St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TROCHANTERIC PLATE

Facility

$4,368.00

Service Code	HCPCS C1713
Hospital Charge Code	40209865
Hospital Revenue Code	278
Min. Negotiated Rate	$2,184.00
Max. Negotiated Rate	$2,184.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,184.00

TROCH PLT PROV, NARROW, LEFT

Facility

$823.18

Service Code	HCPCS C1713
Hospital Charge Code	40006817
Hospital Revenue Code	278
Min. Negotiated Rate	$411.59
Max. Negotiated Rate	$411.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.59
Rate for Payer: Hamaspik Choice Inc Medicare	$411.59

TROCH PLT PROV, NARROW, LEFT

Facility

$823.18

Service Code	HCPCS C1713
Hospital Charge Code	40006817
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$864.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$452.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$493.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$411.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$473.33
Rate for Payer: EmblemHealth Commercial	$411.59
Rate for Payer: Fidelis Medicare Advantage	$864.34
Rate for Payer: Group Health Inc Commercial	$411.59
Rate for Payer: Group Health Inc Medicare	$288.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.59
Rate for Payer: Hamaspik Choice Inc Medicare	$411.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$535.07

TROCH PLT PROV, WIDE, LEFT

Facility

$823.18

Service Code	HCPCS C1713
Hospital Charge Code	40006819
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$864.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$452.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$493.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$411.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$473.33
Rate for Payer: EmblemHealth Commercial	$411.59
Rate for Payer: Fidelis Medicare Advantage	$864.34
Rate for Payer: Group Health Inc Commercial	$411.59
Rate for Payer: Group Health Inc Medicare	$288.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.59
Rate for Payer: Hamaspik Choice Inc Medicare	$411.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$535.07

TROCH PLT PROV, WIDE, LEFT

Facility

$823.18

Service Code	HCPCS C1713
Hospital Charge Code	40006819
Hospital Revenue Code	278
Min. Negotiated Rate	$411.59
Max. Negotiated Rate	$411.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.59
Rate for Payer: Hamaspik Choice Inc Medicare	$411.59

TROCH PLT PROV, WIDE, RIGHT

Facility

$823.18

Service Code	HCPCS C1713
Hospital Charge Code	40006818
Hospital Revenue Code	278
Min. Negotiated Rate	$411.59
Max. Negotiated Rate	$411.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.59
Rate for Payer: Hamaspik Choice Inc Medicare	$411.59

TROCH PLT PROV, WIDE, RIGHT

Facility

$823.18

Service Code	HCPCS C1713
Hospital Charge Code	40006818
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$864.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$452.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$493.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$411.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$473.33
Rate for Payer: EmblemHealth Commercial	$411.59
Rate for Payer: Fidelis Medicare Advantage	$864.34
Rate for Payer: Group Health Inc Commercial	$411.59
Rate for Payer: Group Health Inc Medicare	$288.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.59
Rate for Payer: Hamaspik Choice Inc Medicare	$411.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$535.07

TROC PLT PROV, NARROW, RIGHT

Facility

$823.18

Service Code	HCPCS C1713
Hospital Charge Code	40006816
Hospital Revenue Code	278
Min. Negotiated Rate	$411.59
Max. Negotiated Rate	$411.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.59
Rate for Payer: Hamaspik Choice Inc Medicare	$411.59

TROC PLT PROV, NARROW, RIGHT

Facility

$823.18

Service Code	HCPCS C1713
Hospital Charge Code	40006816
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$864.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$452.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$493.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$411.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$473.33
Rate for Payer: EmblemHealth Commercial	$411.59
Rate for Payer: Fidelis Medicare Advantage	$864.34
Rate for Payer: Group Health Inc Commercial	$411.59
Rate for Payer: Group Health Inc Medicare	$288.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.59
Rate for Payer: Hamaspik Choice Inc Medicare	$411.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$535.07

TROFILE(R)

Facility

$4,900.00

Service Code	HCPCS 87999
Hospital Charge Code	40609155
Hospital Revenue Code	300
Min. Negotiated Rate	$5.31
Max. Negotiated Rate	$3,675.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,695.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,450.00
Rate for Payer: Aetna Government	$2,450.00
Rate for Payer: Brighton Health Commercial	$3,675.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.31
Rate for Payer: Group Health Inc Commercial	$2,450.00
Rate for Payer: Group Health Inc Medicare	$1,715.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,450.00

TROMETHAMINE 30 MEQ/100ML IV SOLN [11608]

Facility

$0.86

Service Code	NDC 00409159304
Hospital Charge Code	00409159304
Hospital Revenue Code	278
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.43
Rate for Payer: Hamaspik Choice Inc Medicare	$0.43

TROMETHAMINE 30 MEQ/100ML IV SOLN [11608]

