St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CLIN SIGN VOL OVRLD ASSESS

Facility

$0.01

Service Code	HCPCS 2002F
Hospital Charge Code	30307897
Hospital Revenue Code	969
Max. Negotiated Rate	$2,915.00
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	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
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

CLINTEST

Facility

$12.05

Hospital Charge Code	40200919
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

CLIN WEEKLY MGMT 1OR2 FRACT

Facility

$740.78

Service Code	HCPCS 77431
Hospital Charge Code	66542951
Hospital Revenue Code	333
Min. Negotiated Rate	$127.73
Max. Negotiated Rate	$592.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$407.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.73
Rate for Payer: Aetna Government	$127.73
Rate for Payer: Brighton Health Commercial	$555.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$592.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$503.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$370.39
Rate for Payer: Group Health Inc Medicare	$259.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$370.39
Rate for Payer: Hamaspik Choice Inc Medicare	$370.39

CLIP APPLIER AUTO

Facility

$140.15

Hospital Charge Code	64907084
Hospital Revenue Code	270
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$112.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.08
Rate for Payer: Aetna Government	$70.08
Rate for Payer: Brighton Health Commercial	$105.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.30
Rate for Payer: Group Health Inc Commercial	$70.08
Rate for Payer: Group Health Inc Medicare	$49.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.08
Rate for Payer: Hamaspik Choice Inc Medicare	$70.08

CLIP APPLIER ENDO 10MM LARGE

Facility

$640.30

Hospital Charge Code	40200477
Hospital Revenue Code	270
Min. Negotiated Rate	$224.10
Max. Negotiated Rate	$512.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$352.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$320.15
Rate for Payer: Aetna Government	$320.15
Rate for Payer: Brighton Health Commercial	$480.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$512.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$435.40
Rate for Payer: Group Health Inc Commercial	$320.15
Rate for Payer: Group Health Inc Medicare	$224.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$320.15
Rate for Payer: Hamaspik Choice Inc Medicare	$320.15

CLIP APPLIER ENDO 10MM M/L

Facility

$205.52

Hospital Charge Code	40200412
Hospital Revenue Code	270
Min. Negotiated Rate	$71.93
Max. Negotiated Rate	$164.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$113.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$102.76
Rate for Payer: Aetna Government	$102.76
Rate for Payer: Brighton Health Commercial	$154.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$139.75
Rate for Payer: Group Health Inc Commercial	$102.76
Rate for Payer: Group Health Inc Medicare	$71.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.76
Rate for Payer: Hamaspik Choice Inc Medicare	$102.76

CLIP APPLIER LARGE MULTIPLE

Facility

$205.52

Hospital Charge Code	40200478
Hospital Revenue Code	270
Min. Negotiated Rate	$71.93
Max. Negotiated Rate	$164.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$113.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$102.76
Rate for Payer: Aetna Government	$102.76
Rate for Payer: Brighton Health Commercial	$154.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$139.75
Rate for Payer: Group Health Inc Commercial	$102.76
Rate for Payer: Group Health Inc Medicare	$71.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.76
Rate for Payer: Hamaspik Choice Inc Medicare	$102.76

CLIP CLOSED TUBE

Facility

$273.75

Hospital Charge Code	64907235
Hospital Revenue Code	270
Min. Negotiated Rate	$95.81
Max. Negotiated Rate	$219.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$136.88
Rate for Payer: Aetna Government	$136.88
Rate for Payer: Brighton Health Commercial	$205.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$219.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.15
Rate for Payer: Group Health Inc Commercial	$136.88
Rate for Payer: Group Health Inc Medicare	$95.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.88
Rate for Payer: Hamaspik Choice Inc Medicare	$136.88

CLIP ENDO APPLIER

Facility

$185.08

Hospital Charge Code	64907085
Hospital Revenue Code	270
Min. Negotiated Rate	$64.78
Max. Negotiated Rate	$148.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$92.54
Rate for Payer: Aetna Government	$92.54
Rate for Payer: Brighton Health Commercial	$138.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.85
Rate for Payer: Group Health Inc Commercial	$92.54
Rate for Payer: Group Health Inc Medicare	$64.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.54
Rate for Payer: Hamaspik Choice Inc Medicare	$92.54

CLIP MULTIPLE MEDIUM #MCM20

Facility

$128.32

Hospital Charge Code	40200410
Hospital Revenue Code	270
Min. Negotiated Rate	$44.91
Max. Negotiated Rate	$102.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.16
Rate for Payer: Aetna Government	$64.16
Rate for Payer: Brighton Health Commercial	$96.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$102.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.26
Rate for Payer: Group Health Inc Commercial	$64.16
Rate for Payer: Group Health Inc Medicare	$44.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.16
Rate for Payer: Hamaspik Choice Inc Medicare	$64.16

CLIP MULTIPLE SMALL #MCS20

Facility

$127.74

Hospital Charge Code	40200411
Hospital Revenue Code	270
Min. Negotiated Rate	$44.71
Max. Negotiated Rate	$102.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.87
Rate for Payer: Aetna Government	$63.87
Rate for Payer: Brighton Health Commercial	$95.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$102.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.86
Rate for Payer: Group Health Inc Commercial	$63.87
Rate for Payer: Group Health Inc Medicare	$44.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.87
Rate for Payer: Hamaspik Choice Inc Medicare	$63.87

CLIP OVERSCOPE 12/6 GC

Facility

$1,347.50

Hospital Charge Code	64905529
Hospital Revenue Code	270
Min. Negotiated Rate	$471.62
Max. Negotiated Rate	$1,078.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$741.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$673.75
Rate for Payer: Aetna Government	$673.75
Rate for Payer: Brighton Health Commercial	$1,010.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,078.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$916.30
Rate for Payer: Group Health Inc Commercial	$673.75
Rate for Payer: Group Health Inc Medicare	$471.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$673.75
Rate for Payer: Hamaspik Choice Inc Medicare	$673.75

