St. Barnabas Hospital

All Charges

Charge

Type

Price

AZTREONAM 500MG/D5W ML IVPB

Facility OP

$14.00

Service Code	HCPCS J3490
Hospital Charge Code	41658028
Hospital Revenue Code	636
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$9.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.00
Rate for Payer: Aetna Government	$7.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.05
Rate for Payer: Group Health Inc Commercial	$7.00
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.10

AZTREONAM 500MG/D5W ML IVPB

Facility IP

$14.00

Service Code	HCPCS J3490
Hospital Charge Code	41648028
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00

AZTREONAM 500MG/D5W ML IVPB

Facility IP

$14.00

Service Code	HCPCS J3490
Hospital Charge Code	41658028
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00

AZTREONAM 500MG/D5W ML IVPB

Facility OP

$14.00

Service Code	HCPCS J3490
Hospital Charge Code	41648028
Hospital Revenue Code	636
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$9.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.00
Rate for Payer: Aetna Government	$7.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.05
Rate for Payer: Group Health Inc Commercial	$7.00
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.10

AZTREONAM IVP < 2000MG

Facility IP

$33.80

Service Code	HCPCS S0073
Hospital Charge Code	41657824
Hospital Revenue Code	636
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$16.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.90
Rate for Payer: Hamaspik Choice Inc Medicare	$16.90

AZTREONAM IVP < 2000MG

Facility OP

$33.80

Service Code	HCPCS S0073
Hospital Charge Code	41647825
Hospital Revenue Code	636
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$21.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.01
Rate for Payer: Aetna Government	$12.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.44
Rate for Payer: Group Health Inc Commercial	$16.90
Rate for Payer: Group Health Inc Medicare	$11.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.90
Rate for Payer: Hamaspik Choice Inc Medicare	$16.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.97

AZTREONAM IVP < 2000MG

Facility OP

$33.80

Service Code	HCPCS S0073
Hospital Charge Code	41657825
Hospital Revenue Code	636
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$21.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.01
Rate for Payer: Aetna Government	$12.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.44
Rate for Payer: Group Health Inc Commercial	$16.90
Rate for Payer: Group Health Inc Medicare	$11.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.90
Rate for Payer: Hamaspik Choice Inc Medicare	$16.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.97

AZTREONAM IVP < 2000MG

Facility OP

$33.80

Service Code	HCPCS S0073
Hospital Charge Code	41647824
Hospital Revenue Code	636
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$21.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.01
Rate for Payer: Aetna Government	$12.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.44
Rate for Payer: Group Health Inc Commercial	$16.90
Rate for Payer: Group Health Inc Medicare	$11.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.90
Rate for Payer: Hamaspik Choice Inc Medicare	$16.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.97

AZTREONAM IVP < 2000MG

Facility IP

$33.80

Service Code	HCPCS S0073
Hospital Charge Code	41647824
Hospital Revenue Code	636
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$16.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.90
Rate for Payer: Hamaspik Choice Inc Medicare	$16.90

AZTREONAM IVP < 2000MG

Facility OP

$33.80

Service Code	HCPCS S0073
Hospital Charge Code	41657824
Hospital Revenue Code	636
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$21.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.01
Rate for Payer: Aetna Government	$12.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.44
Rate for Payer: Group Health Inc Commercial	$16.90
Rate for Payer: Group Health Inc Medicare	$11.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.90
Rate for Payer: Hamaspik Choice Inc Medicare	$16.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.97

AZTREONAM IVP < 2000MG

Facility IP

$33.80

Service Code	HCPCS S0073
Hospital Charge Code	41657825
Hospital Revenue Code	636
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$16.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.90
Rate for Payer: Hamaspik Choice Inc Medicare	$16.90

AZTREONAM IVP < 2000MG

Facility IP

$33.80

Service Code	HCPCS S0073
Hospital Charge Code	41647825
Hospital Revenue Code	636
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$16.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.90
Rate for Payer: Hamaspik Choice Inc Medicare	$16.90

B12 RIA

Facility OP

$37.70

Service Code	HCPCS 82607
Hospital Charge Code	40602365
Hospital Revenue Code	301
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$23.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.08
Rate for Payer: Aetna Government	$15.08
Rate for Payer: Cash Price	$15.08
Rate for Payer: Cash Price	$15.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.28
Rate for Payer: Elderplan Medicare Advantage	$15.08
Rate for Payer: EmblemHealth Commercial	$15.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$13.57
Rate for Payer: Fidelis Essential Plan Aliesa	$12.82
Rate for Payer: Fidelis Essential Plan QHP	$13.42
Rate for Payer: Fidelis Medicare Advantage	$15.08
Rate for Payer: Fidelis Qualified Health Plan	$13.42
Rate for Payer: Group Health Inc Commercial	$15.08
Rate for Payer: Group Health Inc Medicare	$15.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.85
Rate for Payer: Hamaspik Choice Inc Medicare	$15.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15.08
Rate for Payer: Healthfirst Medicare Advantage	$15.08
Rate for Payer: Healthfirst QHP	$15.08
Rate for Payer: Senior Whole Health Medicare Advantage	$15.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.06
Rate for Payer: Wellcare Medicare	$13.57

