St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SUBSEQUENT ADMIN IM/SQ

Facility

$17.50

Service Code	HCPCS 90461
Hospital Charge Code	30301291
Hospital Revenue Code	771
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Brighton Health Commercial	$13.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.90
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.75
Rate for Payer: Hamaspik Choice Inc Medicare	$8.75

SUBTALAR 9MM HERIZON TITANIUM

Facility

$4,625.00

Service Code	HCPCS C1713
Hospital Charge Code	64901832
Hospital Revenue Code	278
Min. Negotiated Rate	$2,312.50
Max. Negotiated Rate	$2,312.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,312.50

SUBTALAR 9MM HERIZON TITANIUM

Facility

$4,625.00

Service Code	HCPCS C1713
Hospital Charge Code	64901832
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,856.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,543.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,775.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,312.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,659.38
Rate for Payer: EmblemHealth Commercial	$2,312.50
Rate for Payer: Fidelis Medicare Advantage	$4,856.25
Rate for Payer: Group Health Inc Commercial	$2,312.50
Rate for Payer: Group Health Inc Medicare	$1,618.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,312.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,006.25

SUBTALAR HERIZON TITANIUM 10MM

Facility

$4,625.00

Service Code	HCPCS C1713
Hospital Charge Code	64901834
Hospital Revenue Code	278
Min. Negotiated Rate	$2,312.50
Max. Negotiated Rate	$2,312.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,312.50

SUBTALAR HERIZON TITANIUM 10MM

Facility

$4,625.00

Service Code	HCPCS C1713
Hospital Charge Code	64901834
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,856.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,543.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,775.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,312.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,659.38
Rate for Payer: EmblemHealth Commercial	$2,312.50
Rate for Payer: Fidelis Medicare Advantage	$4,856.25
Rate for Payer: Group Health Inc Commercial	$2,312.50
Rate for Payer: Group Health Inc Medicare	$1,618.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,312.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,006.25

SUBTALAR IMPLANT

Facility

$4,326.00

Hospital Charge Code	40203017
Hospital Revenue Code	272
Min. Negotiated Rate	$1,514.10
Max. Negotiated Rate	$3,460.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,379.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,163.00
Rate for Payer: Aetna Government	$2,163.00
Rate for Payer: Brighton Health Commercial	$3,244.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,460.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,941.68
Rate for Payer: Group Health Inc Commercial	$2,163.00
Rate for Payer: Group Health Inc Medicare	$1,514.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,163.00

SUBTALAR MBA IMPLANT 10MM

Facility

$2,720.00

Hospital Charge Code	40209713
Hospital Revenue Code	272
Min. Negotiated Rate	$952.00
Max. Negotiated Rate	$2,176.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,496.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,360.00
Rate for Payer: Aetna Government	$1,360.00
Rate for Payer: Brighton Health Commercial	$2,040.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,849.60
Rate for Payer: Group Health Inc Commercial	$1,360.00
Rate for Payer: Group Health Inc Medicare	$952.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,360.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,360.00

SUBTOT TO HYSTO AFTER CESAR

Facility

$1,341.63

Service Code	HCPCS 59525
Hospital Charge Code	40052239
Hospital Revenue Code	360
Min. Negotiated Rate	$469.57
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$737.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$585.73
Rate for Payer: Aetna Government	$585.73
Rate for Payer: Brighton Health Commercial	$1,006.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$670.82
Rate for Payer: Group Health Inc Medicare	$469.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$670.82
Rate for Payer: Hamaspik Choice Inc Medicare	$670.82

SUCCIMER 100 MG CAP

Facility

$14.18

Hospital Charge Code	41644010
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$11.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.09
Rate for Payer: Aetna Government	$7.09
Rate for Payer: Brighton Health Commercial	$10.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.64
Rate for Payer: Group Health Inc Commercial	$7.09
Rate for Payer: Group Health Inc Medicare	$4.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.09
Rate for Payer: Hamaspik Choice Inc Medicare	$7.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.22

SUCCIMER 100 MG CAP

Facility

$14.18

Hospital Charge Code	41654010
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$11.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.09
Rate for Payer: Aetna Government	$7.09
Rate for Payer: Brighton Health Commercial	$10.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.64
Rate for Payer: Group Health Inc Commercial	$7.09
Rate for Payer: Group Health Inc Medicare	$4.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.09
Rate for Payer: Hamaspik Choice Inc Medicare	$7.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.22

SUCCIMER 100 MG PO CAPS [11438]

