St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BACITRACIN 500 UNIT/GM EX OINT

Facility

$0.14

Service Code	NDC 0904740267
Hospital Charge Code	0904740267
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

BACITRACIN 500 UNIT/GM EX OINT

Facility

$0.14

Service Code	NDC 0904740267
Hospital Charge Code	0904740267
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

BACITRACIN 500 UNIT/GM OP OINT

Facility

$37.05

Service Code	NDC 0574402235
Hospital Charge Code	0574402235
Hospital Revenue Code	250
Min. Negotiated Rate	$18.53
Max. Negotiated Rate	$18.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.53

BACITRACIN 500 UNIT/GM OP OINT

Facility

$37.05

Service Code	NDC 0574402235
Hospital Charge Code	0574402235
Hospital Revenue Code	250
Min. Negotiated Rate	$12.97
Max. Negotiated Rate	$29.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.53
Rate for Payer: Aetna Government	$18.53
Rate for Payer: Brighton Health Commercial	$27.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.20
Rate for Payer: EmblemHealth Commercial	$18.53
Rate for Payer: Group Health Inc Commercial	$18.53
Rate for Payer: Group Health Inc Medicare	$12.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.53
Rate for Payer: Hamaspik Choice Inc Medicare	$18.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.09

BACITRACIN ZINC 500 UNIT/GM EX OINT

Facility

$0.13

Service Code	NDC 0904702367
Hospital Charge Code	0904702367
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

BACITRACIN ZINC 500 UNIT/GM EX OINT

Facility

$0.13

Service Code	NDC 0904702367
Hospital Charge Code	0904702367
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

BACITRA-NEOMYCIN-POLYMYXIN-HC 1 % OP OINT

Facility

$18.59

Service Code	NDC 2420878555
Hospital Charge Code	2420878555
Hospital Revenue Code	250
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$14.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.29
Rate for Payer: Aetna Government	$9.29
Rate for Payer: Brighton Health Commercial	$13.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.64
Rate for Payer: EmblemHealth Commercial	$9.29
Rate for Payer: Group Health Inc Commercial	$9.29
Rate for Payer: Group Health Inc Medicare	$6.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.29
Rate for Payer: Hamaspik Choice Inc Medicare	$9.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.08

BACITRA-NEOMYCIN-POLYMYXIN-HC 1 % OP OINT

Facility

$18.59

Service Code	NDC 2420878555
Hospital Charge Code	2420878555
Hospital Revenue Code	250
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$9.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.29

BACLOFEN 10 MG PO TABS

Facility

$2.47

Service Code	NDC 0172409660
Hospital Charge Code	0172409660
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.24
Rate for Payer: Aetna Government	$1.24
Rate for Payer: Brighton Health Commercial	$1.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.68
Rate for Payer: EmblemHealth Commercial	$1.24
Rate for Payer: Group Health Inc Commercial	$1.24
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24
Rate for Payer: Hamaspik Choice Inc Medicare	$1.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.61

BACLOFEN 10 MG PO TABS

Facility

$2.47

Service Code	NDC 5281732010
Hospital Charge Code	5281732010
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24

BACLOFEN 10 MG PO TABS

Facility

$2.47

Service Code	NDC 0172409660
Hospital Charge Code	0172409660
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24

BACLOFEN 10 MG PO TABS

Facility

$0.50

Service Code	NDC 0904647561
Hospital Charge Code	0904647561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.33

BACLOFEN 10 MG PO TABS

Facility

$2.47

Service Code	NDC 5281732010
Hospital Charge Code	5281732010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.24
Rate for Payer: Aetna Government	$1.24
Rate for Payer: Brighton Health Commercial	$1.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.68
Rate for Payer: EmblemHealth Commercial	$1.24
Rate for Payer: Group Health Inc Commercial	$1.24
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24
Rate for Payer: Hamaspik Choice Inc Medicare	$1.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.61

BACLOFEN 10 MG PO TABS

Facility

$0.56

Service Code	NDC 6373947910
Hospital Charge Code	6373947910
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: EmblemHealth Commercial	$0.28
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.36

BACLOFEN 10 MG PO TABS

Facility

$0.56

Service Code	NDC 6373947910
Hospital Charge Code	6373947910
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28

BACLOFEN 10 MG PO TABS

Facility

$0.50

Service Code	NDC 0904647561
Hospital Charge Code	0904647561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25

BACLOFEN 20 MG PO TABS

Facility

$1.09

Service Code	NDC 0904647661
Hospital Charge Code	0904647661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54

BACLOFEN 20 MG PO TABS

Facility

$1.09

Service Code	NDC 0904647661
Hospital Charge Code	0904647661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.54
Rate for Payer: Aetna Government	$0.54
Rate for Payer: Brighton Health Commercial	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.74
Rate for Payer: EmblemHealth Commercial	$0.54
Rate for Payer: Group Health Inc Commercial	$0.54
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54
Rate for Payer: Hamaspik Choice Inc Medicare	$0.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

BACLOFEN 20 MG PO TABS

Facility

$5.13

Service Code	NDC 0603240721
Hospital Charge Code	0603240721
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$4.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.56
Rate for Payer: Aetna Government	$2.56
Rate for Payer: Brighton Health Commercial	$3.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.49
Rate for Payer: EmblemHealth Commercial	$2.56
Rate for Payer: Group Health Inc Commercial	$2.56
Rate for Payer: Group Health Inc Medicare	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.56
Rate for Payer: Hamaspik Choice Inc Medicare	$2.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.33

