St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TD TOXINS (VFC) 0.5ML IM

Facility

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41649568
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TD TOXINS (VFC) 0.5ML IM

Facility

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41649568
Hospital Revenue Code	636
Max. Negotiated Rate	$26.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TD TOXIODS (VFC) 0.5ML IM VIAL

Facility

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41649569
Hospital Revenue Code	636
Max. Negotiated Rate	$26.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TD TOXIODS (VFC) 0.5ML IM VIAL

Facility

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41649569
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TD TOXIODS (VFC) O.5ML IM

Facility

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41659568
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TD TOXIODS (VFC) O.5ML IM

Facility

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41659568
Hospital Revenue Code	636
Max. Negotiated Rate	$26.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TD TOXOIDS (VFC) 0.5ML IM VIAL

Facility

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41659569
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TD TOXOIDS (VFC) 0.5ML IM VIAL

Facility

$0.01

Service Code	HCPCS 90714
Hospital Charge Code	41659569
Hospital Revenue Code	636
Max. Negotiated Rate	$26.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TD VACCINE, IM

Facility

$56.70

Service Code	HCPCS 90714
Hospital Charge Code	30300145
Hospital Revenue Code	636
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.35
Rate for Payer: Hamaspik Choice Inc Medicare	$28.35

TD VACCINE, IM

Facility

$56.70

Service Code	HCPCS 90714
Hospital Charge Code	30300145
Hospital Revenue Code	636
Min. Negotiated Rate	$19.84
Max. Negotiated Rate	$36.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Brighton Health Commercial	$34.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.60
Rate for Payer: Group Health Inc Commercial	$28.35
Rate for Payer: Group Health Inc Medicare	$19.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.35
Rate for Payer: Hamaspik Choice Inc Medicare	$28.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.86

TD VACCINE NO PRSRV >/= 7 IM

Facility

$75.00

Service Code	HCPCS 90714
Hospital Charge Code	30103323
Hospital Revenue Code	636
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50

TD VACCINE NO PRSRV >/= 7 IM

Facility

$75.00

Service Code	HCPCS 90714
Hospital Charge Code	30103323
Hospital Revenue Code	636
Min. Negotiated Rate	$19.96
Max. Negotiated Rate	$48.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Brighton Health Commercial	$45.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.12
Rate for Payer: Group Health Inc Commercial	$37.50
Rate for Payer: Group Health Inc Medicare	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$48.75

TECHNETIUM PC-99M EXAMETAZIME

Facility

$3,364.25

Service Code	HCPCS A9521
Hospital Charge Code	41646487
Hospital Revenue Code	343
Min. Negotiated Rate	$1,177.49
Max. Negotiated Rate	$2,691.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,850.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,265.82
Rate for Payer: Aetna Government	$1,265.82
Rate for Payer: Brighton Health Commercial	$2,523.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,691.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,287.69
Rate for Payer: Group Health Inc Commercial	$1,682.12
Rate for Payer: Group Health Inc Medicare	$1,177.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,682.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,682.12

TECHNETIUM TC-00M MEDRONATE

Facility

$43.00

Service Code	HCPCS A9503
Hospital Charge Code	41646489
Hospital Revenue Code	343
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$34.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.76
Rate for Payer: Aetna Government	$10.76
Rate for Payer: Brighton Health Commercial	$32.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.24
Rate for Payer: Group Health Inc Commercial	$21.50
Rate for Payer: Group Health Inc Medicare	$15.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.50
Rate for Payer: Hamaspik Choice Inc Medicare	$21.50

TECHNETIUM TC 99M BICISATE IV KIT [187940]

Facility

$4,271.45

Service Code	HCPCS A9540
Hospital Charge Code	11994000602
Hospital Revenue Code	278
Min. Negotiated Rate	$2,135.72
Max. Negotiated Rate	$2,135.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,135.72
Rate for Payer: Hamaspik Choice Inc Medicare	$2,135.72

TECHNETIUM TC 99M BICISATE IV KIT [187940]

Facility

$4,271.45

Service Code	HCPCS A9540
Hospital Charge Code	11994000602
Hospital Revenue Code	278
Min. Negotiated Rate	$24.84
Max. Negotiated Rate	$4,485.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,349.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.84
Rate for Payer: Aetna Government	$24.84
Rate for Payer: Brighton Health Commercial	$2,562.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,135.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,456.08
Rate for Payer: EmblemHealth Commercial	$2,135.72
Rate for Payer: Fidelis Medicare Advantage	$4,485.02
Rate for Payer: Group Health Inc Commercial	$2,135.72
Rate for Payer: Group Health Inc Medicare	$1,495.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,135.72
Rate for Payer: Hamaspik Choice Inc Medicare	$2,135.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,776.44

