St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CLINIMIX 5-15% 1L

Facility

$22.86

Hospital Charge Code	41658563
Hospital Revenue Code	250
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$18.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.43
Rate for Payer: Aetna Government	$11.43
Rate for Payer: Brighton Health Commercial	$17.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.54
Rate for Payer: Group Health Inc Commercial	$11.43
Rate for Payer: Group Health Inc Medicare	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.43
Rate for Payer: Hamaspik Choice Inc Medicare	$11.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.86

CLINIMIX 5-15% 1L

Facility

$22.86

Hospital Charge Code	41648563
Hospital Revenue Code	250
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$18.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.43
Rate for Payer: Aetna Government	$11.43
Rate for Payer: Brighton Health Commercial	$17.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.54
Rate for Payer: Group Health Inc Commercial	$11.43
Rate for Payer: Group Health Inc Medicare	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.43
Rate for Payer: Hamaspik Choice Inc Medicare	$11.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.86

CLINIMIX 5-15% 2L

Facility

$30.47

Hospital Charge Code	41658566
Hospital Revenue Code	250
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$24.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.24
Rate for Payer: Aetna Government	$15.24
Rate for Payer: Brighton Health Commercial	$22.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.72
Rate for Payer: Group Health Inc Commercial	$15.24
Rate for Payer: Group Health Inc Medicare	$10.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.24
Rate for Payer: Hamaspik Choice Inc Medicare	$15.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.81

CLINIMIX 5-15% 2L

Facility

$30.47

Hospital Charge Code	41648566
Hospital Revenue Code	250
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$24.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.24
Rate for Payer: Aetna Government	$15.24
Rate for Payer: Brighton Health Commercial	$22.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.72
Rate for Payer: Group Health Inc Commercial	$15.24
Rate for Payer: Group Health Inc Medicare	$10.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.24
Rate for Payer: Hamaspik Choice Inc Medicare	$15.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.81

CLINIMIX/DEXTROSE (4.25/10) 4.25 % IV SOLN [25750]

Facility

$0.05

Service Code	NDC 00338113403
Hospital Charge Code	00338113403
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

CLINIMIX/DEXTROSE (4.25/10) 4.25 % IV SOLN [25750]

Facility

$0.05

Service Code	NDC 00338109104
Hospital Charge Code	00338109104
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
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	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.05
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
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

CLINIMIX/DEXTROSE (4.25/10) 4.25 % IV SOLN [25750]

Facility

$0.05

Service Code	NDC 00338113403
Hospital Charge Code	00338113403
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
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	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.05
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
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

CLINIMIX/DEXTROSE (4.25/10) 4.25 % IV SOLN [25750]

Facility

$0.05

Service Code	NDC 00338109104
Hospital Charge Code	00338109104
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

CLINIMIX/DEXTROSE (4.25/5) 4.25 % IV SOLN [25749]

Facility

$0.05

Service Code	NDC 00338113303
Hospital Charge Code	00338113303
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

CLINIMIX/DEXTROSE (4.25/5) 4.25 % IV SOLN [25749]

Facility

$0.05

Service Code	NDC 00338108904
Hospital Charge Code	00338108904
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

CLINIMIX/DEXTROSE (4.25/5) 4.25 % IV SOLN [25749]

Facility

$0.05

Service Code	NDC 00338113303
Hospital Charge Code	00338113303
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
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	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.05
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
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

CLINIMIX/DEXTROSE (4.25/5) 4.25 % IV SOLN [25749]

Facility

$0.05

Service Code	NDC 00338108904
Hospital Charge Code	00338108904
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
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	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.05
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
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

CLINIMIX/DEXTROSE (5/15) 5 % IV SOLN [25752]

Facility

$0.05

Service Code	NDC 00338109904
Hospital Charge Code	00338109904
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

CLINIMIX/DEXTROSE (5/15) 5 % IV SOLN [25752]

Facility

$0.05

Service Code	NDC 00338113703
Hospital Charge Code	00338113703
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Fidelis Medicare Advantage	$0.06
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

CLINIMIX/DEXTROSE (5/15) 5 % IV SOLN [25752]

Facility

$0.05

Service Code	NDC 00338113703
Hospital Charge Code	00338113703
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03

CLINIMIX/DEXTROSE (5/15) 5 % IV SOLN [25752]

Facility

$0.05

Service Code	NDC 00338109904
Hospital Charge Code	00338109904
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
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	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.05
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
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

CLINIMIX/DEXTROSE (8/10) 8 % IV SOLN [174879]

Facility

$0.06

Service Code	NDC 00338019404
Hospital Charge Code	00338019404
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Fidelis Medicare Advantage	$0.07
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

CLINIMIX/DEXTROSE (8/10) 8 % IV SOLN [174879]

Facility

$0.06

Service Code	NDC 00338019401
Hospital Charge Code	00338019401
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Fidelis Medicare Advantage	$0.07
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

CLINIMIX/DEXTROSE (8/10) 8 % IV SOLN [174879]

Facility

$0.06

Service Code	NDC 00338019401
Hospital Charge Code	00338019401
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03

CLINIMIX/DEXTROSE (8/10) 8 % IV SOLN [174879]

Facility

$0.06

Service Code	NDC 00338019404
Hospital Charge Code	00338019404
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03

CLINIMIX E 2.75-10% 1 L

Facility

$14.19

Hospital Charge Code	41658561
Hospital Revenue Code	250
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$11.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.10
Rate for Payer: Aetna Government	$7.10
Rate for Payer: Brighton Health Commercial	$10.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.65
Rate for Payer: Group Health Inc Commercial	$7.10
Rate for Payer: Group Health Inc Medicare	$4.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.10
Rate for Payer: Hamaspik Choice Inc Medicare	$7.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.22

CLINIMIX E 2.75-10% 1L

Facility

$14.19

Hospital Charge Code	41648561
Hospital Revenue Code	250
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$11.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.10
Rate for Payer: Aetna Government	$7.10
Rate for Payer: Brighton Health Commercial	$10.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.65
Rate for Payer: Group Health Inc Commercial	$7.10
Rate for Payer: Group Health Inc Medicare	$4.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.10
Rate for Payer: Hamaspik Choice Inc Medicare	$7.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.22

CLINIMIX E 4.25-10% 1L

Facility

$20.96

Hospital Charge Code	41658567
Hospital Revenue Code	250
Min. Negotiated Rate	$7.34
Max. Negotiated Rate	$16.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.48
Rate for Payer: Aetna Government	$10.48
Rate for Payer: Brighton Health Commercial	$15.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.25
Rate for Payer: Group Health Inc Commercial	$10.48
Rate for Payer: Group Health Inc Medicare	$7.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.48
Rate for Payer: Hamaspik Choice Inc Medicare	$10.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.62

CLINIMIX E 4.25-10% 1L

Facility

$20.96

Hospital Charge Code	41648567
Hospital Revenue Code	250
Min. Negotiated Rate	$7.34
Max. Negotiated Rate	$16.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.48
Rate for Payer: Aetna Government	$10.48
Rate for Payer: Brighton Health Commercial	$15.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.25
Rate for Payer: Group Health Inc Commercial	$10.48
Rate for Payer: Group Health Inc Medicare	$7.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.48
Rate for Payer: Hamaspik Choice Inc Medicare	$10.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.62

CLINIMIX E 4.25/5

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640345
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
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: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
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

Know your out-of-pocket cost for care.

All Charges