St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PAROXETINE HCL 20 MG PO TABS

Facility

$2.73

Service Code	NDC 6838209806
Hospital Charge Code	6838209806
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37

PAROXETINE HCL 30 MG PO TABS

Facility

$2.78

Service Code	NDC 6808404601
Hospital Charge Code	6808404601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.39

PAROXETINE HCL 30 MG PO TABS

Facility

$2.78

Service Code	NDC 6808404611
Hospital Charge Code	6808404611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.39
Rate for Payer: Aetna Government	$1.39
Rate for Payer: Brighton Health Commercial	$2.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.89
Rate for Payer: EmblemHealth Commercial	$1.39
Rate for Payer: Group Health Inc Commercial	$1.39
Rate for Payer: Group Health Inc Medicare	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.39
Rate for Payer: Hamaspik Choice Inc Medicare	$1.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.81

PAROXETINE HCL 30 MG PO TABS

Facility

$2.82

Service Code	NDC 6838209906
Hospital Charge Code	6838209906
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$2.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.41
Rate for Payer: Aetna Government	$1.41
Rate for Payer: Brighton Health Commercial	$2.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.91
Rate for Payer: EmblemHealth Commercial	$1.41
Rate for Payer: Group Health Inc Commercial	$1.41
Rate for Payer: Group Health Inc Medicare	$0.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.41
Rate for Payer: Hamaspik Choice Inc Medicare	$1.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.83

PAROXETINE HCL 30 MG PO TABS

Facility

$2.78

Service Code	NDC 6808404611
Hospital Charge Code	6808404611
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.39

PAROXETINE HCL 30 MG PO TABS

Facility

$2.82

Service Code	NDC 6838209906
Hospital Charge Code	6838209906
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.41

PAROXETINE HCL 30 MG PO TABS

Facility

$2.78

Service Code	NDC 6808404601
Hospital Charge Code	6808404601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.39
Rate for Payer: Aetna Government	$1.39
Rate for Payer: Brighton Health Commercial	$2.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.89
Rate for Payer: EmblemHealth Commercial	$1.39
Rate for Payer: Group Health Inc Commercial	$1.39
Rate for Payer: Group Health Inc Medicare	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.39
Rate for Payer: Hamaspik Choice Inc Medicare	$1.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.81

PAROXETINE HCL 30 MG PO TABS

Facility

$2.72

Service Code	NDC 5026864215
Hospital Charge Code	5026864215
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.36
Rate for Payer: Aetna Government	$1.36
Rate for Payer: Brighton Health Commercial	$2.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.85
Rate for Payer: EmblemHealth Commercial	$1.36
Rate for Payer: Group Health Inc Commercial	$1.36
Rate for Payer: Group Health Inc Medicare	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.77

PAROXETINE HCL 30 MG PO TABS

Facility

$2.72

Service Code	NDC 5026864211
Hospital Charge Code	5026864211
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.36
Rate for Payer: Aetna Government	$1.36
Rate for Payer: Brighton Health Commercial	$2.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.85
Rate for Payer: EmblemHealth Commercial	$1.36
Rate for Payer: Group Health Inc Commercial	$1.36
Rate for Payer: Group Health Inc Medicare	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.77

PAROXETINE HCL 30 MG PO TABS

Facility

$2.72

Service Code	NDC 5026864215
Hospital Charge Code	5026864215
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36

PAROXETINE HCL 30 MG PO TABS

Facility

$2.72

Service Code	NDC 5026864211
Hospital Charge Code	5026864211
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36

Partial thickness burns without skin graft

Facility

$65,118.04

Service Code	APR-DRG 8443
Min. Negotiated Rate	$28,941.35
Max. Negotiated Rate	$65,118.04
Rate for Payer: Affinity Essential Plan 1&2	$65,118.04
Rate for Payer: Affinity Essential Plan 3&4	$65,118.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,941.35
Rate for Payer: Amida Care Medicaid	$28,941.35
Rate for Payer: EmblemHealth Essential Plan 1&2	$65,118.04
Rate for Payer: EmblemHealth Essential Plan 3&4	$28,941.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,941.35
Rate for Payer: Fidelis Qualified Health Plan	$34,729.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,941.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,941.35
Rate for Payer: Healthfirst Commercial	$35,767.00
Rate for Payer: Healthfirst Essential Plan	$65,118.04
Rate for Payer: Healthfirst QHP	$43,299.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,941.35
Rate for Payer: SOMOS Essential	$65,118.04
Rate for Payer: United Healthcare Essential Plan 1&2	$65,118.04
Rate for Payer: United Healthcare Essential Plan 3&4	$65,118.04
Rate for Payer: United Healthcare Medicaid	$28,941.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,941.35

