St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CLOPIDOGREL BISULFATE 75 MG PO TABS

Facility

$4.36

Service Code	NDC 0904629461
Hospital Charge Code	0904629461
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$3.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.18
Rate for Payer: Aetna Government	$2.18
Rate for Payer: Brighton Health Commercial	$3.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.97
Rate for Payer: EmblemHealth Commercial	$2.18
Rate for Payer: Group Health Inc Commercial	$2.18
Rate for Payer: Group Health Inc Medicare	$1.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.18
Rate for Payer: Hamaspik Choice Inc Medicare	$2.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.84

CLOPIDOGREL BISULFATE 75 MG PO TABS

Facility

$6.81

Service Code	NDC 6808453611
Hospital Charge Code	6808453611
Hospital Revenue Code	250
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$5.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.41
Rate for Payer: Aetna Government	$3.41
Rate for Payer: Brighton Health Commercial	$5.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.63
Rate for Payer: EmblemHealth Commercial	$3.41
Rate for Payer: Group Health Inc Commercial	$3.41
Rate for Payer: Group Health Inc Medicare	$2.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.41
Rate for Payer: Hamaspik Choice Inc Medicare	$3.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.43

CLOPIDOGREL BISULFATE 75 MG PO TABS

Facility

$6.96

Service Code	NDC 5511119690
Hospital Charge Code	5511119690
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.48
Rate for Payer: Aetna Government	$3.48
Rate for Payer: Brighton Health Commercial	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.73
Rate for Payer: EmblemHealth Commercial	$3.48
Rate for Payer: Group Health Inc Commercial	$3.48
Rate for Payer: Group Health Inc Medicare	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.48
Rate for Payer: Hamaspik Choice Inc Medicare	$3.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.52

CLOPIDOGREL BISULFATE 75 MG PO TABS

Facility

$4.36

Service Code	NDC 0904629461
Hospital Charge Code	0904629461
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.18

CLOPIDOGREL BISULFATE 75 MG PO TABS

Facility

$6.96

Service Code	NDC 5022812405
Hospital Charge Code	5022812405
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.48
Rate for Payer: Aetna Government	$3.48
Rate for Payer: Brighton Health Commercial	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.73
Rate for Payer: EmblemHealth Commercial	$3.48
Rate for Payer: Group Health Inc Commercial	$3.48
Rate for Payer: Group Health Inc Medicare	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.48
Rate for Payer: Hamaspik Choice Inc Medicare	$3.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.52

CLOSED TREATMENT FX AND DISLOCATION

Facility

$874.61

Service Code	EAPG 00041
Min. Negotiated Rate	$634.12
Max. Negotiated Rate	$874.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$634.12
Rate for Payer: Healthfirst Commercial	$874.61

CLOTRIMAZOLE 10 MG MT TROC

Facility

$1.61

Service Code	NDC 0574010770
Hospital Charge Code	0574010770
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: EmblemHealth Commercial	$0.80
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.05

CLOTRIMAZOLE 10 MG MT TROC

Facility

$1.61

Service Code	NDC 0574010770
Hospital Charge Code	0574010770
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80

CLOTRIMAZOLE 1 % EX CREA

Facility

$0.40

Service Code	NDC 4580243401
Hospital Charge Code	4580243401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

CLOTRIMAZOLE 1 % EX CREA

Facility

$0.57

Service Code	NDC 5167220021
Hospital Charge Code	5167220021
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.39
Rate for Payer: EmblemHealth Commercial	$0.28
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.37

CLOTRIMAZOLE 1 % EX CREA

Facility

$1.33

Service Code	NDC 5167212751
Hospital Charge Code	5167212751
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
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	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: EmblemHealth Commercial	$0.66
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.47
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

CLOTRIMAZOLE 1 % EX CREA

Facility

$1.33

Service Code	NDC 6846218117
Hospital Charge Code	6846218117
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	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: EmblemHealth Commercial	$0.66
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

CLOTRIMAZOLE 1 % EX CREA

Facility

$0.40

Service Code	NDC 4580243401
Hospital Charge Code	4580243401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

CLOTRIMAZOLE 1 % EX CREA

Facility

$1.33

Service Code	NDC 6846218117
Hospital Charge Code	6846218117
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66

CLOTRIMAZOLE 1 % EX CREA

Facility

$1.33

Service Code	NDC 5167212751
Hospital Charge Code	5167212751
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66

CLOTRIMAZOLE 1 % EX CREA

Facility

$0.57

Service Code	NDC 5167220021
Hospital Charge Code	5167220021
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28

CLOTRIMAZOLE 1 % EX SOLN

Facility

$1.64

Service Code	NDC 7139905001
Hospital Charge Code	7139905001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82

CLOTRIMAZOLE 1 % EX SOLN

Facility

$1.64

Service Code	NDC 7139905001
Hospital Charge Code	7139905001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$1.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.11
Rate for Payer: EmblemHealth Commercial	$0.82
Rate for Payer: Group Health Inc Commercial	$0.82
Rate for Payer: Group Health Inc Medicare	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82
Rate for Payer: Hamaspik Choice Inc Medicare	$0.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.06

CLOTRIMAZOLE 1 % EX SOLN

Facility

$4.51

Service Code	NDC 5167220371
Hospital Charge Code	5167220371
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$2.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.26

CLOTRIMAZOLE 1 % EX SOLN

Facility

$4.51

Service Code	NDC 5167220371
Hospital Charge Code	5167220371
Hospital Revenue Code	250
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$3.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$3.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.07
Rate for Payer: EmblemHealth Commercial	$2.26
Rate for Payer: Group Health Inc Commercial	$2.26
Rate for Payer: Group Health Inc Medicare	$1.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.26
Rate for Payer: Hamaspik Choice Inc Medicare	$2.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.93

CLOTRIMAZOLE 1 % VA CREA

Facility

$0.11

Service Code	NDC 6126922063
Hospital Charge Code	6126922063
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

CLOTRIMAZOLE 1 % VA CREA

Facility

$0.11

Service Code	NDC 6126922063
Hospital Charge Code	6126922063
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

CLOTRIMAZOLE 1 % VA CREA

Facility

$0.11

Service Code	NDC 6126922041
Hospital Charge Code	6126922041
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

CLOTRIMAZOLE 1 % VA CREA

Facility

$0.18

Service Code	NDC 5167220036
Hospital Charge Code	5167220036
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
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	$0.12

CLOTRIMAZOLE 1 % VA CREA

Facility

$0.11

Service Code	NDC 6126922041
Hospital Charge Code	6126922041
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

Know your out-of-pocket cost for care.

All Charges