St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

KETOCONAZOLE 2 % EX CREA [10368]

Facility

$1.32

Service Code	NDC 00168009960
Hospital Charge Code	00168009960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.66
Rate for Payer: Aetna Government	$0.66
Rate for Payer: Brighton Health Commercial	$0.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.86

KETOCONAZOLE 2 % EX CREA [10368]

Facility

$4.62

Service Code	NDC 21922002507
Hospital Charge Code	21922002507
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$3.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.31
Rate for Payer: Aetna Government	$2.31
Rate for Payer: Brighton Health Commercial	$3.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.14
Rate for Payer: Group Health Inc Commercial	$2.31
Rate for Payer: Group Health Inc Medicare	$1.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31
Rate for Payer: Hamaspik Choice Inc Medicare	$2.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.00

KETOCONAZOLE 2 % EX CREA [10368]

Facility

$6.95

Service Code	NDC 51672129802
Hospital Charge Code	51672129802
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$5.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.47
Rate for Payer: Aetna Government	$3.47
Rate for Payer: Brighton Health Commercial	$5.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.72
Rate for Payer: Group Health Inc Commercial	$3.47
Rate for Payer: Group Health Inc Medicare	$2.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.47
Rate for Payer: Hamaspik Choice Inc Medicare	$3.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.52

KETOCONAZOLE 2 % EX SHAM [14132]

Facility

$0.25

Service Code	NDC 45802046564
Hospital Charge Code	45802046564
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

KETOCONAZOLE 2% SHAMPOO

Facility

$19.40

Hospital Charge Code	41654620
Hospital Revenue Code	250
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$15.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.70
Rate for Payer: Aetna Government	$9.70
Rate for Payer: Brighton Health Commercial	$14.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.19
Rate for Payer: Group Health Inc Commercial	$9.70
Rate for Payer: Group Health Inc Medicare	$6.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.70
Rate for Payer: Hamaspik Choice Inc Medicare	$9.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.61

KETOCONAZOLE 2% SHAMPOO

Facility

$19.40

Hospital Charge Code	41644620
Hospital Revenue Code	250
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$15.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.70
Rate for Payer: Aetna Government	$9.70
Rate for Payer: Brighton Health Commercial	$14.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.19
Rate for Payer: Group Health Inc Commercial	$9.70
Rate for Payer: Group Health Inc Medicare	$6.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.70
Rate for Payer: Hamaspik Choice Inc Medicare	$9.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.61

KETOCONAZOLE 2% TOPICAL CREAM - NF 15 GR

Facility

$7.00

Hospital Charge Code	41653445
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

KETOCONAZOLE 2% TOPICAL CREAM - NF 15 GR

Facility

$7.00

Hospital Charge Code	41643445
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

KETONE,SERUM

Facility

$11.30

Service Code	HCPCS 82009
Hospital Charge Code	40602320
Hospital Revenue Code	300
Rate for Payer: Cash Price	$4.52

KETONE,SERUM

Facility

$11.30

Service Code	HCPCS 82009
Hospital Charge Code	40602320
Hospital Revenue Code	300
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$8.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.52
Rate for Payer: Aetna Government	$4.52
Rate for Payer: Affinity Essential Plan 1&2	$3.16
Rate for Payer: Affinity Essential Plan 3&4	$3.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.16
Rate for Payer: Brighton Health Commercial	$8.48
Rate for Payer: Cash Price	$4.52
Rate for Payer: Cash Price	$4.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.08
Rate for Payer: Elderplan Medicare Advantage	$4.52
Rate for Payer: EmblemHealth Commercial	$4.52
Rate for Payer: Fidelis Essential Plan Aliesa	$3.84
Rate for Payer: Fidelis Essential Plan QHP	$4.02
Rate for Payer: Fidelis Medicare Advantage	$4.52
Rate for Payer: Fidelis Qualified Health Plan	$4.02
Rate for Payer: Group Health Inc Commercial	$4.52
Rate for Payer: Group Health Inc Medicare	$4.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.65
Rate for Payer: Hamaspik Choice Inc Medicare	$4.52
Rate for Payer: Healthfirst Medicare Advantage	$4.52
Rate for Payer: Healthfirst QHP	$4.52
Rate for Payer: Humana Medicare	$4.61
Rate for Payer: Senior Whole Health Medicare Advantage	$4.52
Rate for Payer: United Healthcare Commercial	$5.72
Rate for Payer: United Healthcare Medicare Advantage	$4.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.62
Rate for Payer: Wellcare Medicare	$4.07

