St. Barnabas Hospital

All Charges

Charge

Type

Price

CYCLOSPORINE (NEORAL) 100 MG CAP - NF

Facility IP

$4.00

Hospital Charge Code	41640362
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00

CYCLOSPORINE (NEORAL) 100 MG CAP - NF

Facility IP

$4.00

Hospital Charge Code	41650362
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00

CYCLOSPORINE (NEORAL) 100 MG CAP - NF

Facility OP

$4.00

Hospital Charge Code	41640362
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$2.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

CYCLOSPORINE (NEORAL) 25 MG CAP- NF

Facility OP

$1.04

Service Code	HCPCS J7515
Hospital Charge Code	41640392
Hospital Revenue Code	636
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.68
Rate for Payer: Group Health Inc Commercial	$0.52
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52
Rate for Payer: Hamaspik Choice Inc Medicare	$0.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.98
Rate for Payer: SOMOS Essential	$0.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.68

CYCLOSPORINE (NEORAL) 25 MG CAP- NF

Facility IP

$1.04

Service Code	HCPCS J7515
Hospital Charge Code	41650392
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52
Rate for Payer: Hamaspik Choice Inc Medicare	$0.52

CYCLOSPORINE (NEORAL) 25 MG CAP- NF

Facility OP

$1.04

Service Code	HCPCS J7515
Hospital Charge Code	41650392
Hospital Revenue Code	636
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.68
Rate for Payer: Group Health Inc Commercial	$0.52
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52
Rate for Payer: Hamaspik Choice Inc Medicare	$0.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.98
Rate for Payer: SOMOS Essential	$0.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.68

CYCLOSPORINE (NEORAL) 25 MG CAP- NF

Facility IP

$1.04

Service Code	HCPCS J7515
Hospital Charge Code	41640392
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52
Rate for Payer: Hamaspik Choice Inc Medicare	$0.52

CYCLOSPORINE(SANDIMMUNE)100MG/ML

Facility IP

$14.00

Service Code	HCPCS J7502
Hospital Charge Code	41641148
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00

CYCLOSPORINE(SANDIMMUNE)100MG/ML

Facility IP

$14.00

Service Code	HCPCS J7502
Hospital Charge Code	41651148
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00

CYCLOSPORINE(SANDIMMUNE)100MG/ML

Facility OP

$14.00

Service Code	HCPCS J7502
Hospital Charge Code	41651148
Hospital Revenue Code	636
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$9.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1.58
Rate for Payer: Group Health Inc Commercial	$7.00
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.43
Rate for Payer: SOMOS Essential	$2.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.10

CYCLOSPORINE(SANDIMMUNE)100MG/ML

Facility OP

$14.00

Service Code	HCPCS J7502
Hospital Charge Code	41641148
Hospital Revenue Code	636
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$9.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1.58
Rate for Payer: Group Health Inc Commercial	$7.00
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.43
Rate for Payer: SOMOS Essential	$2.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.10

CYCLOSPORINE (SANDIMMUNE) 25 MG CAP

Facility OP

$5.00

Service Code	HCPCS J7515
Hospital Charge Code	41641147
Hospital Revenue Code	636
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$3.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.68
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.98
Rate for Payer: SOMOS Essential	$0.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

CYCLOSPORINE (SANDIMMUNE) 25 MG CAP

Facility IP

$5.00

Service Code	HCPCS J7515
Hospital Charge Code	41641147
Hospital Revenue Code	636
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50

CYCLOSPORINE (SANDIMMUNE) 25 MG CAP

Facility OP

$5.00

Service Code	HCPCS J7515
Hospital Charge Code	41651147
Hospital Revenue Code	636
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$3.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.68
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.98
Rate for Payer: SOMOS Essential	$0.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

CYCLOSPORINE (SANDIMMUNE) 25 MG CAP

Facility IP

$5.00

Service Code	HCPCS J7515
Hospital Charge Code	41651147
Hospital Revenue Code	636
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50

CYLINDER SET W/PUMP - 16CM

Facility OP

$14,840.00

Service Code	HCPCS C1813
Hospital Charge Code	40203033
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$15,582.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,162.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8,533.00
Rate for Payer: Fidelis Medicare Advantage	$15,582.00
Rate for Payer: Group Health Inc Commercial	$7,420.00
Rate for Payer: Group Health Inc Medicare	$5,194.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7,420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9,646.00

CYLINDER SET W/PUMP - 16CM

Facility IP

$14,840.00

Service Code	HCPCS C1813
Hospital Charge Code	40203033
Hospital Revenue Code	278
Min. Negotiated Rate	$7,420.00
Max. Negotiated Rate	$7,420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7,420.00

CYLINDER SET W/PUMP - 20CM

Facility IP

$14,840.00

Service Code	HCPCS C1813
Hospital Charge Code	40203034
Hospital Revenue Code	278
Min. Negotiated Rate	$7,420.00
Max. Negotiated Rate	$7,420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7,420.00

CYLINDER SET W/PUMP - 20CM

Facility OP

$14,840.00

Service Code	HCPCS C1813
Hospital Charge Code	40203034
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$15,582.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,162.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8,533.00
Rate for Payer: Fidelis Medicare Advantage	$15,582.00
Rate for Payer: Group Health Inc Commercial	$7,420.00
Rate for Payer: Group Health Inc Medicare	$5,194.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7,420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9,646.00

CYLINDER SET W/PUMP - 22CM

Facility OP

$14,840.00

Service Code	HCPCS C1813
Hospital Charge Code	40203035
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$15,582.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,162.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8,533.00
Rate for Payer: Fidelis Medicare Advantage	$15,582.00
Rate for Payer: Group Health Inc Commercial	$7,420.00
Rate for Payer: Group Health Inc Medicare	$5,194.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7,420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9,646.00

CYLINDER SET W/PUMP - 22CM

Facility IP

$14,840.00

Service Code	HCPCS C1813
Hospital Charge Code	40203035
Hospital Revenue Code	278
Min. Negotiated Rate	$7,420.00
Max. Negotiated Rate	$7,420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7,420.00

CYLINDER SET ZERO ANGLE

Facility OP

$10,450.00

Hospital Charge Code	64906032
Hospital Revenue Code	270
Min. Negotiated Rate	$3,657.50
Max. Negotiated Rate	$8,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,747.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,225.00
Rate for Payer: Aetna Government	$5,225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,360.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,106.00
Rate for Payer: Group Health Inc Commercial	$5,225.00
Rate for Payer: Group Health Inc Medicare	$3,657.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,225.00

CYMETRA INJECTABLE 1 CC

Facility IP

$602.85

Service Code	HCPCS Q4112
Hospital Charge Code	40205800
Hospital Revenue Code	636
Min. Negotiated Rate	$301.42
Max. Negotiated Rate	$301.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$301.42
Rate for Payer: Hamaspik Choice Inc Medicare	$301.42

CYMETRA INJECTABLE 1 CC

Facility OP

$602.85

Service Code	HCPCS Q4112
Hospital Charge Code	40205800
Hospital Revenue Code	636
Min. Negotiated Rate	$211.00
Max. Negotiated Rate	$872.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$331.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$872.08
Rate for Payer: Aetna Government	$872.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$301.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$346.64
Rate for Payer: Group Health Inc Commercial	$301.42
Rate for Payer: Group Health Inc Medicare	$211.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$301.42
Rate for Payer: Hamaspik Choice Inc Medicare	$301.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$391.85

CYPROHEPTADINE 2 MG/5 ML LIQUID

Facility OP

$0.20

Hospital Charge Code	41653415
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
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	$0.13

Price Transparency.

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