CLIP RESOLUTION 360 235CM

Facility

$413.82

Hospital Charge Code	64906814
Hospital Revenue Code	279
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$331.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$227.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$206.91
Rate for Payer: Aetna Government	$206.91
Rate for Payer: Brighton Health Commercial	$310.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$331.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$281.40
Rate for Payer: Group Health Inc Commercial	$206.91
Rate for Payer: Group Health Inc Medicare	$144.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$206.91
Rate for Payer: Hamaspik Choice Inc Medicare	$206.91

CLIP RETRACTABLE PURELL GEAR

Facility

$2.37

Hospital Charge Code	64903458
Hospital Revenue Code	270
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.18
Rate for Payer: Aetna Government	$1.18
Rate for Payer: Brighton Health Commercial	$1.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.61
Rate for Payer: Group Health Inc Commercial	$1.18
Rate for Payer: Group Health Inc Medicare	$0.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1.18

CLIP SCALP RANEY

Facility

$2.80

Hospital Charge Code	64903984
Hospital Revenue Code	270
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$2.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.40
Rate for Payer: Aetna Government	$1.40
Rate for Payer: Brighton Health Commercial	$2.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.90
Rate for Payer: Group Health Inc Commercial	$1.40
Rate for Payer: Group Health Inc Medicare	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1.40

CLIP SCREWDRIVER TUBE F/INT

Facility

$273.75

Hospital Charge Code	64904535
Hospital Revenue Code	270
Min. Negotiated Rate	$95.81
Max. Negotiated Rate	$219.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$136.88
Rate for Payer: Aetna Government	$136.88
Rate for Payer: Brighton Health Commercial	$205.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$219.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.15
Rate for Payer: Group Health Inc Commercial	$136.88
Rate for Payer: Group Health Inc Medicare	$95.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.88
Rate for Payer: Hamaspik Choice Inc Medicare	$136.88

CLMP BLLDG WLDN MINATURE3.4CM STR

Facility

$260.00

Hospital Charge Code	40200837
Hospital Revenue Code	270
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$208.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$143.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$130.00
Rate for Payer: Aetna Government	$130.00
Rate for Payer: Brighton Health Commercial	$195.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$176.80
Rate for Payer: Group Health Inc Commercial	$130.00
Rate for Payer: Group Health Inc Medicare	$91.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.00
Rate for Payer: Hamaspik Choice Inc Medicare	$130.00

CLMP BLLDG WLDN MINATURE3.4 CURVD

Facility

$268.00

Hospital Charge Code	40200836
Hospital Revenue Code	270
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$214.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.00
Rate for Payer: Aetna Government	$134.00
Rate for Payer: Brighton Health Commercial	$201.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$214.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.24
Rate for Payer: Group Health Inc Commercial	$134.00
Rate for Payer: Group Health Inc Medicare	$93.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00

CLOBAZAM 10 MG PO TABS [112703]

Facility

$35.78

Service Code	NDC 67386031401
Hospital Charge Code	67386031401
Hospital Revenue Code	250
Min. Negotiated Rate	$12.52
Max. Negotiated Rate	$28.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.89
Rate for Payer: Aetna Government	$17.89
Rate for Payer: Brighton Health Commercial	$26.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.33
Rate for Payer: Group Health Inc Commercial	$17.89
Rate for Payer: Group Health Inc Medicare	$12.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.89
Rate for Payer: Hamaspik Choice Inc Medicare	$17.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.26

CLOBAZAM 10 MG PO TABS [112703]

Facility

$18.31

Service Code	NDC 00832058011
Hospital Charge Code	00832058011
Hospital Revenue Code	250
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$14.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.15
Rate for Payer: Aetna Government	$9.15
Rate for Payer: Brighton Health Commercial	$13.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.45
Rate for Payer: Group Health Inc Commercial	$9.15
Rate for Payer: Group Health Inc Medicare	$6.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.15
Rate for Payer: Hamaspik Choice Inc Medicare	$9.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.90

CLOBAZAM 10MG TAB

Facility

$13.00

Hospital Charge Code	41645975
Hospital Revenue Code	250
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.50
Rate for Payer: Aetna Government	$6.50
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.84
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

CLOBAZAM 10MG TAB

Facility

$13.00

Hospital Charge Code	41655975
Hospital Revenue Code	250
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.50
Rate for Payer: Aetna Government	$6.50
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.84
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

CLOBETASOL PROPIONATE 0.05 % CREAM

Facility

$4.20

Hospital Charge Code	41643999
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.10
Rate for Payer: Aetna Government	$2.10
Rate for Payer: Brighton Health Commercial	$3.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.86
Rate for Payer: Group Health Inc Commercial	$2.10
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.73

CLOBETASOL PROPIONATE 0.05 % CREAM

Facility

$4.20

Hospital Charge Code	41653999
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.10
Rate for Payer: Aetna Government	$2.10
Rate for Payer: Brighton Health Commercial	$3.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.86
Rate for Payer: Group Health Inc Commercial	$2.10
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.73

CLOBETASOL PROPIONATE 0.05 % EX CREA [9630]

Facility

$8.55

Service Code	NDC 50383026715
Hospital Charge Code	50383026715
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$6.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.27
Rate for Payer: Aetna Government	$4.27
Rate for Payer: Brighton Health Commercial	$6.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.81
Rate for Payer: Group Health Inc Commercial	$4.27
Rate for Payer: Group Health Inc Medicare	$2.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.27
Rate for Payer: Hamaspik Choice Inc Medicare	$4.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.56

Know your out-of-pocket cost for care.

All Charges