BACLOFEN 20 MG PO TABS

Facility

$5.13

Service Code	NDC 0603240721
Hospital Charge Code	0603240721
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$2.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.56

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$180.52

Service Code	EAPG 00518
Min. Negotiated Rate	$180.52
Max. Negotiated Rate	$180.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$180.52

Bacterial & tuberculous infections of nervous system

Facility

$136,969.85

Service Code	APR-DRG 0494
Min. Negotiated Rate	$53,770.00
Max. Negotiated Rate	$136,969.85
Rate for Payer: Affinity Essential Plan 1&2	$136,969.85
Rate for Payer: Affinity Essential Plan 3&4	$136,969.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$60,875.49
Rate for Payer: Amida Care Medicaid	$60,875.49
Rate for Payer: EmblemHealth Essential Plan 1&2	$136,969.85
Rate for Payer: EmblemHealth Essential Plan 3&4	$60,875.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$60,875.49
Rate for Payer: Fidelis Qualified Health Plan	$73,050.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$60,875.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60,875.49
Rate for Payer: Healthfirst Commercial	$88,637.00
Rate for Payer: Healthfirst Essential Plan	$136,969.85
Rate for Payer: Healthfirst QHP	$53,770.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60,875.49
Rate for Payer: SOMOS Essential	$136,969.85
Rate for Payer: United Healthcare Essential Plan 1&2	$136,969.85
Rate for Payer: United Healthcare Essential Plan 3&4	$136,969.85
Rate for Payer: United Healthcare Medicaid	$60,875.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$60,875.49

Bacterial & tuberculous infections of nervous system

Facility

$52,502.54

Service Code	APR-DRG 0491
Min. Negotiated Rate	$14,939.00
Max. Negotiated Rate	$52,502.54
Rate for Payer: Affinity Essential Plan 1&2	$52,502.54
Rate for Payer: Affinity Essential Plan 3&4	$52,502.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,334.46
Rate for Payer: Amida Care Medicaid	$23,334.46
Rate for Payer: EmblemHealth Essential Plan 1&2	$52,502.54
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,334.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,334.46
Rate for Payer: Fidelis Qualified Health Plan	$28,001.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,334.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,334.46
Rate for Payer: Healthfirst Commercial	$24,428.00
Rate for Payer: Healthfirst Essential Plan	$52,502.54
Rate for Payer: Healthfirst QHP	$14,939.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,334.46
Rate for Payer: SOMOS Essential	$52,502.54
Rate for Payer: United Healthcare Essential Plan 1&2	$52,502.54
Rate for Payer: United Healthcare Essential Plan 3&4	$52,502.54
Rate for Payer: United Healthcare Medicaid	$23,334.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,334.46

Bacterial & tuberculous infections of nervous system

Facility

$75,793.61

Service Code	APR-DRG 0492
Min. Negotiated Rate	$24,659.00
Max. Negotiated Rate	$75,793.61
Rate for Payer: Affinity Essential Plan 1&2	$75,793.61
Rate for Payer: Affinity Essential Plan 3&4	$75,793.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,686.05
Rate for Payer: Amida Care Medicaid	$33,686.05
Rate for Payer: EmblemHealth Essential Plan 1&2	$75,793.61
Rate for Payer: EmblemHealth Essential Plan 3&4	$33,686.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,686.05
Rate for Payer: Fidelis Qualified Health Plan	$40,423.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,686.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,686.05
Rate for Payer: Healthfirst Commercial	$43,046.00
Rate for Payer: Healthfirst Essential Plan	$75,793.61
Rate for Payer: Healthfirst QHP	$24,659.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,686.05
Rate for Payer: SOMOS Essential	$75,793.61
Rate for Payer: United Healthcare Essential Plan 1&2	$75,793.61
Rate for Payer: United Healthcare Essential Plan 3&4	$75,793.61
Rate for Payer: United Healthcare Medicaid	$33,686.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,686.05

Bacterial & tuberculous infections of nervous system

Facility

$88,305.35

Service Code	APR-DRG 0493
Min. Negotiated Rate	$31,358.00
Max. Negotiated Rate	$88,305.35
Rate for Payer: Affinity Essential Plan 1&2	$88,305.35
Rate for Payer: Affinity Essential Plan 3&4	$88,305.35
Rate for Payer: Affinity Medicaid/CHP/HARP	$39,246.82
Rate for Payer: Amida Care Medicaid	$39,246.82
Rate for Payer: EmblemHealth Essential Plan 1&2	$88,305.35
Rate for Payer: EmblemHealth Essential Plan 3&4	$39,246.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,246.82
Rate for Payer: Fidelis Qualified Health Plan	$47,096.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,246.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,246.82
Rate for Payer: Healthfirst Commercial	$57,619.00
Rate for Payer: Healthfirst Essential Plan	$88,305.35
Rate for Payer: Healthfirst QHP	$31,358.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,246.82
Rate for Payer: SOMOS Essential	$88,305.35
Rate for Payer: United Healthcare Essential Plan 1&2	$88,305.35
Rate for Payer: United Healthcare Essential Plan 3&4	$88,305.35
Rate for Payer: United Healthcare Medicaid	$39,246.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,246.82

Know your out-of-pocket cost for care.

All Charges