St. Barnabas Hospital

All Charges

Charge

Type

Price

CHLORAMPHENICOL 1000 MG INJ

Facility OP

$47.38

Service Code	HCPCS J0720
Hospital Charge Code	41653551
Hospital Revenue Code	636
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$50.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.32
Rate for Payer: Aetna Government	$36.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$45.23
Rate for Payer: Group Health Inc Commercial	$23.69
Rate for Payer: Group Health Inc Medicare	$16.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.69
Rate for Payer: Hamaspik Choice Inc Medicare	$23.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$50.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.80

CHLORAMPHENICOL 1000 MG INJ

Facility IP

$47.38

Service Code	HCPCS J0720
Hospital Charge Code	41643551
Hospital Revenue Code	636
Min. Negotiated Rate	$23.69
Max. Negotiated Rate	$23.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.69
Rate for Payer: Hamaspik Choice Inc Medicare	$23.69

CHLORAMPHENICOL 1000 MG INJ

Facility IP

$47.38

Service Code	HCPCS J0720
Hospital Charge Code	41653551
Hospital Revenue Code	636
Min. Negotiated Rate	$23.69
Max. Negotiated Rate	$23.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.69
Rate for Payer: Hamaspik Choice Inc Medicare	$23.69

CHLORAMPHENICOL 1000 MG INJ

Facility OP

$47.38

Service Code	HCPCS J0720
Hospital Charge Code	41643551
Hospital Revenue Code	636
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$50.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.32
Rate for Payer: Aetna Government	$36.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$45.23
Rate for Payer: Group Health Inc Commercial	$23.69
Rate for Payer: Group Health Inc Medicare	$16.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.69
Rate for Payer: Hamaspik Choice Inc Medicare	$23.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$50.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.80

CHLORA PREP

Facility OP

$0.12

Hospital Charge Code	40209487
Hospital Revenue Code	270
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06

CHLORDIAZEPOXIDE 10 MG CAP

Facility OP

$0.25

Hospital Charge Code	41644099
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

CHLORDIAZEPOXIDE 10 MG CAP

Facility OP

$0.25

Hospital Charge Code	41654099
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

CHLORDIAZEPOXIDE 25 MG CAP

Facility OP

$0.27

Hospital Charge Code	41643349
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.18

CHLORDIAZEPOXIDE 25 MG CAP

Facility OP

$0.27

Hospital Charge Code	41653349
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.18

CHLORDIAZEPOXIDE 5 MG CAP

Facility OP

$1.00

Hospital Charge Code	41642598
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: 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

CHLORDIAZEPOXIDE 5 MG CAP

Facility OP

$1.00

Hospital Charge Code	41652598
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: 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

CHLORHEXIDINE 0.12% 15ML

Facility OP

$0.10

Hospital Charge Code	41648451
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: 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

CHLORHEXIDINE 0.12% 15ML

Facility OP

$0.10

Hospital Charge Code	41658451
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: 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

CHLORHEXIDINE 0.12% MOUTHWASH 15 ML

Facility OP

$1.00

Hospital Charge Code	41652453
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: 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

CHLORHEXIDINE 0.12% MOUTHWASH 15 ML

Facility OP

$1.00

Hospital Charge Code	41642453
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: 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

CHLORHEXIDINE 4% SCRUB SOLUTION

Facility OP

$2.04

Hospital Charge Code	41644710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.02
Rate for Payer: Aetna Government	$1.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.39
Rate for Payer: Group Health Inc Commercial	$1.02
Rate for Payer: Group Health Inc Medicare	$0.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.02
Rate for Payer: Hamaspik Choice Inc Medicare	$1.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.33

CHLORHEXIDINE 4% SCRUB SOLUTION

Facility OP

$2.04

Hospital Charge Code	41654710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.02
Rate for Payer: Aetna Government	$1.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.39
Rate for Payer: Group Health Inc Commercial	$1.02
Rate for Payer: Group Health Inc Medicare	$0.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.02
Rate for Payer: Hamaspik Choice Inc Medicare	$1.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.33

CHLORIDES

Facility OP

$11.50

Service Code	HCPCS 82435
Hospital Charge Code	40602070
Hospital Revenue Code	301
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$7.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.60
Rate for Payer: Aetna Government	$4.60
Rate for Payer: Cash Price	$4.60
Rate for Payer: Cash Price	$4.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.19
Rate for Payer: Elderplan Medicare Advantage	$4.60
Rate for Payer: EmblemHealth Commercial	$4.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.14
Rate for Payer: Fidelis Essential Plan Aliesa	$3.91
Rate for Payer: Fidelis Essential Plan QHP	$4.09
Rate for Payer: Fidelis Medicare Advantage	$4.60
Rate for Payer: Fidelis Qualified Health Plan	$4.09
Rate for Payer: Group Health Inc Commercial	$4.60
Rate for Payer: Group Health Inc Medicare	$4.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.60
Rate for Payer: Healthfirst Medicare Advantage	$4.60
Rate for Payer: Healthfirst QHP	$4.60
Rate for Payer: Senior Whole Health Medicare Advantage	$4.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.68
Rate for Payer: Wellcare Medicare	$4.14

CHLOROPROCAINE PF 3 % INJ

Facility OP

$15.00

Service Code	HCPCS J2400
Hospital Charge Code	41654135
Hospital Revenue Code	636
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$29.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.03
Rate for Payer: Aetna Government	$29.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.62
Rate for Payer: Group Health Inc Commercial	$7.50
Rate for Payer: Group Health Inc Medicare	$5.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.75

CHLOROPROCAINE PF 3 % INJ

Facility IP

$15.00

Service Code	HCPCS J2400
Hospital Charge Code	41644135
Hospital Revenue Code	636
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50

CHLOROPROCAINE PF 3 % INJ

Facility IP

$15.00

Service Code	HCPCS J2400
Hospital Charge Code	41654135
Hospital Revenue Code	636
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50

CHLOROPROCAINE PF 3 % INJ

Facility OP

$15.00

Service Code	HCPCS J2400
Hospital Charge Code	41644135
Hospital Revenue Code	636
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$29.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.03
Rate for Payer: Aetna Government	$29.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.62
Rate for Payer: Group Health Inc Commercial	$7.50
Rate for Payer: Group Health Inc Medicare	$5.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.75

CHLOROTHIAZIDE 50 MG/ML SUSP NEONATAL

Facility OP

$1.00

Hospital Charge Code	41653051
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: 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

CHLOROTHIAZIDE 50 MG/ML SUSP NEONATAL

Facility OP

$1.00

Hospital Charge Code	41643051
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: 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

CHLORPHENIRAMINE 4 MG TAB

Facility OP

$1.00

Hospital Charge Code	41650772
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: 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

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