TECHNETIUM TC-99M EXAMETAZIME

Facility

$3,364.25

Service Code	HCPCS A9521
Hospital Charge Code	41656487
Hospital Revenue Code	343
Min. Negotiated Rate	$1,177.49
Max. Negotiated Rate	$2,691.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,850.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,265.82
Rate for Payer: Aetna Government	$1,265.82
Rate for Payer: Brighton Health Commercial	$2,523.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,691.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,287.69
Rate for Payer: Group Health Inc Commercial	$1,682.12
Rate for Payer: Group Health Inc Medicare	$1,177.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,682.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,682.12

TECHNETIUM TC 99M EXAMETAZIME IV KIT [98453]

Facility

$10,283.81

Service Code	NDC 17156002205
Hospital Charge Code	17156002205
Hospital Revenue Code	278
Min. Negotiated Rate	$5,141.90
Max. Negotiated Rate	$5,141.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,141.90
Rate for Payer: Hamaspik Choice Inc Medicare	$5,141.90

TECHNETIUM TC 99M EXAMETAZIME IV KIT [98453]

Facility

$10,283.81

Service Code	NDC 17156002205
Hospital Charge Code	17156002205
Hospital Revenue Code	278
Min. Negotiated Rate	$3,599.33
Max. Negotiated Rate	$10,798.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,656.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,141.90
Rate for Payer: Aetna Government	$5,141.90
Rate for Payer: Brighton Health Commercial	$6,170.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,141.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,913.19
Rate for Payer: EmblemHealth Commercial	$5,141.90
Rate for Payer: Fidelis Medicare Advantage	$10,798.00
Rate for Payer: Group Health Inc Commercial	$5,141.90
Rate for Payer: Group Health Inc Medicare	$3,599.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,141.90
Rate for Payer: Hamaspik Choice Inc Medicare	$5,141.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,684.48

TECHNETIUM TC 99M EXAMETAZIME IV KIT [98453]

Facility

$2,159.60

Service Code	NDC 17156002505
Hospital Charge Code	17156002505
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.80
Max. Negotiated Rate	$1,079.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.80

TECHNETIUM TC 99M EXAMETAZIME IV KIT [98453]

Facility

$2,159.60

Service Code	NDC 17156002505
Hospital Charge Code	17156002505
Hospital Revenue Code	278
Min. Negotiated Rate	$755.86
Max. Negotiated Rate	$2,267.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,187.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,079.80
Rate for Payer: Aetna Government	$1,079.80
Rate for Payer: Brighton Health Commercial	$1,295.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,079.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,241.77
Rate for Payer: EmblemHealth Commercial	$1,079.80
Rate for Payer: Fidelis Medicare Advantage	$2,267.58
Rate for Payer: Group Health Inc Commercial	$1,079.80
Rate for Payer: Group Health Inc Medicare	$755.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,403.74

TECHNETIUM TC-99M MEBROFENIN

Facility

$129.00

Service Code	HCPCS A9537
Hospital Charge Code	41646563
Hospital Revenue Code	343
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$103.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.80
Rate for Payer: Aetna Government	$45.80
Rate for Payer: Brighton Health Commercial	$96.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.72
Rate for Payer: Group Health Inc Commercial	$64.50
Rate for Payer: Group Health Inc Medicare	$45.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.50
Rate for Payer: Hamaspik Choice Inc Medicare	$64.50

TECHNETIUM TC-99M MEBROFENIN

Facility

$129.00

Service Code	HCPCS A9537
Hospital Charge Code	41656563
Hospital Revenue Code	343
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$103.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.80
Rate for Payer: Aetna Government	$45.80
Rate for Payer: Brighton Health Commercial	$96.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.72
Rate for Payer: Group Health Inc Commercial	$64.50
Rate for Payer: Group Health Inc Medicare	$45.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.50
Rate for Payer: Hamaspik Choice Inc Medicare	$64.50

TECHNETIUM TC 99M MEBROFENIN [40840063]

Facility

$49.52

Service Code	NDC 09999408442
Hospital Charge Code	09999408442
Hospital Revenue Code	250
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$39.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.76
Rate for Payer: Aetna Government	$24.76
Rate for Payer: Brighton Health Commercial	$37.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.67
Rate for Payer: Group Health Inc Commercial	$24.76
Rate for Payer: Group Health Inc Medicare	$17.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.76
Rate for Payer: Hamaspik Choice Inc Medicare	$24.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.19

TECHNETIUM TC 99M MEBROFENIN IV KIT [103948]

Facility

$113.46

Service Code	HCPCS A9537
Hospital Charge Code	45567045501
Hospital Revenue Code	278
Min. Negotiated Rate	$56.73
Max. Negotiated Rate	$56.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.73
Rate for Payer: Hamaspik Choice Inc Medicare	$56.73

Know your out-of-pocket cost for care.

All Charges