St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TRAB MTL MNBLCK TIB COMPONENT SZ4

Facility

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40200051
Hospital Revenue Code	278
Min. Negotiated Rate	$3,884.00
Max. Negotiated Rate	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00

TRAB MTL MNBLCK TIB COMPONENT SZ5

Facility

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40200052
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,156.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,272.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,660.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,884.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,466.60
Rate for Payer: EmblemHealth Commercial	$3,884.00
Rate for Payer: Fidelis Medicare Advantage	$8,156.40
Rate for Payer: Group Health Inc Commercial	$3,884.00
Rate for Payer: Group Health Inc Medicare	$2,718.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,049.20

TRAB MTL MNBLCK TIB COMPONENT SZ5

Facility

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40200052
Hospital Revenue Code	278
Min. Negotiated Rate	$3,884.00
Max. Negotiated Rate	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00

TRAB MTL MNBLCK TRIB METAL MTL ST

Facility

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40200053
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,329.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,744.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,902.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,585.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,823.44
Rate for Payer: EmblemHealth Commercial	$1,585.60
Rate for Payer: Fidelis Medicare Advantage	$3,329.76
Rate for Payer: Group Health Inc Commercial	$1,585.60
Rate for Payer: Group Health Inc Medicare	$1,109.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,061.28

TRAB MTL MNBLCK TRIB METAL MTL ST

Facility

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40200053
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.60
Max. Negotiated Rate	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.60

TRAB MTL MONOBLK TIB COMP SZ 6

Facility

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40200054
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,329.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,744.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,902.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,585.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,823.44
Rate for Payer: EmblemHealth Commercial	$1,585.60
Rate for Payer: Fidelis Medicare Advantage	$3,329.76
Rate for Payer: Group Health Inc Commercial	$1,585.60
Rate for Payer: Group Health Inc Medicare	$1,109.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,061.28

TRAB MTL MONOBLK TIB COMP SZ 6

Facility

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40200054
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.60
Max. Negotiated Rate	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.60

TRAB MT MOBK TIB 5FEM C-H 10MM HT

Facility

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40009107
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,156.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,272.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,660.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,884.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,466.60
Rate for Payer: EmblemHealth Commercial	$3,884.00
Rate for Payer: Fidelis Medicare Advantage	$8,156.40
Rate for Payer: Group Health Inc Commercial	$3,884.00
Rate for Payer: Group Health Inc Medicare	$2,718.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,049.20

TRAB MT MOBK TIB 5FEM C-H 10MM HT

Facility

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40009107
Hospital Revenue Code	278
Min. Negotiated Rate	$3,884.00
Max. Negotiated Rate	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00

TRACE ELEMENTS

Facility

$49.99

Service Code	HCPCS J3490
Hospital Charge Code	41650203
Hospital Revenue Code	636
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$25.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00

TRACE ELEMENTS

Facility

$49.99

Service Code	HCPCS J3490
Hospital Charge Code	41650203
Hospital Revenue Code	636
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$32.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$29.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.74
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.49

TRACE ELEMENTS

Facility

$49.99

Service Code	HCPCS J3490
Hospital Charge Code	41640203
Hospital Revenue Code	636
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$25.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00

TRACE ELEMENTS

Facility

$49.99

Service Code	HCPCS J3490
Hospital Charge Code	41640203
Hospital Revenue Code	636
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$32.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$29.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.74
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.49

TRACE ELEMENTS INJ

Facility

$6.00

Hospital Charge Code	41640713
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

TRACE ELEMENTS INJ

Facility

$6.00

Hospital Charge Code	41650713
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

TRACE ELEMENTS INJ PEDIATRIC

Facility

$7.00

Hospital Charge Code	41653629
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

TRACE ELEMENTS INJ PEDIATRIC

Facility

$7.00

Hospital Charge Code	41643629
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

TRACE MINERALS CR-CU-MN-ZN 1-100-25-1000 MCG/ML IV SOLN [18266]

Facility

$4.86

Service Code	NDC 00517920325
Hospital Charge Code	00517920325
Hospital Revenue Code	278
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$2.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.43
Rate for Payer: Hamaspik Choice Inc Medicare	$2.43

