St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CAFFEINE CITRATE 60 MG/3ML IV SOLN [109034]

Facility

$4.40

Service Code	NDC 72485010410
Hospital Charge Code	72485010410
Hospital Revenue Code	278
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$2.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.20
Rate for Payer: Hamaspik Choice Inc Medicare	$2.20

CAGE ANCHOR-C 11 X 12 X 14 X 4DEG

Facility

$11,737.46

Hospital Charge Code	64906589
Hospital Revenue Code	279
Min. Negotiated Rate	$4,108.11
Max. Negotiated Rate	$9,389.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,455.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,868.73
Rate for Payer: Aetna Government	$5,868.73
Rate for Payer: Brighton Health Commercial	$8,803.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,389.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,981.47
Rate for Payer: Group Health Inc Commercial	$5,868.73
Rate for Payer: Group Health Inc Medicare	$4,108.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,868.73
Rate for Payer: Hamaspik Choice Inc Medicare	$5,868.73

CAGE ANCHOR-C 6X12X14X4DG-4832106

Facility

$5,868.73

Service Code	HCPCS C1713
Hospital Charge Code	64906389
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,162.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,227.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,521.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,934.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,374.52
Rate for Payer: EmblemHealth Commercial	$2,934.36
Rate for Payer: Fidelis Medicare Advantage	$6,162.17
Rate for Payer: Group Health Inc Commercial	$2,934.36
Rate for Payer: Group Health Inc Medicare	$2,054.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,934.36
Rate for Payer: Hamaspik Choice Inc Medicare	$2,934.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,814.67

CAGE ANCHOR-C 6X12X14X4DG-4832106

Facility

$5,868.73

Service Code	HCPCS C1713
Hospital Charge Code	64906389
Hospital Revenue Code	278
Min. Negotiated Rate	$2,934.36
Max. Negotiated Rate	$2,934.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,934.36
Rate for Payer: Hamaspik Choice Inc Medicare	$2,934.36

CAGE BENGAL 4MM

Facility

$3,930.00

Hospital Charge Code	40205537
Hospital Revenue Code	279
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$3,144.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,161.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,965.00
Rate for Payer: Aetna Government	$1,965.00
Rate for Payer: Brighton Health Commercial	$2,947.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,144.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,672.40
Rate for Payer: Group Health Inc Commercial	$1,965.00
Rate for Payer: Group Health Inc Medicare	$1,375.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,965.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,965.00

CAGE BENGAL 5MM

Facility

$3,440.00

Hospital Charge Code	40200937
Hospital Revenue Code	279
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,752.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,892.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,720.00
Rate for Payer: Aetna Government	$1,720.00
Rate for Payer: Brighton Health Commercial	$2,580.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,752.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,339.20
Rate for Payer: Group Health Inc Commercial	$1,720.00
Rate for Payer: Group Health Inc Medicare	$1,204.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,720.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,720.00

CAGE BENGAL 6MM

Facility

$3,440.00

Hospital Charge Code	40200938
Hospital Revenue Code	279
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,752.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,892.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,720.00
Rate for Payer: Aetna Government	$1,720.00
Rate for Payer: Brighton Health Commercial	$2,580.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,752.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,339.20
Rate for Payer: Group Health Inc Commercial	$1,720.00
Rate for Payer: Group Health Inc Medicare	$1,204.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,720.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,720.00

CAGE BENGAL 7MM

Facility

$3,440.00

Hospital Charge Code	40200939
Hospital Revenue Code	279
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,752.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,892.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,720.00
Rate for Payer: Aetna Government	$1,720.00
Rate for Payer: Brighton Health Commercial	$2,580.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,752.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,339.20
Rate for Payer: Group Health Inc Commercial	$1,720.00
Rate for Payer: Group Health Inc Medicare	$1,204.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,720.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,720.00

CAGE BENGAL 9MM

Facility

$3,550.00

Hospital Charge Code	40205538
Hospital Revenue Code	279
Min. Negotiated Rate	$1,242.50
Max. Negotiated Rate	$2,840.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,952.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,775.00
Rate for Payer: Aetna Government	$1,775.00
Rate for Payer: Brighton Health Commercial	$2,662.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,840.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,414.00
Rate for Payer: Group Health Inc Commercial	$1,775.00
Rate for Payer: Group Health Inc Medicare	$1,242.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,775.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,775.00

CAGE CAPRI 30MM

Facility

$17,812.50

Service Code	HCPCS C1889
Hospital Charge Code	64907491
Hospital Revenue Code	278
Min. Negotiated Rate	$8,906.25
Max. Negotiated Rate	$8,906.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,906.25
Rate for Payer: Hamaspik Choice Inc Medicare	$8,906.25

CAGE CAPRI 30MM

Facility

$17,812.50

Service Code	HCPCS C1889
Hospital Charge Code	64907491
Hospital Revenue Code	278
Min. Negotiated Rate	$6,234.38
Max. Negotiated Rate	$18,703.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,796.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,906.25
Rate for Payer: Aetna Government	$8,906.25
Rate for Payer: Brighton Health Commercial	$10,687.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,906.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,242.19
Rate for Payer: EmblemHealth Commercial	$8,906.25
Rate for Payer: Fidelis Medicare Advantage	$18,703.12
Rate for Payer: Group Health Inc Commercial	$8,906.25
Rate for Payer: Group Health Inc Medicare	$6,234.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,906.25
Rate for Payer: Hamaspik Choice Inc Medicare	$8,906.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,578.12

