St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHRONOS (TM) GRANULES-LG 10CC

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	40200222
Hospital Revenue Code	278
Min. Negotiated Rate	$800.00
Max. Negotiated Rate	$800.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$800.00
Rate for Payer: Hamaspik Choice Inc Medicare	$800.00

CHRONOS (TM) GRANULES-LG 10CC

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	40200222
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,680.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$960.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$920.00
Rate for Payer: EmblemHealth Commercial	$800.00
Rate for Payer: Fidelis Medicare Advantage	$1,680.00
Rate for Payer: Group Health Inc Commercial	$800.00
Rate for Payer: Group Health Inc Medicare	$560.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$800.00
Rate for Payer: Hamaspik Choice Inc Medicare	$800.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,040.00

CHUCK FOR PINS HOFF

Facility

$1,865.50

Service Code	HCPCS C1776
Hospital Charge Code	64907452
Hospital Revenue Code	278
Min. Negotiated Rate	$932.75
Max. Negotiated Rate	$932.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$932.75
Rate for Payer: Hamaspik Choice Inc Medicare	$932.75

CHUCK FOR PINS HOFF

Facility

$1,865.50

Service Code	HCPCS C1776
Hospital Charge Code	64907452
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,958.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,026.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,119.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$932.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,072.66
Rate for Payer: EmblemHealth Commercial	$932.75
Rate for Payer: Fidelis Medicare Advantage	$1,958.78
Rate for Payer: Group Health Inc Commercial	$932.75
Rate for Payer: Group Health Inc Medicare	$652.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$932.75
Rate for Payer: Hamaspik Choice Inc Medicare	$932.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,212.58

CHUCKS (UNDERPAD)

Facility

$12.05

Hospital Charge Code	40201080
Hospital Revenue Code	270
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$9.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.02
Rate for Payer: Aetna Government	$6.02
Rate for Payer: Brighton Health Commercial	$9.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.19
Rate for Payer: Group Health Inc Commercial	$6.02
Rate for Payer: Group Health Inc Medicare	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.02
Rate for Payer: Hamaspik Choice Inc Medicare	$6.02

CH VEIN HOOK A

Facility

$493.75

Hospital Charge Code	64903616
Hospital Revenue Code	270
Min. Negotiated Rate	$172.81
Max. Negotiated Rate	$395.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$271.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.88
Rate for Payer: Aetna Government	$246.88
Rate for Payer: Brighton Health Commercial	$370.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$395.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$335.75
Rate for Payer: Group Health Inc Commercial	$246.88
Rate for Payer: Group Health Inc Medicare	$172.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$246.88
Rate for Payer: Hamaspik Choice Inc Medicare	$246.88

CH VEIN HOOK B

Facility

$493.75

Hospital Charge Code	64903618
Hospital Revenue Code	270
Min. Negotiated Rate	$172.81
Max. Negotiated Rate	$395.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$271.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.88
Rate for Payer: Aetna Government	$246.88
Rate for Payer: Brighton Health Commercial	$370.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$395.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$335.75
Rate for Payer: Group Health Inc Commercial	$246.88
Rate for Payer: Group Health Inc Medicare	$172.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$246.88
Rate for Payer: Hamaspik Choice Inc Medicare	$246.88

CILOSTAZOL 100 MG PO TABS [24474]

Facility

$2.25

Service Code	NDC 50268017715
Hospital Charge Code	50268017715
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Brighton Health Commercial	$1.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.53
Rate for Payer: Group Health Inc Commercial	$1.12
Rate for Payer: Group Health Inc Medicare	$0.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.46

CINACALCET 30 MG TAB

Facility

$3.12

Service Code	HCPCS J0604
Hospital Charge Code	41643862
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.79
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.03

CINACALCET 30 MG TAB

Facility

$3.12

Service Code	HCPCS J0604
Hospital Charge Code	41653862
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.79
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.03

CINACALCET 30 MG TAB

Facility

$3.12

Service Code	HCPCS J0604
Hospital Charge Code	41653862
Hospital Revenue Code	636
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

CINACALCET 30 MG TAB

Facility

$3.12

Service Code	HCPCS J0604
Hospital Charge Code	41643862
Hospital Revenue Code	636
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

