St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CLINIMIX/DEXTROSE (5/15) 5 % IV SOLN

Facility

$0.05

Service Code	NDC 0338113703
Hospital Charge Code	0338113703
Hospital Revenue Code	258
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: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$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

CLINIMIX/DEXTROSE (8/10) 8 % IV SOLN

Facility

$0.06

Service Code	NDC 0338019404
Hospital Charge Code	0338019404
Hospital Revenue Code	258
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
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: 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: EmblemHealth Commercial	$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	$0.04

CLINIMIX/DEXTROSE (8/10) 8 % IV SOLN

Facility

$0.06

Service Code	NDC 0338019404
Hospital Charge Code	0338019404
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

CLINIMIX/DEXTROSE (8/10) 8 % IV SOLN

Facility

$0.06

Service Code	NDC 0338019401
Hospital Charge Code	0338019401
Hospital Revenue Code	258
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
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: 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: EmblemHealth Commercial	$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	$0.04

CLINIMIX/DEXTROSE (8/10) 8 % IV SOLN

Facility

$0.06

Service Code	NDC 0338019401
Hospital Charge Code	0338019401
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

CLINIMIX E/DEXTROSE (4.25/10) 4.25 % IV SOLN

Facility

$0.06

Service Code	NDC 0338114503
Hospital Charge Code	0338114503
Hospital Revenue Code	258
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
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: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$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	$0.04

CLINIMIX E/DEXTROSE (4.25/10) 4.25 % IV SOLN

Facility

$0.06

Service Code	NDC 0338114503
Hospital Charge Code	0338114503
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

CLINIMIX E/DEXTROSE (4.25/10) 4.25 % IV SOLN

Facility

$0.05

Service Code	NDC 0338111504
Hospital Charge Code	0338111504
Hospital Revenue Code	258
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

CLINIMIX E/DEXTROSE (4.25/10) 4.25 % IV SOLN

Facility

$0.05

Service Code	NDC 0338111504
Hospital Charge Code	0338111504
Hospital Revenue Code	258
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	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

CLINIMIX E/DEXTROSE (4.25/5) 4.25 % IV SOLN

Facility

$0.05

Service Code	NDC 0338114403
Hospital Charge Code	0338114403
Hospital Revenue Code	258
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: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$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

CLINIMIX E/DEXTROSE (4.25/5) 4.25 % IV SOLN

Facility

$0.05

Service Code	NDC 0338111304
Hospital Charge Code	0338111304
Hospital Revenue Code	258
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

CLINIMIX E/DEXTROSE (4.25/5) 4.25 % IV SOLN

Facility

$0.05

Service Code	NDC 0338111304
Hospital Charge Code	0338111304
Hospital Revenue Code	258
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	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

CLINIMIX E/DEXTROSE (4.25/5) 4.25 % IV SOLN

Facility

$0.05

Service Code	NDC 0338114403
Hospital Charge Code	0338114403
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

CLINIMIX E/DEXTROSE (5/15) 5 % IV SOLN

Facility

$0.05

Service Code	NDC 0338112304
Hospital Charge Code	0338112304
Hospital Revenue Code	258
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: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$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

CLINIMIX E/DEXTROSE (5/15) 5 % IV SOLN

Facility

$0.05

Service Code	NDC 0338114703
Hospital Charge Code	0338114703
Hospital Revenue Code	258
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: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$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	$0.04

CLINIMIX E/DEXTROSE (5/15) 5 % IV SOLN

Facility

$0.05

Service Code	NDC 0338114703
Hospital Charge Code	0338114703
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

CLINIMIX E/DEXTROSE (5/15) 5 % IV SOLN

Facility

$0.05

Service Code	NDC 0338112304
Hospital Charge Code	0338112304
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

CLINIMIX E/DEXTROSE (8/10) 8 % IV SOLN

Facility

$0.08

Service Code	NDC 0338021006
Hospital Charge Code	0338021006
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

CLINIMIX E/DEXTROSE (8/10) 8 % IV SOLN

Facility

$0.08

Service Code	NDC 0338021006
Hospital Charge Code	0338021006
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

CLOBAZAM 10 MG PO TABS

Facility

$18.31

Service Code	NDC 0832058011
Hospital Charge Code	0832058011
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.15

CLOBAZAM 10 MG PO TABS

Facility

$18.31

Service Code	NDC 0832058011
Hospital Charge Code	0832058011
Hospital Revenue Code	250
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$14.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.15
Rate for Payer: Aetna Government	$9.15
Rate for Payer: Brighton Health Commercial	$13.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.45
Rate for Payer: EmblemHealth Commercial	$9.15
Rate for Payer: Group Health Inc Commercial	$9.15
Rate for Payer: Group Health Inc Medicare	$6.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.15
Rate for Payer: Hamaspik Choice Inc Medicare	$9.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.90

CLOBAZAM 10 MG PO TABS

Facility

$35.78

Service Code	NDC 6738631401
Hospital Charge Code	6738631401
Hospital Revenue Code	250
Min. Negotiated Rate	$12.52
Max. Negotiated Rate	$28.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.89
Rate for Payer: Aetna Government	$17.89
Rate for Payer: Brighton Health Commercial	$26.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.33
Rate for Payer: EmblemHealth Commercial	$17.89
Rate for Payer: Group Health Inc Commercial	$17.89
Rate for Payer: Group Health Inc Medicare	$12.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.89
Rate for Payer: Hamaspik Choice Inc Medicare	$17.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.26

CLOBAZAM 10 MG PO TABS

Facility

$19.00

Service Code	NDC 4257131501
Hospital Charge Code	4257131501
Hospital Revenue Code	250
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$15.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.50
Rate for Payer: Aetna Government	$9.50
Rate for Payer: Brighton Health Commercial	$14.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.92
Rate for Payer: EmblemHealth Commercial	$9.50
Rate for Payer: Group Health Inc Commercial	$9.50
Rate for Payer: Group Health Inc Medicare	$6.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.35

CLOBAZAM 10 MG PO TABS

Facility

$19.00

Service Code	NDC 4257131501
Hospital Charge Code	4257131501
Hospital Revenue Code	250
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$9.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50

CLOBAZAM 10 MG PO TABS

Facility

$35.78

Service Code	NDC 6738631401
Hospital Charge Code	6738631401
Hospital Revenue Code	250
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.89

Know your out-of-pocket cost for care.

All Charges