Partial thickness burns without skin graft

Facility

$121,355.71

Service Code	APR-DRG 8444
Min. Negotiated Rate	$42,257.00
Max. Negotiated Rate	$121,355.71
Rate for Payer: Affinity Essential Plan 1&2	$121,355.71
Rate for Payer: Affinity Essential Plan 3&4	$121,355.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$53,935.87
Rate for Payer: Amida Care Medicaid	$53,935.87
Rate for Payer: EmblemHealth Essential Plan 1&2	$121,355.71
Rate for Payer: EmblemHealth Essential Plan 3&4	$53,935.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53,935.87
Rate for Payer: Fidelis Qualified Health Plan	$64,723.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$53,935.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53,935.87
Rate for Payer: Healthfirst Commercial	$42,257.00
Rate for Payer: Healthfirst Essential Plan	$121,355.71
Rate for Payer: Healthfirst QHP	$90,505.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53,935.87
Rate for Payer: SOMOS Essential	$121,355.71
Rate for Payer: United Healthcare Essential Plan 1&2	$121,355.71
Rate for Payer: United Healthcare Essential Plan 3&4	$121,355.71
Rate for Payer: United Healthcare Medicaid	$53,935.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$53,935.87

Partial thickness burns without skin graft

Facility

$43,436.21

Service Code	APR-DRG 8441
Min. Negotiated Rate	$7,278.00
Max. Negotiated Rate	$43,436.21
Rate for Payer: Affinity Essential Plan 1&2	$43,436.21
Rate for Payer: Affinity Essential Plan 3&4	$43,436.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,304.98
Rate for Payer: Amida Care Medicaid	$19,304.98
Rate for Payer: EmblemHealth Essential Plan 1&2	$43,436.21
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,304.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,304.98
Rate for Payer: Fidelis Qualified Health Plan	$23,165.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,304.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,304.98
Rate for Payer: Healthfirst Commercial	$13,184.00
Rate for Payer: Healthfirst Essential Plan	$43,436.21
Rate for Payer: Healthfirst QHP	$7,278.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,304.98
Rate for Payer: SOMOS Essential	$43,436.21
Rate for Payer: United Healthcare Essential Plan 1&2	$43,436.21
Rate for Payer: United Healthcare Essential Plan 3&4	$43,436.21
Rate for Payer: United Healthcare Medicaid	$19,304.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,304.98

Partial thickness burns without skin graft

Facility

$50,722.69

Service Code	APR-DRG 8442
Min. Negotiated Rate	$21,751.00
Max. Negotiated Rate	$50,722.69
Rate for Payer: Affinity Essential Plan 1&2	$50,722.69
Rate for Payer: Affinity Essential Plan 3&4	$50,722.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,543.42
Rate for Payer: Amida Care Medicaid	$22,543.42
Rate for Payer: EmblemHealth Essential Plan 1&2	$50,722.69
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,543.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,543.42
Rate for Payer: Fidelis Qualified Health Plan	$27,052.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,543.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,543.42
Rate for Payer: Healthfirst Commercial	$21,751.00
Rate for Payer: Healthfirst Essential Plan	$50,722.69
Rate for Payer: Healthfirst QHP	$27,333.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,543.42
Rate for Payer: SOMOS Essential	$50,722.69
Rate for Payer: United Healthcare Essential Plan 1&2	$50,722.69
Rate for Payer: United Healthcare Essential Plan 3&4	$50,722.69
Rate for Payer: United Healthcare Medicaid	$22,543.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,543.42

PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT

Facility

$275.19

Service Code	EAPG 00861
Min. Negotiated Rate	$199.03
Max. Negotiated Rate	$275.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$199.03
Rate for Payer: Healthfirst Commercial	$275.19