CINACALCET 60 MG TAB

Facility

$3.12

Service Code	HCPCS J0604
Hospital Charge Code	41644681
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.79
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.03

CINACALCET 60 MG TAB

Facility

$3.12

Service Code	HCPCS J0604
Hospital Charge Code	41654681
Hospital Revenue Code	636
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

CINACALCET 60 MG TAB

Facility

$3.12

Service Code	HCPCS J0604
Hospital Charge Code	41644681
Hospital Revenue Code	636
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

CINACALCET 60 MG TAB

Facility

$3.12

Service Code	HCPCS J0604
Hospital Charge Code	41654681
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.79
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.03

CINACALCET 90 MG TAB

Facility

$3.12

Service Code	HCPCS J0604
Hospital Charge Code	41644682
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.79
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.03

CINACALCET 90 MG TAB

Facility

$3.12

Service Code	HCPCS J0604
Hospital Charge Code	41644682
Hospital Revenue Code	636
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

CINACALCET 90 MG TAB

Facility

$3.12

Service Code	HCPCS J0604
Hospital Charge Code	41654682
Hospital Revenue Code	636
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

CINACALCET 90 MG TAB

Facility

$3.12

Service Code	HCPCS J0604
Hospital Charge Code	41654682
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.79
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.03

CINACALCET HCL 30 MG PO TABS [38100]

Facility

$30.66

Service Code	NDC 47335037983
Hospital Charge Code	47335037983
Hospital Revenue Code	250
Min. Negotiated Rate	$10.73
Max. Negotiated Rate	$24.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.33
Rate for Payer: Aetna Government	$15.33
Rate for Payer: Brighton Health Commercial	$22.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.85
Rate for Payer: Group Health Inc Commercial	$15.33
Rate for Payer: Group Health Inc Medicare	$10.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.33
Rate for Payer: Hamaspik Choice Inc Medicare	$15.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.93

CINACALCET HCL 30 MG PO TABS [38100]

Facility

$32.27

Service Code	NDC 55513007330
Hospital Charge Code	55513007330
Hospital Revenue Code	250
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$25.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.13
Rate for Payer: Aetna Government	$16.13
Rate for Payer: Brighton Health Commercial	$24.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.94
Rate for Payer: Group Health Inc Commercial	$16.13
Rate for Payer: Group Health Inc Medicare	$11.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.13
Rate for Payer: Hamaspik Choice Inc Medicare	$16.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.97

CINACALCET HCL 30 MG PO TABS [38100]

Facility

$30.66

Service Code	NDC 43598036730
Hospital Charge Code	43598036730
Hospital Revenue Code	250
Min. Negotiated Rate	$10.73
Max. Negotiated Rate	$24.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.33
Rate for Payer: Aetna Government	$15.33
Rate for Payer: Brighton Health Commercial	$22.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.85
Rate for Payer: Group Health Inc Commercial	$15.33
Rate for Payer: Group Health Inc Medicare	$10.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.33
Rate for Payer: Hamaspik Choice Inc Medicare	$15.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.93

CINACALCET HCL 30 MG PO TABS [38100]

Facility

$30.66

Service Code	NDC 16729044010
Hospital Charge Code	16729044010
Hospital Revenue Code	250
Min. Negotiated Rate	$10.73
Max. Negotiated Rate	$24.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.33
Rate for Payer: Aetna Government	$15.33
Rate for Payer: Brighton Health Commercial	$22.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.85
Rate for Payer: Group Health Inc Commercial	$15.33
Rate for Payer: Group Health Inc Medicare	$10.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.33
Rate for Payer: Hamaspik Choice Inc Medicare	$15.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.93

CINACALCET HCL 60 MG PO TABS [38101]

Facility

$61.31

Service Code	NDC 47335038083
Hospital Charge Code	47335038083
Hospital Revenue Code	250
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$49.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.65
Rate for Payer: Aetna Government	$30.65
Rate for Payer: Brighton Health Commercial	$45.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$41.69
Rate for Payer: Group Health Inc Commercial	$30.65
Rate for Payer: Group Health Inc Medicare	$21.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.65
Rate for Payer: Hamaspik Choice Inc Medicare	$30.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.85

Know your out-of-pocket cost for care.

All Charges