St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN

Facility

$3.24

Service Code	HCPCS J2430
Hospital Charge Code	6745743010
Hospital Revenue Code	258
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.62

PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN

Facility

$1.68

Service Code	HCPCS J2430
Hospital Charge Code	6170332418
Hospital Revenue Code	258
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84

PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN

Facility

$1.68

Service Code	HCPCS J2430
Hospital Charge Code	6170332418
Hospital Revenue Code	258
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$9.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.16
Rate for Payer: Aetna Government	$9.16
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: EmblemHealth Commercial	$0.84
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$9.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

PANCREAS DIAGNOSES EXCEPT MALIGNANCY

Facility

$218.00

Service Code	EAPG 00635
Min. Negotiated Rate	$157.37
Max. Negotiated Rate	$218.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$157.37
Rate for Payer: Healthfirst Commercial	$218.00

Pancreas transplant

Facility

$199,383.00

Service Code	APR-DRG 0062
Min. Negotiated Rate	$53,745.92
Max. Negotiated Rate	$199,383.00
Rate for Payer: Affinity Essential Plan 1&2	$120,928.32
Rate for Payer: Affinity Essential Plan 3&4	$120,928.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$53,745.92
Rate for Payer: Amida Care Medicaid	$53,745.92
Rate for Payer: EmblemHealth Essential Plan 1&2	$120,928.32
Rate for Payer: EmblemHealth Essential Plan 3&4	$53,745.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53,745.92
Rate for Payer: Fidelis Qualified Health Plan	$64,495.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$53,745.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53,745.92
Rate for Payer: Healthfirst Commercial	$199,383.00
Rate for Payer: Healthfirst Essential Plan	$120,928.32
Rate for Payer: Healthfirst QHP	$99,982.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53,745.92
Rate for Payer: SOMOS Essential	$120,928.32
Rate for Payer: United Healthcare Essential Plan 1&2	$120,928.32
Rate for Payer: United Healthcare Essential Plan 3&4	$120,928.32
Rate for Payer: United Healthcare Medicaid	$53,745.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$53,745.92

Pancreas transplant

Facility

$199,383.00

Service Code	APR-DRG 0061
Min. Negotiated Rate	$53,745.92
Max. Negotiated Rate	$199,383.00
Rate for Payer: Affinity Essential Plan 1&2	$120,928.32
Rate for Payer: Affinity Essential Plan 3&4	$120,928.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$53,745.92
Rate for Payer: Amida Care Medicaid	$53,745.92
Rate for Payer: EmblemHealth Essential Plan 1&2	$120,928.32
Rate for Payer: EmblemHealth Essential Plan 3&4	$53,745.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53,745.92
Rate for Payer: Fidelis Qualified Health Plan	$64,495.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$53,745.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53,745.92
Rate for Payer: Healthfirst Commercial	$199,383.00
Rate for Payer: Healthfirst Essential Plan	$120,928.32
Rate for Payer: Healthfirst QHP	$99,982.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53,745.92
Rate for Payer: SOMOS Essential	$120,928.32
Rate for Payer: United Healthcare Essential Plan 1&2	$120,928.32
Rate for Payer: United Healthcare Essential Plan 3&4	$120,928.32
Rate for Payer: United Healthcare Medicaid	$53,745.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$53,745.92

Pancreas transplant

Facility

$207,018.00

Service Code	APR-DRG 0063
Min. Negotiated Rate	$71,402.17
Max. Negotiated Rate	$207,018.00
Rate for Payer: Affinity Essential Plan 1&2	$160,654.88
Rate for Payer: Affinity Essential Plan 3&4	$160,654.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$71,402.17
Rate for Payer: Amida Care Medicaid	$71,402.17
Rate for Payer: EmblemHealth Essential Plan 1&2	$160,654.88
Rate for Payer: EmblemHealth Essential Plan 3&4	$71,402.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$71,402.17
Rate for Payer: Fidelis Qualified Health Plan	$85,682.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$71,402.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$71,402.17
Rate for Payer: Healthfirst Commercial	$207,018.00
Rate for Payer: Healthfirst Essential Plan	$160,654.88
Rate for Payer: Healthfirst QHP	$121,196.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71,402.17
Rate for Payer: SOMOS Essential	$160,654.88
Rate for Payer: United Healthcare Essential Plan 1&2	$160,654.88
Rate for Payer: United Healthcare Essential Plan 3&4	$160,654.88
Rate for Payer: United Healthcare Medicaid	$71,402.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$71,402.17