TRACE MINERALS CR-CU-MN-ZN 1-100-25-1000 MCG/ML IV SOLN [18266]

Facility

$4.86

Service Code	NDC 00517920325
Hospital Charge Code	00517920325
Hospital Revenue Code	278
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$5.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.43
Rate for Payer: Aetna Government	$2.43
Rate for Payer: Brighton Health Commercial	$2.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.79
Rate for Payer: EmblemHealth Commercial	$2.43
Rate for Payer: Fidelis Medicare Advantage	$5.10
Rate for Payer: Group Health Inc Commercial	$2.43
Rate for Payer: Group Health Inc Medicare	$1.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.43
Rate for Payer: Hamaspik Choice Inc Medicare	$2.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.16

TRACE MINERALS CU-MN-SE-ZN 300-55-60-3000 MCG/ML IV SOLN [174502]

Facility

$29.65

Service Code	NDC 00517930525
Hospital Charge Code	00517930525
Hospital Revenue Code	278
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$31.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.83
Rate for Payer: Aetna Government	$14.83
Rate for Payer: Brighton Health Commercial	$17.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.05
Rate for Payer: EmblemHealth Commercial	$14.83
Rate for Payer: Fidelis Medicare Advantage	$31.13
Rate for Payer: Group Health Inc Commercial	$14.83
Rate for Payer: Group Health Inc Medicare	$10.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.83
Rate for Payer: Hamaspik Choice Inc Medicare	$14.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.27

TRACE MINERALS CU-MN-SE-ZN 300-55-60-3000 MCG/ML IV SOLN [174502]

Facility

$29.65

Service Code	NDC 00517930525
Hospital Charge Code	00517930525
Hospital Revenue Code	278
Min. Negotiated Rate	$14.83
Max. Negotiated Rate	$14.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.83
Rate for Payer: Hamaspik Choice Inc Medicare	$14.83

TRACE MINERALS CU-MN-SE-ZN 60-3-6-1000 MCG/ML IV SOLN [181111]

Facility

$27.38

Service Code	NDC 00517930201
Hospital Charge Code	00517930201
Hospital Revenue Code	278
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$28.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.69
Rate for Payer: Aetna Government	$13.69
Rate for Payer: Brighton Health Commercial	$16.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.74
Rate for Payer: EmblemHealth Commercial	$13.69
Rate for Payer: Fidelis Medicare Advantage	$28.75
Rate for Payer: Group Health Inc Commercial	$13.69
Rate for Payer: Group Health Inc Medicare	$9.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.69
Rate for Payer: Hamaspik Choice Inc Medicare	$13.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.80

TRACE MINERALS CU-MN-SE-ZN 60-3-6-1000 MCG/ML IV SOLN [181111]

Facility

$27.38

Service Code	NDC 00517930201
Hospital Charge Code	00517930201
Hospital Revenue Code	278
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.69
Rate for Payer: Hamaspik Choice Inc Medicare	$13.69

TRACE MINERALS CU-MN-SE-ZN 60-3-6-1000 MCG/ML IV SOLN [181111]

Facility

$27.38

Service Code	NDC 00517930225
Hospital Charge Code	00517930225
Hospital Revenue Code	278
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.69
Rate for Payer: Hamaspik Choice Inc Medicare	$13.69

TRACE MINERALS CU-MN-SE-ZN 60-3-6-1000 MCG/ML IV SOLN [181111]

Facility

$27.38

Service Code	NDC 00517930225
Hospital Charge Code	00517930225
Hospital Revenue Code	278
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$28.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.69
Rate for Payer: Aetna Government	$13.69
Rate for Payer: Brighton Health Commercial	$16.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.75
Rate for Payer: EmblemHealth Commercial	$13.69
Rate for Payer: Fidelis Medicare Advantage	$28.75
Rate for Payer: Group Health Inc Commercial	$13.69
Rate for Payer: Group Health Inc Medicare	$9.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.69
Rate for Payer: Hamaspik Choice Inc Medicare	$13.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.80

Know your out-of-pocket cost for care.

All Charges