Facility

$0.86

Service Code	NDC 00409159304
Hospital Charge Code	00409159304
Hospital Revenue Code	278
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.43
Rate for Payer: Aetna Government	$0.43
Rate for Payer: Brighton Health Commercial	$0.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
Rate for Payer: EmblemHealth Commercial	$0.43
Rate for Payer: Fidelis Medicare Advantage	$0.90
Rate for Payer: Group Health Inc Commercial	$0.43
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.43
Rate for Payer: Hamaspik Choice Inc Medicare	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.56

TROMETHAMINE 36MG/ML 500ML

Facility

$303.40

Hospital Charge Code	41648443
Hospital Revenue Code	250
Min. Negotiated Rate	$106.19
Max. Negotiated Rate	$242.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$166.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$151.70
Rate for Payer: Aetna Government	$151.70
Rate for Payer: Brighton Health Commercial	$227.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$242.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$206.31
Rate for Payer: Group Health Inc Commercial	$151.70
Rate for Payer: Group Health Inc Medicare	$106.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.70
Rate for Payer: Hamaspik Choice Inc Medicare	$151.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.21

TROMETHAMINE 36MG/ML 500ML

Facility

$303.40

Hospital Charge Code	41658443
Hospital Revenue Code	250
Min. Negotiated Rate	$106.19
Max. Negotiated Rate	$242.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$166.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$151.70
Rate for Payer: Aetna Government	$151.70
Rate for Payer: Brighton Health Commercial	$227.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$242.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$206.31
Rate for Payer: Group Health Inc Commercial	$151.70
Rate for Payer: Group Health Inc Medicare	$106.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.70
Rate for Payer: Hamaspik Choice Inc Medicare	$151.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.21

TRONOGESTREL 68MG

Facility

$39.30

Service Code	HCPCS J7307
Hospital Charge Code	41646614
Hospital Revenue Code	636
Min. Negotiated Rate	$13.76
Max. Negotiated Rate	$1,030.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,030.64
Rate for Payer: Aetna Government	$1,030.64
Rate for Payer: Brighton Health Commercial	$23.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.60
Rate for Payer: Group Health Inc Commercial	$19.65
Rate for Payer: Group Health Inc Medicare	$13.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.65
Rate for Payer: Hamaspik Choice Inc Medicare	$19.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.54

TRONOGESTREL 68MG

Facility

$39.30

Service Code	HCPCS J7307
Hospital Charge Code	41646614
Hospital Revenue Code	636
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.65
Rate for Payer: Hamaspik Choice Inc Medicare	$19.65

TROPICAL LIQUID NUTRITION PO LIQD [137181]

Facility

$0.19

Service Code	NDC 68094012061
Hospital Charge Code	68094012061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

TROPICAL LIQUID NUTRITION PO LIQD [137181]

Facility

$0.11

Service Code	NDC 17856502301
Hospital Charge Code	17856502301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
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	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
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

TROPICAL LIQUID NUTRITION PO LIQD [137181]

Facility

$0.03

Service Code	NDC 54629080098
Hospital Charge Code	54629080098
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
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	$0.02

TROPICAL LIQUID NUTRITION PO LIQD [137181]

Facility

$0.17

Service Code	NDC 81033050150
Hospital Charge Code	81033050150
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
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: 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	$0.11

TROPICAL LIQUID NUTRITION PO LIQD [137181]

Facility

$0.19

Service Code	NDC 68094012059
Hospital Charge Code	68094012059
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

TROPICAMIDE 0.5% OPHTHALMIC SOLN 15 ML

Facility

$9.60

Hospital Charge Code	41651152
Hospital Revenue Code	250
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$7.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.80
Rate for Payer: Aetna Government	$4.80
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.53
Rate for Payer: Group Health Inc Commercial	$4.80
Rate for Payer: Group Health Inc Medicare	$3.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.80
Rate for Payer: Hamaspik Choice Inc Medicare	$4.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.24

TROPICAMIDE 0.5% OPHTHALMIC SOLN 15 ML

Facility

$9.60

Hospital Charge Code	41641152
Hospital Revenue Code	250
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$7.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.80
Rate for Payer: Aetna Government	$4.80
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.53
Rate for Payer: Group Health Inc Commercial	$4.80
Rate for Payer: Group Health Inc Medicare	$3.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.80
Rate for Payer: Hamaspik Choice Inc Medicare	$4.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.24

TROPICAMIDE 0.5 % OP SOLN [8249]

Facility

$0.67

Service Code	NDC 17478010112
Hospital Charge Code	17478010112
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

TROPICAMIDE 0.5 % OP SOLN [8249]

Facility

$1.78

Service Code	NDC 61314035401
Hospital Charge Code	61314035401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.89
Rate for Payer: Aetna Government	$0.89
Rate for Payer: Brighton Health Commercial	$1.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.21
Rate for Payer: Group Health Inc Commercial	$0.89
Rate for Payer: Group Health Inc Medicare	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.89
Rate for Payer: Hamaspik Choice Inc Medicare	$0.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.16

Know your out-of-pocket cost for care.

All Charges