Facility

$26.44

Service Code	NDC 55292020111
Hospital Charge Code	55292020111
Hospital Revenue Code	250
Min. Negotiated Rate	$9.25
Max. Negotiated Rate	$21.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.22
Rate for Payer: Aetna Government	$13.22
Rate for Payer: Brighton Health Commercial	$19.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.98
Rate for Payer: Group Health Inc Commercial	$13.22
Rate for Payer: Group Health Inc Medicare	$9.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.22
Rate for Payer: Hamaspik Choice Inc Medicare	$13.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.19

SUCCINYLCHOLINE 100MG/5ML PFS

Facility

$31.25

Service Code	HCPCS J0330
Hospital Charge Code	41650231
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$20.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$18.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.97
Rate for Payer: Group Health Inc Commercial	$15.62
Rate for Payer: Group Health Inc Medicare	$10.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.62
Rate for Payer: Hamaspik Choice Inc Medicare	$15.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.31

SUCCINYLCHOLINE 100MG/5ML PFS

Facility

$31.25

Service Code	HCPCS J0330
Hospital Charge Code	41640231
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$20.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$18.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.97
Rate for Payer: Group Health Inc Commercial	$15.62
Rate for Payer: Group Health Inc Medicare	$10.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.62
Rate for Payer: Hamaspik Choice Inc Medicare	$15.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.31

SUCCINYLCHOLINE 100MG/5ML PFS

Facility

$31.25

Service Code	HCPCS J0330
Hospital Charge Code	41640231
Hospital Revenue Code	636
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$15.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.62
Rate for Payer: Hamaspik Choice Inc Medicare	$15.62

SUCCINYLCHOLINE 100MG/5ML PFS

Facility

$31.25

Service Code	HCPCS J0330
Hospital Charge Code	41650231
Hospital Revenue Code	636
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$15.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.62
Rate for Payer: Hamaspik Choice Inc Medicare	$15.62

SUCCINYLCHOLINE 20 MG/ML INJ

Facility

$0.76

Service Code	HCPCS J0330
Hospital Charge Code	41654141
Hospital Revenue Code	636
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$0.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

SUCCINYLCHOLINE 20 MG/ML INJ

Facility

$0.76

Service Code	HCPCS J0330
Hospital Charge Code	41644141
Hospital Revenue Code	636
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38

SUCCINYLCHOLINE 20 MG/ML INJ

Facility

$0.76

Service Code	HCPCS J0330
Hospital Charge Code	41654141
Hospital Revenue Code	636
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38

SUCCINYLCHOLINE 20 MG/ML INJ

Facility

$0.76

Service Code	HCPCS J0330
Hospital Charge Code	41644141
Hospital Revenue Code	636
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$0.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

SUCCINYLCHOLINE CHLORIDE 100 MG/5ML IV SOSY [132366]

Facility

$3.36

Service Code	NDC 69374092005
Hospital Charge Code	69374092005
Hospital Revenue Code	278
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$3.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$2.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.93
Rate for Payer: EmblemHealth Commercial	$1.68
Rate for Payer: Fidelis Medicare Advantage	$3.53
Rate for Payer: Group Health Inc Commercial	$1.68
Rate for Payer: Group Health Inc Medicare	$1.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.18

SUCCINYLCHOLINE CHLORIDE 100 MG/5ML IV SOSY [132366]

Facility

$3.36

Service Code	NDC 69374092005
Hospital Charge Code	69374092005
Hospital Revenue Code	278
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1.68

SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN [7536]

Facility

$2.30

Service Code	NDC 31722098110
Hospital Charge Code	31722098110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.15
Rate for Payer: Aetna Government	$1.15
Rate for Payer: Brighton Health Commercial	$1.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.57
Rate for Payer: Group Health Inc Commercial	$1.15
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.15
Rate for Payer: Hamaspik Choice Inc Medicare	$1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.50

SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN [7536]

Facility

$2.40

Service Code	NDC 70710137701
Hospital Charge Code	70710137701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.20
Rate for Payer: Aetna Government	$1.20
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.63
Rate for Payer: Group Health Inc Commercial	$1.20
Rate for Payer: Group Health Inc Medicare	$0.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.20
Rate for Payer: Hamaspik Choice Inc Medicare	$1.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.56

SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN [7536]

Facility

$2.33

Service Code	NDC 00409662902
Hospital Charge Code	00409662902
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.16
Rate for Payer: Aetna Government	$1.16
Rate for Payer: Brighton Health Commercial	$1.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.58
Rate for Payer: Group Health Inc Commercial	$1.16
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.51

SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN [7536]

Facility

$0.91

Service Code	NDC 54879003725
Hospital Charge Code	54879003725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.46
Rate for Payer: Aetna Government	$0.46
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.62
Rate for Payer: Group Health Inc Commercial	$0.46
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

Know your out-of-pocket cost for care.

All Charges