CAGE COROENT 12X38X28MM XLR

Facility

$16,930.00

Service Code	HCPCS C1713
Hospital Charge Code	64905042
Hospital Revenue Code	278
Min. Negotiated Rate	$8,465.00
Max. Negotiated Rate	$8,465.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,465.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8,465.00

CAGE COROENT 12X38X28MM XLR

Facility

$16,930.00

Service Code	HCPCS C1713
Hospital Charge Code	64905042
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$17,776.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,311.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$10,158.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,465.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,734.75
Rate for Payer: EmblemHealth Commercial	$8,465.00
Rate for Payer: Fidelis Medicare Advantage	$17,776.50
Rate for Payer: Group Health Inc Commercial	$8,465.00
Rate for Payer: Group Health Inc Medicare	$5,925.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,465.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8,465.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,004.50

CAGE SPINE 12 12MM (336612012)

Facility

$1,829.54

Service Code	HCPCS C1713
Hospital Charge Code	64906384
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,921.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,006.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,097.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$914.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,051.99
Rate for Payer: EmblemHealth Commercial	$914.77
Rate for Payer: Fidelis Medicare Advantage	$1,921.02
Rate for Payer: Group Health Inc Commercial	$914.77
Rate for Payer: Group Health Inc Medicare	$640.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$914.77
Rate for Payer: Hamaspik Choice Inc Medicare	$914.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,189.20

CAGE SPINE 12 12MM (336612012)

Facility

$1,829.54

Service Code	HCPCS C1713
Hospital Charge Code	64906384
Hospital Revenue Code	278
Min. Negotiated Rate	$914.77
Max. Negotiated Rate	$914.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$914.77
Rate for Payer: Hamaspik Choice Inc Medicare	$914.77

CAGE SPNL

Facility

$18,750.00

Hospital Charge Code	64907240
Hospital Revenue Code	279
Min. Negotiated Rate	$6,562.50
Max. Negotiated Rate	$15,000.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,312.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9,375.00
Rate for Payer: Aetna Government	$9,375.00
Rate for Payer: Brighton Health Commercial	$14,062.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,750.00
Rate for Payer: Group Health Inc Commercial	$9,375.00
Rate for Payer: Group Health Inc Medicare	$6,562.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9,375.00

CAGE UBOSS 40MM 12 DI (336612040)

Facility

$3,811.42

Service Code	HCPCS C1713
Hospital Charge Code	64906386
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,001.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,096.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,286.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,905.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,191.57
Rate for Payer: EmblemHealth Commercial	$1,905.71
Rate for Payer: Fidelis Medicare Advantage	$4,001.99
Rate for Payer: Group Health Inc Commercial	$1,905.71
Rate for Payer: Group Health Inc Medicare	$1,334.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,905.71
Rate for Payer: Hamaspik Choice Inc Medicare	$1,905.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,477.42

CAGE UBOSS 40MM 12 DI (336612040)

Facility

$3,811.42

Service Code	HCPCS C1713
Hospital Charge Code	64906386
Hospital Revenue Code	278
Min. Negotiated Rate	$1,905.71
Max. Negotiated Rate	$1,905.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,905.71
Rate for Payer: Hamaspik Choice Inc Medicare	$1,905.71

CALAMINE 8-8 % EX LOTN [78879]

Facility

$0.01

Service Code	NDC 00904253321
Hospital Charge Code	00904253321
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

CALAMINE + ZINC OXIDE LOTION 120 ML

Facility

$1.42

Hospital Charge Code	41655113
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.71
Rate for Payer: Aetna Government	$0.71
Rate for Payer: Brighton Health Commercial	$1.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: Group Health Inc Commercial	$0.71
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71
Rate for Payer: Hamaspik Choice Inc Medicare	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.92

CALAMINE + ZINC OXIDE LOTION 120 ML

Facility

$1.42

Hospital Charge Code	41645113
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.71
Rate for Payer: Aetna Government	$0.71
Rate for Payer: Brighton Health Commercial	$1.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: Group Health Inc Commercial	$0.71
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71
Rate for Payer: Hamaspik Choice Inc Medicare	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.92

CAL BMI NORM PARAMETERS

Facility

$0.01

Service Code	HCPCS G8420
Hospital Charge Code	30307854
Hospital Revenue Code	510
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$222.00

CALCANEOUS BONE GRAFT

Facility

$1,580.00

Service Code	HCPCS C1713
Hospital Charge Code	40209551
Hospital Revenue Code	278
Min. Negotiated Rate	$790.00
Max. Negotiated Rate	$790.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$790.00
Rate for Payer: Hamaspik Choice Inc Medicare	$790.00

CALCANEOUS BONE GRAFT

Facility

$1,580.00

Service Code	HCPCS C1713
Hospital Charge Code	40209551
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,659.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$869.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$948.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$790.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$908.50
Rate for Payer: EmblemHealth Commercial	$790.00
Rate for Payer: Fidelis Medicare Advantage	$1,659.00
Rate for Payer: Group Health Inc Commercial	$790.00
Rate for Payer: Group Health Inc Medicare	$553.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$790.00
Rate for Payer: Hamaspik Choice Inc Medicare	$790.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,027.00

CALC BMI ABV UP PARAM F/U

Facility

$0.01

Service Code	HCPCS G8417
Hospital Charge Code	30307862
Hospital Revenue Code	510
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$222.00

Know your out-of-pocket cost for care.

All Charges