St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MINERAL OIL ORAL

Facility

$0.87

Hospital Charge Code	41643497
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.44
Rate for Payer: Aetna Government	$0.44
Rate for Payer: Brighton Health Commercial	$0.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.59
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.57

MINERAL OIL PO OIL [5086]

Facility

$0.07

Service Code	NDC 48433020230
Hospital Charge Code	48433020230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

MINERAL OIL RE ENEM [5087]

Facility

$0.02

Service Code	NDC 70000010901
Hospital Charge Code	70000010901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
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	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
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

MINERAL OIL RE ENEM [5087]

Facility

$0.02

Service Code	NDC 00132030140
Hospital Charge Code	00132030140
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
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	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
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	$0.02

MINI DILATOR SET 5 PROBES

Facility

$412.38

Hospital Charge Code	64905107
Hospital Revenue Code	270
Min. Negotiated Rate	$144.33
Max. Negotiated Rate	$329.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$226.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$206.19
Rate for Payer: Aetna Government	$206.19
Rate for Payer: Brighton Health Commercial	$309.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$329.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$280.42
Rate for Payer: Group Health Inc Commercial	$206.19
Rate for Payer: Group Health Inc Medicare	$144.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$206.19
Rate for Payer: Hamaspik Choice Inc Medicare	$206.19

MINI DRIP 60 DROP 1 SITE

Facility

$5.31

Hospital Charge Code	40509807
Hospital Revenue Code	260
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.66
Rate for Payer: Aetna Government	$2.66
Rate for Payer: Brighton Health Commercial	$3.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.61
Rate for Payer: Group Health Inc Commercial	$2.66
Rate for Payer: Group Health Inc Medicare	$1.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.66
Rate for Payer: Hamaspik Choice Inc Medicare	$2.66
Rate for Payer: United Healthcare Commercial	$76.00

MINI-DRIP SET CONTINFLO

Facility

$12.05

Hospital Charge Code	40509799
Hospital Revenue Code	260
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.02
Rate for Payer: Aetna Government	$6.02
Rate for Payer: Brighton Health Commercial	$9.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.19
Rate for Payer: Group Health Inc Commercial	$6.02
Rate for Payer: Group Health Inc Medicare	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.02
Rate for Payer: Hamaspik Choice Inc Medicare	$6.02
Rate for Payer: United Healthcare Commercial	$76.00

MINILOK QCK ANC PLUS SUTURE 2/0WH

Facility

$644.00

Hospital Charge Code	40202053
Hospital Revenue Code	270
Min. Negotiated Rate	$225.40
Max. Negotiated Rate	$515.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$354.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.00
Rate for Payer: Aetna Government	$322.00
Rate for Payer: Brighton Health Commercial	$483.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$515.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$437.92
Rate for Payer: Group Health Inc Commercial	$322.00
Rate for Payer: Group Health Inc Medicare	$225.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$322.00
Rate for Payer: Hamaspik Choice Inc Medicare	$322.00

MININGOCOCCAL B LIPO IM (VFC)

Facility

$0.01

Service Code	HCPCS 90621
Hospital Charge Code	41646595
Hospital Revenue Code	250
Max. Negotiated Rate	$160.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$160.37
Rate for Payer: Aetna Government	$160.37
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: 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

MINI PLATE -16 HOLES

Facility

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	40201243
Hospital Revenue Code	278
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$306.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$160.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$175.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$167.90
Rate for Payer: EmblemHealth Commercial	$146.00
Rate for Payer: Fidelis Medicare Advantage	$306.60
Rate for Payer: Group Health Inc Commercial	$146.00
Rate for Payer: Group Health Inc Medicare	$102.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.00
Rate for Payer: Hamaspik Choice Inc Medicare	$146.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$189.80

MINI PLATE -16 HOLES

Facility

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	40201243
Hospital Revenue Code	278
Min. Negotiated Rate	$146.00
Max. Negotiated Rate	$146.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.00
Rate for Payer: Hamaspik Choice Inc Medicare	$146.00

MINI PLATE -4 HOLES

Facility

$164.00

Service Code	HCPCS C1713
Hospital Charge Code	40201244
Hospital Revenue Code	278
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$172.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$98.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$94.30
Rate for Payer: EmblemHealth Commercial	$82.00
Rate for Payer: Fidelis Medicare Advantage	$172.20
Rate for Payer: Group Health Inc Commercial	$82.00
Rate for Payer: Group Health Inc Medicare	$57.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$106.60

MINI PLATE -4 HOLES

Facility

$164.00

Service Code	HCPCS C1713
Hospital Charge Code	40201244
Hospital Revenue Code	278
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$82.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00

