St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

KANAMYCIN 1000 MG/3 ML INJ

Facility

$37.00

Service Code	HCPCS J1840
Hospital Charge Code	41652990
Hospital Revenue Code	636
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$24.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.22
Rate for Payer: Aetna Government	$6.22
Rate for Payer: Brighton Health Commercial	$22.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.28
Rate for Payer: Group Health Inc Commercial	$18.50
Rate for Payer: Group Health Inc Medicare	$12.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.50
Rate for Payer: Hamaspik Choice Inc Medicare	$18.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.05

KANAMYCIN 1000 MG/3 ML INJ

Facility

$37.00

Service Code	HCPCS J1840
Hospital Charge Code	41642990
Hospital Revenue Code	636
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$18.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.50
Rate for Payer: Hamaspik Choice Inc Medicare	$18.50

KANE THREE PRIVATE

Facility

$4,209.70

Hospital Charge Code	30000065
Hospital Revenue Code	124
Min. Negotiated Rate	$718.11
Max. Negotiated Rate	$1,085.00
Rate for Payer: Amida Care Medicaid	$800.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$760.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$860.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,085.00
Rate for Payer: Fidelis Essential Plan QHP	$1,085.00
Rate for Payer: Healthfirst QHP	$718.11
Rate for Payer: Optum Commercial/Medicare	$776.00
Rate for Payer: Optum Medicaid	$776.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$800.00

KANE THREE SEMI-PRIVATE

Facility

$4,093.10

Hospital Charge Code	30000066
Hospital Revenue Code	124
Min. Negotiated Rate	$718.11
Max. Negotiated Rate	$1,085.00
Rate for Payer: Amida Care Medicaid	$800.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$760.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$860.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,085.00
Rate for Payer: Fidelis Essential Plan QHP	$1,085.00
Rate for Payer: Healthfirst QHP	$718.11
Rate for Payer: Optum Commercial/Medicare	$776.00
Rate for Payer: Optum Medicaid	$776.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$800.00

KANE THREE WARD

Facility

$4,093.10

Hospital Charge Code	30000067
Hospital Revenue Code	124
Min. Negotiated Rate	$718.11
Max. Negotiated Rate	$1,085.00
Rate for Payer: Amida Care Medicaid	$800.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$760.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$860.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,085.00
Rate for Payer: Fidelis Essential Plan QHP	$1,085.00
Rate for Payer: Healthfirst QHP	$718.11
Rate for Payer: Optum Commercial/Medicare	$776.00
Rate for Payer: Optum Medicaid	$776.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$800.00

KANE TWO PRIVATE

Facility

$4,209.70

Hospital Charge Code	30000060
Hospital Revenue Code	124
Min. Negotiated Rate	$718.11
Max. Negotiated Rate	$1,085.00
Rate for Payer: Amida Care Medicaid	$800.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$760.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$860.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,085.00
Rate for Payer: Fidelis Essential Plan QHP	$1,085.00
Rate for Payer: Healthfirst QHP	$718.11
Rate for Payer: Optum Commercial/Medicare	$776.00
Rate for Payer: Optum Medicaid	$776.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$800.00

KANE TWO SEMI-PRIVATE

Facility

$4,093.10

Hospital Charge Code	30000061
Hospital Revenue Code	124
Min. Negotiated Rate	$718.11
Max. Negotiated Rate	$1,085.00
Rate for Payer: Amida Care Medicaid	$800.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$760.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$860.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,085.00
Rate for Payer: Fidelis Essential Plan QHP	$1,085.00
Rate for Payer: Healthfirst QHP	$718.11
Rate for Payer: Optum Commercial/Medicare	$776.00
Rate for Payer: Optum Medicaid	$776.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$800.00

KANGAROO BAG

Facility

$16.31

Hospital Charge Code	40203309
Hospital Revenue Code	270
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$13.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.16
Rate for Payer: Aetna Government	$8.16
Rate for Payer: Brighton Health Commercial	$12.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.09
Rate for Payer: Group Health Inc Commercial	$8.16
Rate for Payer: Group Health Inc Medicare	$5.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.16
Rate for Payer: Hamaspik Choice Inc Medicare	$8.16

K ANTIGEN TYPE

Facility

$858.38

Service Code	HCPCS 86905
Hospital Charge Code	40701252
Hospital Revenue Code	300
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$643.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$472.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$415.67
Rate for Payer: Aetna Government	$415.67
Rate for Payer: Affinity Essential Plan 1&2	$290.97
Rate for Payer: Affinity Essential Plan 3&4	$290.97
Rate for Payer: Affinity Medicaid/CHP/HARP	$290.97
Rate for Payer: Brighton Health Commercial	$643.78
Rate for Payer: Cash Price	$415.67
Rate for Payer: Cash Price	$415.67
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$415.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.15
Rate for Payer: Elderplan Medicare Advantage	$415.67
Rate for Payer: EmblemHealth Commercial	$415.67
Rate for Payer: Fidelis Essential Plan Aliesa	$353.32
Rate for Payer: Fidelis Essential Plan QHP	$369.95
Rate for Payer: Fidelis Medicare Advantage	$415.67
Rate for Payer: Fidelis Qualified Health Plan	$369.95
Rate for Payer: Group Health Inc Commercial	$415.67
Rate for Payer: Group Health Inc Medicare	$415.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$429.19
Rate for Payer: Hamaspik Choice Inc Medicare	$415.67
Rate for Payer: Healthfirst Medicare Advantage	$415.67
Rate for Payer: Healthfirst QHP	$415.67
Rate for Payer: Humana Medicare	$423.98
Rate for Payer: Senior Whole Health Medicare Advantage	$415.67
Rate for Payer: United Healthcare Commercial	$4.84
Rate for Payer: United Healthcare Medicare Advantage	$415.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$415.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$332.54
Rate for Payer: Wellcare Medicare	$374.10