B2-GLYCOPROTEIN I AB (IGG)

Facility OP

$63.63

Service Code	HCPCS 86146
Hospital Charge Code	40728345
Hospital Revenue Code	302
Min. Negotiated Rate	$20.36
Max. Negotiated Rate	$40.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.45
Rate for Payer: Aetna Government	$25.45
Rate for Payer: Cash Price	$25.45
Rate for Payer: Cash Price	$25.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$25.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.21
Rate for Payer: Elderplan Medicare Advantage	$25.45
Rate for Payer: EmblemHealth Commercial	$25.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22.90
Rate for Payer: Fidelis Essential Plan Aliesa	$21.63
Rate for Payer: Fidelis Essential Plan QHP	$22.65
Rate for Payer: Fidelis Medicare Advantage	$25.45
Rate for Payer: Fidelis Qualified Health Plan	$22.65
Rate for Payer: Group Health Inc Commercial	$25.45
Rate for Payer: Group Health Inc Medicare	$25.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.82
Rate for Payer: Hamaspik Choice Inc Medicare	$25.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.45
Rate for Payer: Healthfirst Medicare Advantage	$25.45
Rate for Payer: Healthfirst QHP	$25.45
Rate for Payer: Senior Whole Health Medicare Advantage	$25.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.36
Rate for Payer: Wellcare Medicare	$22.90

BACITRACIN

Facility OP

$28.35

Hospital Charge Code	40200602
Hospital Revenue Code	270
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$22.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.18
Rate for Payer: Aetna Government	$14.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.28
Rate for Payer: Group Health Inc Commercial	$14.18
Rate for Payer: Group Health Inc Medicare	$9.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.18
Rate for Payer: Hamaspik Choice Inc Medicare	$14.18

BACITRACIN 50,000 UNITS INJ

Facility OP

$9.00

Hospital Charge Code	41653123
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$7.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.12
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

BACITRACIN 50,000 UNITS INJ

Facility IP

$9.00

Service Code	HCPCS J3490
Hospital Charge Code	41643123
Hospital Revenue Code	636
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50

BACITRACIN 50,000 UNITS INJ

Facility OP

$9.00

Service Code	HCPCS J3490
Hospital Charge Code	41643123
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$5.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.18
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

BACITRACIN OPHTHALMIC OINT

Facility OP

$97.00

Hospital Charge Code	41650586
Hospital Revenue Code	250
Min. Negotiated Rate	$33.95
Max. Negotiated Rate	$77.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.50
Rate for Payer: Aetna Government	$48.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$77.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.96
Rate for Payer: Group Health Inc Commercial	$48.50
Rate for Payer: Group Health Inc Medicare	$33.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.50
Rate for Payer: Hamaspik Choice Inc Medicare	$48.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.05

BACITRACIN OPHTHALMIC OINT

Facility OP

$97.00

Hospital Charge Code	41640586
Hospital Revenue Code	250
Min. Negotiated Rate	$33.95
Max. Negotiated Rate	$77.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.50
Rate for Payer: Aetna Government	$48.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$77.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.96
Rate for Payer: Group Health Inc Commercial	$48.50
Rate for Payer: Group Health Inc Medicare	$33.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.50
Rate for Payer: Hamaspik Choice Inc Medicare	$48.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.05

BACITRACIN + POLYMYXIN B TOPICAL POWDER

Facility OP

$19.28

Hospital Charge Code	41642436
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$15.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.64
Rate for Payer: Aetna Government	$9.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.11
Rate for Payer: Group Health Inc Commercial	$9.64
Rate for Payer: Group Health Inc Medicare	$6.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.64
Rate for Payer: Hamaspik Choice Inc Medicare	$9.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.53

BACITRACIN + POLYMYXIN B TOPICAL POWDER

Facility OP

$19.28

Hospital Charge Code	41652436
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$15.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.64
Rate for Payer: Aetna Government	$9.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.11
Rate for Payer: Group Health Inc Commercial	$9.64
Rate for Payer: Group Health Inc Medicare	$6.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.64
Rate for Payer: Hamaspik Choice Inc Medicare	$9.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.53

BACITRACIN/POLYMYXIN OINT 0.94 G

Facility OP

$1.00

Hospital Charge Code	41655905
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BACITRACIN/POLYMYXIN OINT 0.94G

Facility OP

$1.00

Hospital Charge Code	41645905
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BACITRACIN TOPICAL OINTMENT

Facility OP

$0.05

Hospital Charge Code	41654311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
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	$0.03

Price Transparency.

All Charges