MINI PLATE- 6 HOLES

Facility

$208.00

Service Code	HCPCS C1713
Hospital Charge Code	40201245
Hospital Revenue Code	278
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$218.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$114.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$124.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.60
Rate for Payer: EmblemHealth Commercial	$104.00
Rate for Payer: Fidelis Medicare Advantage	$218.40
Rate for Payer: Group Health Inc Commercial	$104.00
Rate for Payer: Group Health Inc Medicare	$72.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.00
Rate for Payer: Hamaspik Choice Inc Medicare	$104.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$135.20

MINI PLATE- 6 HOLES

Facility

$208.00

Service Code	HCPCS C1713
Hospital Charge Code	40201245
Hospital Revenue Code	278
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$104.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.00
Rate for Payer: Hamaspik Choice Inc Medicare	$104.00

MINIPLATE INLAY MOD 2.0

Facility

$172.00

Service Code	HCPCS C1713
Hospital Charge Code	40201246
Hospital Revenue Code	278
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$180.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$103.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.90
Rate for Payer: EmblemHealth Commercial	$86.00
Rate for Payer: Fidelis Medicare Advantage	$180.60
Rate for Payer: Group Health Inc Commercial	$86.00
Rate for Payer: Group Health Inc Medicare	$60.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.80

MINIPLATE INLAY MOD 2.0

Facility

$172.00

Service Code	HCPCS C1713
Hospital Charge Code	40201246
Hospital Revenue Code	278
Min. Negotiated Rate	$86.00
Max. Negotiated Rate	$86.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00

MINI PLATE MOD 2.0

Facility

$172.00

Service Code	HCPCS C1713
Hospital Charge Code	40201247
Hospital Revenue Code	278
Min. Negotiated Rate	$86.00
Max. Negotiated Rate	$86.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00

MINI PLATE MOD 2.0

Facility

$172.00

Service Code	HCPCS C1713
Hospital Charge Code	40201247
Hospital Revenue Code	278
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$180.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$103.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.90
Rate for Payer: EmblemHealth Commercial	$86.00
Rate for Payer: Fidelis Medicare Advantage	$180.60
Rate for Payer: Group Health Inc Commercial	$86.00
Rate for Payer: Group Health Inc Medicare	$60.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.80

MINI PLT, 16 HOLES

Facility

$292.00

Service Code	HCPCS C1781
Hospital Charge Code	40209736
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$306.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$160.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$175.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$167.90
Rate for Payer: EmblemHealth Commercial	$146.00
Rate for Payer: Fidelis Medicare Advantage	$306.60
Rate for Payer: Group Health Inc Commercial	$146.00
Rate for Payer: Group Health Inc Medicare	$102.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.00
Rate for Payer: Hamaspik Choice Inc Medicare	$146.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$189.80

MINI PLT, 16 HOLES

Facility

$292.00

Service Code	HCPCS C1781
Hospital Charge Code	40209736
Hospital Revenue Code	278
Min. Negotiated Rate	$146.00
Max. Negotiated Rate	$146.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.00
Rate for Payer: Hamaspik Choice Inc Medicare	$146.00

MINI PLT, 4 HOLES

Facility

$164.00

Service Code	HCPCS C1781
Hospital Charge Code	40209737
Hospital Revenue Code	278
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$172.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$98.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$94.30
Rate for Payer: EmblemHealth Commercial	$82.00
Rate for Payer: Fidelis Medicare Advantage	$172.20
Rate for Payer: Group Health Inc Commercial	$82.00
Rate for Payer: Group Health Inc Medicare	$57.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$106.60

MINI PLT, 4 HOLES

Facility

$164.00

Service Code	HCPCS C1781
Hospital Charge Code	40209737
Hospital Revenue Code	278
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$82.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00

MINI PLT, 4 HOLES W/ BAR

Facility

$620.00

Service Code	HCPCS C1781
Hospital Charge Code	40209738
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$651.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$341.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$372.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$310.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$356.50
Rate for Payer: EmblemHealth Commercial	$310.00
Rate for Payer: Fidelis Medicare Advantage	$651.00
Rate for Payer: Group Health Inc Commercial	$310.00
Rate for Payer: Group Health Inc Medicare	$217.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$310.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$403.00

MINI PLT, 4 HOLES W/ BAR

Facility

$620.00

Service Code	HCPCS C1781
Hospital Charge Code	40209738
Hospital Revenue Code	278
Min. Negotiated Rate	$310.00
Max. Negotiated Rate	$310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$310.00

Know your out-of-pocket cost for care.

All Charges