PATHOLOGY CONSULTATION AND INTERPRETATION

Facility

$85.63

Service Code	EAPG 00158
Min. Negotiated Rate	$85.63
Max. Negotiated Rate	$85.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$85.63

PEG 3350 17 G PO PACK

Facility

$1.67

Service Code	NDC 0904693186
Hospital Charge Code	0904693186
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
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	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

PEG 3350 17 G PO PACK

Facility

$1.67

Service Code	NDC 0904693186
Hospital Charge Code	0904693186
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84

PEG 3350-KCL-NABCB-NACL-NASULF 236 G PO SOLR

Facility

$0.01

Service Code	NDC 5226810001
Hospital Charge Code	5226810001
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

PEG 3350-KCL-NABCB-NACL-NASULF 236 G PO SOLR

Facility

$0.01

Service Code	NDC 5226810001
Hospital Charge Code	5226810001
Hospital Revenue Code	250
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

PEGFILGRASTIM 6 MG/0.6ML SC PSKT

Facility

$12.00

Service Code	HCPCS J2506
Hospital Charge Code	5551319201
Hospital Revenue Code	250
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00

PEGFILGRASTIM 6 MG/0.6ML SC PSKT

Facility

$12.00

Service Code	HCPCS J2506
Hospital Charge Code	5551319201
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$91.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$89.34
Rate for Payer: Aetna Government	$89.34
Rate for Payer: Affinity Essential Plan 1&2	$62.54
Rate for Payer: Affinity Essential Plan 3&4	$62.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$62.54
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$89.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: Elderplan Medicare Advantage	$89.34
Rate for Payer: EmblemHealth Commercial	$89.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$80.41
Rate for Payer: Fidelis Essential Plan Aliesa	$75.94
Rate for Payer: Fidelis Essential Plan QHP	$79.51
Rate for Payer: Fidelis Medicare Advantage	$89.34
Rate for Payer: Fidelis Qualified Health Plan	$79.51
Rate for Payer: Group Health Inc Commercial	$89.34
Rate for Payer: Group Health Inc Medicare	$89.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.34
Rate for Payer: Hamaspik Choice Inc Medicare	$89.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$89.34
Rate for Payer: Healthfirst Medicare Advantage	$75.94
Rate for Payer: Healthfirst QHP	$89.34
Rate for Payer: Humana Medicare	$91.13
Rate for Payer: Senior Whole Health Medicare Advantage	$89.34
Rate for Payer: United Healthcare Medicare Advantage	$89.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$84.87
Rate for Payer: Wellcare Medicare	$84.87

PEGFILGRASTIM 6 MG/0.6ML SC SOSY

Facility

$12.00

Service Code	HCPCS J2506
Hospital Charge Code	5551319001
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$91.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$89.34
Rate for Payer: Aetna Government	$89.34
Rate for Payer: Affinity Essential Plan 1&2	$62.54
Rate for Payer: Affinity Essential Plan 3&4	$62.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$62.54
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$89.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: Elderplan Medicare Advantage	$89.34
Rate for Payer: EmblemHealth Commercial	$89.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$80.41
Rate for Payer: Fidelis Essential Plan Aliesa	$75.94
Rate for Payer: Fidelis Essential Plan QHP	$79.51
Rate for Payer: Fidelis Medicare Advantage	$89.34
Rate for Payer: Fidelis Qualified Health Plan	$79.51
Rate for Payer: Group Health Inc Commercial	$89.34
Rate for Payer: Group Health Inc Medicare	$89.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.34
Rate for Payer: Hamaspik Choice Inc Medicare	$89.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$89.34
Rate for Payer: Healthfirst Medicare Advantage	$75.94
Rate for Payer: Healthfirst QHP	$89.34
Rate for Payer: Humana Medicare	$91.13
Rate for Payer: Senior Whole Health Medicare Advantage	$89.34
Rate for Payer: United Healthcare Medicare Advantage	$89.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$84.87
Rate for Payer: Wellcare Medicare	$84.87

PEGFILGRASTIM 6 MG/0.6ML SC SOSY

Facility

$12.00

Service Code	HCPCS J2506
Hospital Charge Code	5551319001
Hospital Revenue Code	250
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00

Know your out-of-pocket cost for care.

All Charges