Pancreas transplant

Facility

$230,289.00

Service Code	APR-DRG 0064
Min. Negotiated Rate	$73,940.24
Max. Negotiated Rate	$230,289.00
Rate for Payer: Affinity Essential Plan 1&2	$166,365.54
Rate for Payer: Affinity Essential Plan 3&4	$166,365.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$73,940.24
Rate for Payer: Amida Care Medicaid	$73,940.24
Rate for Payer: EmblemHealth Essential Plan 1&2	$166,365.54
Rate for Payer: EmblemHealth Essential Plan 3&4	$73,940.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$73,940.24
Rate for Payer: Fidelis Qualified Health Plan	$88,728.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$73,940.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$73,940.24
Rate for Payer: Healthfirst Commercial	$230,289.00
Rate for Payer: Healthfirst Essential Plan	$166,365.54
Rate for Payer: Healthfirst QHP	$162,943.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$73,940.24
Rate for Payer: SOMOS Essential	$166,365.54
Rate for Payer: United Healthcare Essential Plan 1&2	$166,365.54
Rate for Payer: United Healthcare Essential Plan 3&4	$166,365.54
Rate for Payer: United Healthcare Medicaid	$73,940.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$73,940.24

PANCRELIPASE (LIP-PROT-AMYL) 5000-24000 UNITS PO CPEP

Facility

$2.48

Service Code	NDC 7356211501
Hospital Charge Code	7356211501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$1.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.24
Rate for Payer: Aetna Government	$1.24
Rate for Payer: Brighton Health Commercial	$1.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.69
Rate for Payer: EmblemHealth Commercial	$1.24
Rate for Payer: Group Health Inc Commercial	$1.24
Rate for Payer: Group Health Inc Medicare	$0.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24
Rate for Payer: Hamaspik Choice Inc Medicare	$1.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.61

PANCRELIPASE (LIP-PROT-AMYL) 5000-24000 UNITS PO CPEP

Facility

$2.29

Service Code	NDC 0023611501
Hospital Charge Code	0023611501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.14
Rate for Payer: Aetna Government	$1.14
Rate for Payer: Brighton Health Commercial	$1.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.55
Rate for Payer: EmblemHealth Commercial	$1.14
Rate for Payer: Group Health Inc Commercial	$1.14
Rate for Payer: Group Health Inc Medicare	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.49

PANCRELIPASE (LIP-PROT-AMYL) 5000-24000 UNITS PO CPEP

Facility

$2.29

Service Code	NDC 0023611501
Hospital Charge Code	0023611501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14

PANCRELIPASE (LIP-PROT-AMYL) 5000-24000 UNITS PO CPEP

Facility

$2.48

Service Code	NDC 7356211501
Hospital Charge Code	7356211501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24

PANITUMUMAB 100 MG/5ML IV SOLN

Facility

$395.50

Service Code	HCPCS J9303
Hospital Charge Code	5551395401
Hospital Revenue Code	258
Min. Negotiated Rate	$121.12
Max. Negotiated Rate	$316.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$173.03
Rate for Payer: Aetna Government	$173.03
Rate for Payer: Affinity Essential Plan 1&2	$121.12
Rate for Payer: Affinity Essential Plan 3&4	$121.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$121.12
Rate for Payer: Brighton Health Commercial	$296.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$173.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$316.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$268.94
Rate for Payer: Elderplan Medicare Advantage	$173.03
Rate for Payer: EmblemHealth Commercial	$173.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$155.73
Rate for Payer: Fidelis Essential Plan Aliesa	$147.08
Rate for Payer: Fidelis Essential Plan QHP	$154.00
Rate for Payer: Fidelis Medicare Advantage	$173.03
Rate for Payer: Fidelis Qualified Health Plan	$154.00
Rate for Payer: Group Health Inc Commercial	$173.03
Rate for Payer: Group Health Inc Medicare	$173.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.03
Rate for Payer: Hamaspik Choice Inc Medicare	$173.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$173.03
Rate for Payer: Healthfirst Medicare Advantage	$147.08
Rate for Payer: Healthfirst QHP	$173.03
Rate for Payer: Humana Medicare	$176.49
Rate for Payer: Senior Whole Health Medicare Advantage	$173.03
Rate for Payer: United Healthcare Medicare Advantage	$173.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$257.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$164.38
Rate for Payer: Wellcare Medicare	$164.38

PANITUMUMAB 100 MG/5ML IV SOLN

Facility

$395.50

Service Code	HCPCS J9303
Hospital Charge Code	5551395401
Hospital Revenue Code	258
Min. Negotiated Rate	$197.75
Max. Negotiated Rate	$197.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.75

