government	$7.50
Rate for Payer: Brighton Health Commercial	$11.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.20
Rate for Payer: EmblemHealth Commercial	$7.50
Rate for Payer: Group Health Inc Commercial	$7.50
Rate for Payer: Group Health Inc Medicare	$5.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.75

NAFCILLIN SODIUM 2 G IJ SOLR

Facility

$12.34

Service Code	NDC 7248540601
Hospital Charge Code	7248540601
Hospital Revenue Code	250
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$6.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.17

Know your out-of-pocket cost for care.

All Charges