St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CIPROFLOXACIN HCL 250 MG PO TABS [25118]

Facility

$4.59

Service Code	NDC 00143992701
Hospital Charge Code	00143992701
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$3.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.30
Rate for Payer: Aetna Government	$2.30
Rate for Payer: Brighton Health Commercial	$3.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.12
Rate for Payer: Group Health Inc Commercial	$2.30
Rate for Payer: Group Health Inc Medicare	$1.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.30
Rate for Payer: Hamaspik Choice Inc Medicare	$2.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.99

CIPROFLOXACIN HCL 250 MG PO TABS [25118]

Facility

$4.44

Service Code	NDC 55111012601
Hospital Charge Code	55111012601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$3.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.22
Rate for Payer: Aetna Government	$2.22
Rate for Payer: Brighton Health Commercial	$3.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.02
Rate for Payer: Group Health Inc Commercial	$2.22
Rate for Payer: Group Health Inc Medicare	$1.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.22
Rate for Payer: Hamaspik Choice Inc Medicare	$2.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.88

CIPROFLOXACIN HCL 500 MG PO TABS [25119]

Facility

$5.19

Service Code	NDC 62135030920
Hospital Charge Code	62135030920
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.60
Rate for Payer: Aetna Government	$2.60
Rate for Payer: Brighton Health Commercial	$3.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.53
Rate for Payer: Group Health Inc Commercial	$2.60
Rate for Payer: Group Health Inc Medicare	$1.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.60
Rate for Payer: Hamaspik Choice Inc Medicare	$2.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.37

CIPROFLOXACIN HCL 500 MG PO TABS [25119]

Facility

$4.93

Service Code	NDC 65862007705
Hospital Charge Code	65862007705
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$3.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.47
Rate for Payer: Aetna Government	$2.47
Rate for Payer: Brighton Health Commercial	$3.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.35
Rate for Payer: Group Health Inc Commercial	$2.47
Rate for Payer: Group Health Inc Medicare	$1.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.47
Rate for Payer: Hamaspik Choice Inc Medicare	$2.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.21

CIPROFLOXACIN HCL 500 MG PO TABS [25119]

Facility

$0.35

Service Code	NDC 00904708361
Hospital Charge Code	00904708361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

CIPROFLOXACIN HCL 500 MG PO TABS [25119]

Facility

$5.37

Service Code	NDC 00143992801
Hospital Charge Code	00143992801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$4.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.68
Rate for Payer: Aetna Government	$2.68
Rate for Payer: Brighton Health Commercial	$4.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.65
Rate for Payer: Group Health Inc Commercial	$2.68
Rate for Payer: Group Health Inc Medicare	$1.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.68
Rate for Payer: Hamaspik Choice Inc Medicare	$2.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.49

CIPROFLOXACIN HCL 750 MG PO TABS [25120]

Facility

$5.45

Service Code	NDC 55111012850
Hospital Charge Code	55111012850
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$4.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.72
Rate for Payer: Aetna Government	$2.72
Rate for Payer: Brighton Health Commercial	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.70
Rate for Payer: Group Health Inc Commercial	$2.72
Rate for Payer: Group Health Inc Medicare	$1.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.72
Rate for Payer: Hamaspik Choice Inc Medicare	$2.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.54

CIPROFLOXACIN HCL 750 MG PO TABS [25120]

Facility

$5.65

Service Code	NDC 00143992950
Hospital Charge Code	00143992950
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$4.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.82
Rate for Payer: Aetna Government	$2.82
Rate for Payer: Brighton Health Commercial	$4.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.84
Rate for Payer: Group Health Inc Commercial	$2.82
Rate for Payer: Group Health Inc Medicare	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.82
Rate for Payer: Hamaspik Choice Inc Medicare	$2.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.67

CIPROFLOXACIN HCL 750 MG PO TABS [25120]

Facility

$5.63

Service Code	NDC 65862007850
Hospital Charge Code	65862007850
Hospital Revenue Code	250
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$4.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.81
Rate for Payer: Aetna Government	$2.81
Rate for Payer: Brighton Health Commercial	$4.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.82
Rate for Payer: Group Health Inc Commercial	$2.81
Rate for Payer: Group Health Inc Medicare	$1.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.81
Rate for Payer: Hamaspik Choice Inc Medicare	$2.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.66

CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN [108130]

Facility

$0.03

Service Code	HCPCS J0744
Hospital Charge Code	00409230024
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02

CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN [108130]

Facility

$0.03

Service Code	HCPCS J0744
Hospital Charge Code	00409230024
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.03
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN [108130]

Facility

$0.04

Service Code	HCPCS J0744
Hospital Charge Code	36000000824
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02

CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN [108130]

Facility

$0.04

Service Code	HCPCS J0744
Hospital Charge Code	36000000824
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.04
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN [108132]

Facility

$0.04

Service Code	HCPCS J0744
Hospital Charge Code	25021011487
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.04
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN [108132]

Facility

$0.02

Service Code	HCPCS J0744
Hospital Charge Code	00409330001
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
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: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.02
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
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

CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN [108132]

Facility

$0.02

Service Code	HCPCS J0744
Hospital Charge Code	36000000924
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
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: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.02
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
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

CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN [108132]

Facility

$0.02

Service Code	HCPCS J0744
Hospital Charge Code	00409330001
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN [108132]

Facility

$0.04

Service Code	HCPCS J0744
Hospital Charge Code	25021011487
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02

CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN [108132]

Facility

$0.02

Service Code	HCPCS J0744
Hospital Charge Code	36000000924
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

CIPROFLOXACIN IV SYRINGE 2 MG/ML IN D5W (NEO/PED) [401239]

Facility

$0.02

Service Code	HCPCS J0744
Hospital Charge Code	36000029724
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
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: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.02
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
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

CIPROFLOXACIN IV SYRINGE 2 MG/ML IN D5W (NEO/PED) [401239]

Facility

$0.03

Service Code	HCPCS J0744
Hospital Charge Code	00409230001
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.03
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

CIPROFLOXACIN IV SYRINGE 2 MG/ML IN D5W (NEO/PED) [401239]

Facility

$0.03

Service Code	HCPCS J0744
Hospital Charge Code	00409230001
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02

CIPROFLOXACIN IV SYRINGE 2 MG/ML IN D5W (NEO/PED) [401239]

Facility

$0.02

Service Code	HCPCS J0744
Hospital Charge Code	36000029724
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

CIRCLIPS HMRS

Facility

$1,140.00

Service Code	HCPCS C1776
Hospital Charge Code	64907251
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,197.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$627.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$684.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$570.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$655.50
Rate for Payer: EmblemHealth Commercial	$570.00
Rate for Payer: Fidelis Medicare Advantage	$1,197.00
Rate for Payer: Group Health Inc Commercial	$570.00
Rate for Payer: Group Health Inc Medicare	$399.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$570.00
Rate for Payer: Hamaspik Choice Inc Medicare	$570.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$741.00

CIRCLIPS HMRS

Facility

$1,140.00

Service Code	HCPCS C1776
Hospital Charge Code	64907251
Hospital Revenue Code	278
Min. Negotiated Rate	$570.00
Max. Negotiated Rate	$570.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$570.00
Rate for Payer: Hamaspik Choice Inc Medicare	$570.00

Know your out-of-pocket cost for care.

All Charges