K ANTIGEN TYPE

Facility

$858.38

Service Code	HCPCS 86905
Hospital Charge Code	40701252
Hospital Revenue Code	300
Rate for Payer: Cash Price	$415.67

KARAYA WASHERS

Facility

$12.76

Hospital Charge Code	40207623
Hospital Revenue Code	270
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$10.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.38
Rate for Payer: Aetna Government	$6.38
Rate for Payer: Brighton Health Commercial	$9.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.68
Rate for Payer: Group Health Inc Commercial	$6.38
Rate for Payer: Group Health Inc Medicare	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.38
Rate for Payer: Hamaspik Choice Inc Medicare	$6.38

KCFW-6.0-35-55CM HI FLEX ANSEL

Facility

$160.00

Hospital Charge Code	64905034
Hospital Revenue Code	270
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$128.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.00
Rate for Payer: Aetna Government	$80.00
Rate for Payer: Brighton Health Commercial	$120.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$128.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.80
Rate for Payer: Group Health Inc Commercial	$80.00
Rate for Payer: Group Health Inc Medicare	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00

KCI ABTHERA DRESSING

Facility

$200.00

Hospital Charge Code	40205005
Hospital Revenue Code	270
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$160.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$100.00
Rate for Payer: Aetna Government	$100.00
Rate for Payer: Brighton Health Commercial	$150.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.00
Rate for Payer: Group Health Inc Commercial	$100.00
Rate for Payer: Group Health Inc Medicare	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00

KCI ABTHERA MACHINE

Facility

$55.00

Hospital Charge Code	40205004
Hospital Revenue Code	294
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$44.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.50
Rate for Payer: Aetna Government	$27.50
Rate for Payer: Brighton Health Commercial	$41.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.40
Rate for Payer: Group Health Inc Commercial	$27.50
Rate for Payer: Group Health Inc Medicare	$19.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.50
Rate for Payer: Hamaspik Choice Inc Medicare	$27.50

KCI VAC GRANUF ABDOM. DRESS KIT

Facility

$3,084.00

Hospital Charge Code	40209317
Hospital Revenue Code	270
Min. Negotiated Rate	$1,079.40
Max. Negotiated Rate	$2,467.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,696.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,542.00
Rate for Payer: Aetna Government	$1,542.00
Rate for Payer: Brighton Health Commercial	$2,313.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,467.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,097.12
Rate for Payer: Group Health Inc Commercial	$1,542.00
Rate for Payer: Group Health Inc Medicare	$1,079.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,542.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,542.00

KCI VAC GRANUF MEDIUM DRESS KIT

Facility

$124.95

Hospital Charge Code	40209318
Hospital Revenue Code	270
Min. Negotiated Rate	$43.73
Max. Negotiated Rate	$99.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.48
Rate for Payer: Aetna Government	$62.48
Rate for Payer: Brighton Health Commercial	$93.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$99.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.97
Rate for Payer: Group Health Inc Commercial	$62.48
Rate for Payer: Group Health Inc Medicare	$43.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.48
Rate for Payer: Hamaspik Choice Inc Medicare	$62.48

KCL (0.149%) IN NACL 20-0.45 MEQ/L-% IV SOLN [191015]

Facility

$0.01

Service Code	NDC 00990925739
Hospital Charge Code	00990925739
Hospital Revenue Code	278
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	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Fidelis Medicare Advantage	$0.01
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	$0.01

KCL (0.149%) IN NACL 20-0.45 MEQ/L-% IV SOLN [191015]

Facility

$0.01

Service Code	NDC 00990925739
Hospital Charge Code	00990925739
Hospital Revenue Code	278
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00

KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN [9799]

Facility

$0.01

Service Code	NDC 00338066904
Hospital Charge Code	00338066904
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN [9799]

Facility

$0.01

Service Code	NDC 00338066904
Hospital Charge Code	00338066904
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
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	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

KCL IN DEXTROSE-NACL 20-5-0.2 MEQ/L-%-% IV SOLN [9800]

Facility

$0.01

Service Code	NDC 00338066304
Hospital Charge Code	00338066304
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
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	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

KCL IN DEXTROSE-NACL 20-5-0.2 MEQ/L-%-% IV SOLN [9800]

Facility

$0.01

Service Code	NDC 00338066304
Hospital Charge Code	00338066304
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN [9801]

Facility

$0.01

Service Code	NDC 00264763500
Hospital Charge Code	00264763500
Hospital Revenue Code	278
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00

KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN [9801]

Facility

$0.01

Service Code	NDC 00264763500
Hospital Charge Code	00264763500
Hospital Revenue Code	278
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	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Fidelis Medicare Advantage	$0.01
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

KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN [9801]

Facility

$0.01

Service Code	NDC 00338067104
Hospital Charge Code	00338067104
Hospital Revenue Code	278
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00

Know your out-of-pocket cost for care.

All Charges