KETOROLAC 30 MG/ML INJ 1 ML

Facility

$0.61

Service Code	HCPCS J1885
Hospital Charge Code	41654342
Hospital Revenue Code	636
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31

KETOROLAC 30 MG/ML INJ 1 ML

Facility

$0.61

Service Code	HCPCS J1885
Hospital Charge Code	41654342
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.74
Rate for Payer: SOMOS Essential	$0.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.40

KETOROLAC 30 MG/ML INJ 1 ML

Facility

$0.61

Service Code	HCPCS J1885
Hospital Charge Code	41644342
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.74
Rate for Payer: SOMOS Essential	$0.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.40

KETOROLAC 30 MG/ML INJ 1 ML

Facility

$0.61

Service Code	HCPCS J1885
Hospital Charge Code	41644342
Hospital Revenue Code	636
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31

KETOROLAC 30 MG/ML INJ 2 ML

Facility

$0.32

Service Code	HCPCS J1885
Hospital Charge Code	41644343
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.74
Rate for Payer: SOMOS Essential	$0.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.21

KETOROLAC 30 MG/ML INJ 2 ML

Facility

$0.32

Service Code	HCPCS J1885
Hospital Charge Code	41654343
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.74
Rate for Payer: SOMOS Essential	$0.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.21

KETOROLAC 30 MG/ML INJ 2 ML

Facility

$0.32

Service Code	HCPCS J1885
Hospital Charge Code	41654343
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16

KETOROLAC 30 MG/ML INJ 2 ML

Facility

$0.32

Service Code	HCPCS J1885
Hospital Charge Code	41644343
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16

KETOROLAC/PLACEBO SUSPENSION

Facility

$2.38

Service Code	HCPCS J1885
Hospital Charge Code	41657852
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$1.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.37
Rate for Payer: Group Health Inc Commercial	$1.19
Rate for Payer: Group Health Inc Medicare	$0.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.74
Rate for Payer: SOMOS Essential	$0.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.55

KETOROLAC/PLACEBO SUSPENSION

Facility

$2.38

Service Code	HCPCS J1885
Hospital Charge Code	41657852
Hospital Revenue Code	636
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1.19

KETOROLAC/PLACEBO SUSPENSION

Facility

$2.38

Service Code	HCPCS J1885
Hospital Charge Code	41647852
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$1.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.37
Rate for Payer: Group Health Inc Commercial	$1.19
Rate for Payer: Group Health Inc Medicare	$0.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.74
Rate for Payer: SOMOS Essential	$0.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.55

KETOROLAC/PLACEBO SUSPENSION

Facility

$2.38

Service Code	HCPCS J1885
Hospital Charge Code	41647852
Hospital Revenue Code	636
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1.19

KETOROLAC TROMETHAMINE

Facility

$11.12

Hospital Charge Code	41647817
Hospital Revenue Code	250
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$8.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.56
Rate for Payer: Aetna Government	$5.56
Rate for Payer: Brighton Health Commercial	$8.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.56
Rate for Payer: Group Health Inc Commercial	$5.56
Rate for Payer: Group Health Inc Medicare	$3.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.56
Rate for Payer: Hamaspik Choice Inc Medicare	$5.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.23

KETOROLAC TROMETHAMINE

Facility

$11.12

Hospital Charge Code	41657817
Hospital Revenue Code	250
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$8.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.56
Rate for Payer: Aetna Government	$5.56
Rate for Payer: Brighton Health Commercial	$8.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.56
Rate for Payer: Group Health Inc Commercial	$5.56
Rate for Payer: Group Health Inc Medicare	$3.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.56
Rate for Payer: Hamaspik Choice Inc Medicare	$5.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.23

KETOROLAC TROMETHAMINE 0.4 % OP SOLN [36631]

Facility

$67.96

Service Code	NDC 00023927705
Hospital Charge Code	00023927705
Hospital Revenue Code	250
Min. Negotiated Rate	$23.78
Max. Negotiated Rate	$54.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$33.98
Rate for Payer: Aetna Government	$33.98
Rate for Payer: Brighton Health Commercial	$50.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.21
Rate for Payer: Group Health Inc Commercial	$33.98
Rate for Payer: Group Health Inc Medicare	$23.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.98
Rate for Payer: Hamaspik Choice Inc Medicare	$33.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.17

Know your out-of-pocket cost for care.

All Charges