St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TROPICAMIDE 1 % OP SOLN

Facility

$2.38

Service Code	NDC 7006912101
Hospital Charge Code	7006912101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.19
Rate for Payer: Aetna Government	$1.19
Rate for Payer: Brighton Health Commercial	$1.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.61
Rate for Payer: EmblemHealth Commercial	$1.19
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.54

TROPICAMIDE 1 % OP SOLN

Facility

$5.00

Service Code	NDC 2420858559
Hospital Charge Code	2420858559
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50

TROPICAMIDE 1 % OP SOLN

Facility

$4.67

Service Code	NDC 6131435501
Hospital Charge Code	6131435501
Hospital Revenue Code	250
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$2.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.33

TROPICAMIDE 1 % OP SOLN

Facility

$2.38

Service Code	NDC 7006912101
Hospital Charge Code	7006912101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.19

TROPICAMIDE 1 % OP SOLN

Facility

$4.67

Service Code	NDC 6131435501
Hospital Charge Code	6131435501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$3.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.33
Rate for Payer: Aetna Government	$2.33
Rate for Payer: Brighton Health Commercial	$3.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.17
Rate for Payer: EmblemHealth Commercial	$2.33
Rate for Payer: Group Health Inc Commercial	$2.33
Rate for Payer: Group Health Inc Medicare	$1.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.33
Rate for Payer: Hamaspik Choice Inc Medicare	$2.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.03

TRYPAN BLUE 0.06 % IO SOSY

Facility

$192.24

Service Code	NDC 6880361210
Hospital Charge Code	6880361210
Hospital Revenue Code	250
Min. Negotiated Rate	$96.12
Max. Negotiated Rate	$96.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.12

TRYPAN BLUE 0.06 % IO SOSY

Facility

$192.24

Service Code	NDC 6880361210
Hospital Charge Code	6880361210
Hospital Revenue Code	250
Min. Negotiated Rate	$67.28
Max. Negotiated Rate	$153.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$105.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.12
Rate for Payer: Aetna Government	$96.12
Rate for Payer: Brighton Health Commercial	$144.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$153.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$130.72
Rate for Payer: EmblemHealth Commercial	$96.12
Rate for Payer: Group Health Inc Commercial	$96.12
Rate for Payer: Group Health Inc Medicare	$67.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.12
Rate for Payer: Hamaspik Choice Inc Medicare	$96.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$124.96

TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN

Facility

$115.57

Service Code	NDC 4928175221
Hospital Charge Code	4928175221
Hospital Revenue Code	250
Min. Negotiated Rate	$57.78
Max. Negotiated Rate	$57.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.78

TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN

Facility

$106.60

Service Code	NDC 4202310401
Hospital Charge Code	4202310401
Hospital Revenue Code	250
Min. Negotiated Rate	$37.31
Max. Negotiated Rate	$85.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$53.30
Rate for Payer: Aetna Government	$53.30
Rate for Payer: Brighton Health Commercial	$79.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.49
Rate for Payer: EmblemHealth Commercial	$53.30
Rate for Payer: Group Health Inc Commercial	$53.30
Rate for Payer: Group Health Inc Medicare	$37.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.30
Rate for Payer: Hamaspik Choice Inc Medicare	$53.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.29

TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN

Facility

$106.60

Service Code	NDC 4202310401
Hospital Charge Code	4202310401
Hospital Revenue Code	250
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$53.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.30

TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN

Facility

$115.57

Service Code	NDC 4928175221
Hospital Charge Code	4928175221
Hospital Revenue Code	250
Min. Negotiated Rate	$40.45
Max. Negotiated Rate	$92.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.78
Rate for Payer: Aetna Government	$57.78
Rate for Payer: Brighton Health Commercial	$86.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.59
Rate for Payer: EmblemHealth Commercial	$57.78
Rate for Payer: Group Health Inc Commercial	$57.78
Rate for Payer: Group Health Inc Medicare	$40.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.78
Rate for Payer: Hamaspik Choice Inc Medicare	$57.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75.12

TUBE REPLACEMENT, REVISION OR REMOVAL

Facility

$624.22

Service Code	EAPG 00421
Min. Negotiated Rate	$453.60
Max. Negotiated Rate	$624.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$453.60
Rate for Payer: Healthfirst Commercial	$624.22

TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOSY

Facility

$319.06

Service Code	NDC 4928179051
Hospital Charge Code	4928179051
Hospital Revenue Code	250
Min. Negotiated Rate	$159.53
Max. Negotiated Rate	$159.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.53

TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOSY

Facility

$319.06

Service Code	NDC 4928179051
Hospital Charge Code	4928179051
Hospital Revenue Code	250
Min. Negotiated Rate	$111.67
Max. Negotiated Rate	$255.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$175.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$159.53
Rate for Payer: Aetna Government	$159.53
Rate for Payer: Brighton Health Commercial	$239.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$255.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$216.96
Rate for Payer: EmblemHealth Commercial	$159.53
Rate for Payer: Group Health Inc Commercial	$159.53
Rate for Payer: Group Health Inc Medicare	$111.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.53
Rate for Payer: Hamaspik Choice Inc Medicare	$159.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$207.39

ULIPRISTAL ACETATE 30 MG PO TABS

Facility

$46.50

Service Code	NDC 7330245601
Hospital Charge Code	7330245601
Hospital Revenue Code	250
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$23.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.25

ULIPRISTAL ACETATE 30 MG PO TABS

Facility

$46.50

Service Code	NDC 7330245601
Hospital Charge Code	7330245601
Hospital Revenue Code	250
Min. Negotiated Rate	$16.27
Max. Negotiated Rate	$37.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.25
Rate for Payer: Aetna Government	$23.25
Rate for Payer: Brighton Health Commercial	$34.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.62
Rate for Payer: EmblemHealth Commercial	$23.25
Rate for Payer: Group Health Inc Commercial	$23.25
Rate for Payer: Group Health Inc Medicare	$16.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.25
Rate for Payer: Hamaspik Choice Inc Medicare	$23.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.23

ULTRASOUND GUIDANCE

Facility

$368.38

Service Code	EAPG 00472
Min. Negotiated Rate	$268.46
Max. Negotiated Rate	$368.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$268.46
Rate for Payer: Healthfirst Commercial	$368.38

UNNA-FLEX ELASTIC UNNA BOOT EX MISC

Facility

$13.71

Service Code	NDC 6845510764
Hospital Charge Code	6845510764
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$10.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.86
Rate for Payer: Aetna Government	$6.86
Rate for Payer: Brighton Health Commercial	$10.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.32
Rate for Payer: EmblemHealth Commercial	$6.86
Rate for Payer: Group Health Inc Commercial	$6.86
Rate for Payer: Group Health Inc Medicare	$4.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.86
Rate for Payer: Hamaspik Choice Inc Medicare	$6.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.91

UNNA-FLEX ELASTIC UNNA BOOT EX MISC

Facility

$12.22

Service Code	NDC 6845510763
Hospital Charge Code	6845510763
Hospital Revenue Code	250
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$6.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.11

UNNA-FLEX ELASTIC UNNA BOOT EX MISC

Facility

$13.71

Service Code	NDC 6845510764
Hospital Charge Code	6845510764
Hospital Revenue Code	250
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$6.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.86

UNNA-FLEX ELASTIC UNNA BOOT EX MISC

Facility

$12.22

Service Code	NDC 6845510763
Hospital Charge Code	6845510763
Hospital Revenue Code	250
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$9.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.11
Rate for Payer: Aetna Government	$6.11
Rate for Payer: Brighton Health Commercial	$9.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.31
Rate for Payer: EmblemHealth Commercial	$6.11
Rate for Payer: Group Health Inc Commercial	$6.11
Rate for Payer: Group Health Inc Medicare	$4.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.11
Rate for Payer: Hamaspik Choice Inc Medicare	$6.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.94

UREA 20 % EX CREA

Facility

$0.14

Service Code	NDC 5898061030
Hospital Charge Code	5898061030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

UREA 20 % EX CREA

Facility

$0.10

Service Code	NDC 4452361803
Hospital Charge Code	4452361803
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

UREA 20 % EX CREA

Facility

$0.17

Service Code	NDC 5026882085
Hospital Charge Code	5026882085
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

UREA 20 % EX CREA

Facility

$0.17

Service Code	NDC 7139984343
Hospital Charge Code	7139984343
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

Know your out-of-pocket cost for care.

All Charges