PANITUMUMAB 400 MG/20ML IV SOLN

Facility

$395.50

Service Code	HCPCS J9303
Hospital Charge Code	5551395601
Hospital Revenue Code	258
Min. Negotiated Rate	$121.12
Max. Negotiated Rate	$316.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$173.03
Rate for Payer: Aetna Government	$173.03
Rate for Payer: Affinity Essential Plan 1&2	$121.12
Rate for Payer: Affinity Essential Plan 3&4	$121.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$121.12
Rate for Payer: Brighton Health Commercial	$296.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$173.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$316.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$268.94
Rate for Payer: Elderplan Medicare Advantage	$173.03
Rate for Payer: EmblemHealth Commercial	$173.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$155.73
Rate for Payer: Fidelis Essential Plan Aliesa	$147.08
Rate for Payer: Fidelis Essential Plan QHP	$154.00
Rate for Payer: Fidelis Medicare Advantage	$173.03
Rate for Payer: Fidelis Qualified Health Plan	$154.00
Rate for Payer: Group Health Inc Commercial	$173.03
Rate for Payer: Group Health Inc Medicare	$173.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.03
Rate for Payer: Hamaspik Choice Inc Medicare	$173.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$173.03
Rate for Payer: Healthfirst Medicare Advantage	$147.08
Rate for Payer: Healthfirst QHP	$173.03
Rate for Payer: Humana Medicare	$176.49
Rate for Payer: Senior Whole Health Medicare Advantage	$173.03
Rate for Payer: United Healthcare Medicare Advantage	$173.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$257.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$164.38
Rate for Payer: Wellcare Medicare	$164.38

PANITUMUMAB 400 MG/20ML IV SOLN

Facility

$395.50

Service Code	HCPCS J9303
Hospital Charge Code	5551395601
Hospital Revenue Code	258
Min. Negotiated Rate	$197.75
Max. Negotiated Rate	$197.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.75

PANTOPRAZOLE SODIUM 40 MG/10ML IV (WET SOLR VIAL)

Facility

$6.09

Service Code	NDC 0008092355
Hospital Charge Code	0008092355
Hospital Revenue Code	258
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.04
Rate for Payer: Aetna Government	$3.04
Rate for Payer: Brighton Health Commercial	$4.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: EmblemHealth Commercial	$3.04
Rate for Payer: Group Health Inc Commercial	$3.04
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.04
Rate for Payer: Hamaspik Choice Inc Medicare	$3.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

PANTOPRAZOLE SODIUM 40 MG/10ML IV (WET SOLR VIAL)

Facility

$6.13

Service Code	NDC 0781323295
Hospital Charge Code	0781323295
Hospital Revenue Code	258
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06

PANTOPRAZOLE SODIUM 40 MG/10ML IV (WET SOLR VIAL)

Facility

$8.50

Service Code	NDC 6275612944
Hospital Charge Code	6275612944
Hospital Revenue Code	258
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$6.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.25
Rate for Payer: Aetna Government	$4.25
Rate for Payer: Brighton Health Commercial	$6.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.78
Rate for Payer: EmblemHealth Commercial	$4.25
Rate for Payer: Group Health Inc Commercial	$4.25
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.53

PANTOPRAZOLE SODIUM 40 MG/10ML IV (WET SOLR VIAL)

Facility

$8.50

Service Code	NDC 5515020210
Hospital Charge Code	5515020210
Hospital Revenue Code	258
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25

PANTOPRAZOLE SODIUM 40 MG/10ML IV (WET SOLR VIAL)

Facility

$8.50

Service Code	NDC 5515020210
Hospital Charge Code	5515020210
Hospital Revenue Code	258
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$6.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.25
Rate for Payer: Aetna Government	$4.25
Rate for Payer: Brighton Health Commercial	$6.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.78
Rate for Payer: EmblemHealth Commercial	$4.25
Rate for Payer: Group Health Inc Commercial	$4.25
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.53

PANTOPRAZOLE SODIUM 40 MG/10ML IV (WET SOLR VIAL)

Facility

$6.13

Service Code	NDC 0781323295
Hospital Charge Code	0781323295
Hospital Revenue Code	258
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.17
Rate for Payer: EmblemHealth Commercial	$3.06
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

PANTOPRAZOLE SODIUM 40 MG/10ML IV (WET SOLR VIAL)

Facility

$6.09

Service Code	NDC 0008092355
Hospital Charge Code	0008092355
Hospital Revenue Code	258
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.04

PANTOPRAZOLE SODIUM 40 MG/10ML IV (WET SOLR VIAL)

Facility

$8.50

Service Code	NDC 6275612944
Hospital Charge Code	6275612944
Hospital Revenue Code	258
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.25

PANTOPRAZOLE SODIUM 40 MG IV SOLR

Facility

$3.56

Service Code	NDC 7128860010
Hospital Charge Code	7128860010
Hospital Revenue Code	258
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$1.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.78

Know your out-of-pocket cost for care.

All Charges