St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

URSODIOL 250 MG PO TABS [22660]

Facility

$2.68

Service Code	NDC 49884041201
Hospital Charge Code	49884041201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$2.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.34
Rate for Payer: Aetna Government	$1.34
Rate for Payer: Brighton Health Commercial	$2.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.82
Rate for Payer: Group Health Inc Commercial	$1.34
Rate for Payer: Group Health Inc Medicare	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.74

URSODIOL 250 MG PO TABS [22660]

Facility

$2.68

Service Code	NDC 64380091806
Hospital Charge Code	64380091806
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$2.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.34
Rate for Payer: Aetna Government	$1.34
Rate for Payer: Brighton Health Commercial	$2.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.82
Rate for Payer: Group Health Inc Commercial	$1.34
Rate for Payer: Group Health Inc Medicare	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.74

URSODIOL 250 MG TAB

Facility

$3.09

Hospital Charge Code	41644613
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$2.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.54
Rate for Payer: Aetna Government	$1.54
Rate for Payer: Brighton Health Commercial	$2.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.10
Rate for Payer: Group Health Inc Commercial	$1.54
Rate for Payer: Group Health Inc Medicare	$1.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.01

URSODIOL 250 MG TAB

Facility

$3.09

Hospital Charge Code	41654613
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$2.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.54
Rate for Payer: Aetna Government	$1.54
Rate for Payer: Brighton Health Commercial	$2.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.10
Rate for Payer: Group Health Inc Commercial	$1.54
Rate for Payer: Group Health Inc Medicare	$1.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.01

URSODIOL 25 MG/ML SUSP NEONATAL

Facility

$1.00

Hospital Charge Code	41642484
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

URSODIOL 25 MG/ML SUSP NEONATAL

Facility

$1.00

Hospital Charge Code	41652484
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

URSODIOL 300 MG CAP

Facility

$0.48

Hospital Charge Code	41644038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

URSODIOL 300 MG CAP

Facility

$0.48

Hospital Charge Code	41654038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

URSODIOL 300 MG PO CAPS [11624]

Facility

$7.64

Service Code	NDC 60687010001
Hospital Charge Code	60687010001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$6.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.82
Rate for Payer: Aetna Government	$3.82
Rate for Payer: Brighton Health Commercial	$5.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.20
Rate for Payer: Group Health Inc Commercial	$3.82
Rate for Payer: Group Health Inc Medicare	$2.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.82
Rate for Payer: Hamaspik Choice Inc Medicare	$3.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.97

URSODIOL 300 MG PO CAPS [11624]

Facility

$5.27

Service Code	NDC 00904622161
Hospital Charge Code	00904622161
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$4.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$3.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.58
Rate for Payer: Group Health Inc Commercial	$2.64
Rate for Payer: Group Health Inc Medicare	$1.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.64
Rate for Payer: Hamaspik Choice Inc Medicare	$2.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.43

URSODIOL 300 MG PO CAPS [11624]

Facility

$7.35

Service Code	NDC 69238154001
Hospital Charge Code	69238154001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$5.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.68
Rate for Payer: Aetna Government	$3.68
Rate for Payer: Brighton Health Commercial	$5.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.00
Rate for Payer: Group Health Inc Commercial	$3.68
Rate for Payer: Group Health Inc Medicare	$2.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.68
Rate for Payer: Hamaspik Choice Inc Medicare	$3.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.78

URSODIOL 300 MG PO CAPS [11624]

Facility

$7.64

Service Code	NDC 60687010011
Hospital Charge Code	60687010011
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$6.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.82
Rate for Payer: Aetna Government	$3.82
Rate for Payer: Brighton Health Commercial	$5.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.20
Rate for Payer: Group Health Inc Commercial	$3.82
Rate for Payer: Group Health Inc Medicare	$2.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.82
Rate for Payer: Hamaspik Choice Inc Medicare	$3.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.97

URSODIOL 300 MG PO CAPS [11624]

Facility

$5.27

Service Code	NDC 00904716861
Hospital Charge Code	00904716861
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$4.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$3.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.58
Rate for Payer: Group Health Inc Commercial	$2.64
Rate for Payer: Group Health Inc Medicare	$1.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.64
Rate for Payer: Hamaspik Choice Inc Medicare	$2.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.43

US ABD AORTIC ANEURYSM

Facility

$339.45

Service Code	HCPCS 76706 TC
Hospital Charge Code	41301514
Hospital Revenue Code	402
Rate for Payer: Cash Price	$127.14

US ABD AORTIC ANEURYSM

Facility

$339.45

Service Code	HCPCS 76706 TC
Hospital Charge Code	41301514
Hospital Revenue Code	402
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

US ABDOMINAL COMPLETE

Facility

$339.45

Service Code	HCPCS 76700 TC
Hospital Charge Code	41304002
Hospital Revenue Code	402
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

US ABDOMINAL COMPLETE

Facility

$339.45

Service Code	HCPCS 76700 TC
Hospital Charge Code	41304002
Hospital Revenue Code	402
Rate for Payer: Cash Price	$127.14

US ABDOMINAL LIMITED

Facility

$339.45

Service Code	HCPCS 76705 TC
Hospital Charge Code	41304004
Hospital Revenue Code	402
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

US ABDOMINAL LIMITED

Facility

$339.45

Service Code	HCPCS 76705 TC
Hospital Charge Code	41304004
Hospital Revenue Code	402
Rate for Payer: Cash Price	$127.14

US AORTA/IVC/ILIAC COMPLETE

Facility

$705.83

Service Code	HCPCS 93978 TC
Hospital Charge Code	41307395
Hospital Revenue Code	920
Rate for Payer: Cash Price	$283.37

US AORTA/IVC/ILIAC COMPLETE

Facility

$705.83

Service Code	HCPCS 93978 TC
Hospital Charge Code	41307395
Hospital Revenue Code	920
Min. Negotiated Rate	$247.04
Max. Negotiated Rate	$564.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$352.92
Rate for Payer: Aetna Government	$352.92
Rate for Payer: Brighton Health Commercial	$529.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.96
Rate for Payer: Group Health Inc Commercial	$352.92
Rate for Payer: Group Health Inc Medicare	$247.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$352.92

US AORTA/IVC/ILIAC LIMITED

Facility

$339.45

Service Code	HCPCS 93979 TC
Hospital Charge Code	41307396
Hospital Revenue Code	920
Rate for Payer: Cash Price	$127.14

US AORTA/IVC/ILIAC LIMITED

Facility

$339.45

Service Code	HCPCS 93979 TC
Hospital Charge Code	41307396
Hospital Revenue Code	920
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

US BIOPSY - NEEDLE

Facility

$1,144.39

Service Code	HCPCS 76942 TC
Hospital Charge Code	41304052
Hospital Revenue Code	402
Min. Negotiated Rate	$400.54
Max. Negotiated Rate	$915.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$629.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$572.20
Rate for Payer: Aetna Government	$572.20
Rate for Payer: Brighton Health Commercial	$858.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$915.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$778.19
Rate for Payer: Group Health Inc Commercial	$572.20
Rate for Payer: Group Health Inc Medicare	$400.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.20
Rate for Payer: Hamaspik Choice Inc Medicare	$572.20

US BONE DENSITY MEASURE

Facility

$339.45

Service Code	HCPCS 76977 TC
Hospital Charge Code	41309813
Hospital Revenue Code	402
Rate for Payer: Cash Price	$127.14

Know your out-of-pocket cost for care.

All Charges