St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN

Facility

$0.01

Service Code	NDC 0338067104
Hospital Charge Code	0338067104
Hospital Revenue Code	258
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN

Facility

$0.01

Service Code	NDC 0338067104
Hospital Charge Code	0338067104
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
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	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN

Facility

$0.01

Service Code	NDC 0338080304
Hospital Charge Code	0338080304
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN

Facility

$0.01

Service Code	NDC 0338080304
Hospital Charge Code	0338080304
Hospital Revenue Code	258
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: EmblemHealth Commercial	$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

KCL IN DEXTROSE-NACL 40-5-0.45 MEQ/L-%-% IV SOLN

Facility

$0.01

Service Code	NDC 0338067504
Hospital Charge Code	0338067504
Hospital Revenue Code	258
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: EmblemHealth Commercial	$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

KCL IN DEXTROSE-NACL 40-5-0.45 MEQ/L-%-% IV SOLN

Facility

$0.01

Service Code	NDC 0338067504
Hospital Charge Code	0338067504
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

KCL-LACTATED RINGERS-D5W 20 MEQ/L IV SOLN

Facility

$0.01

Service Code	NDC 0338081104
Hospital Charge Code	0338081104
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

KCL-LACTATED RINGERS-D5W 20 MEQ/L IV SOLN

Facility

$0.01

Service Code	NDC 0338081104
Hospital Charge Code	0338081104
Hospital Revenue Code	258
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: EmblemHealth Commercial	$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

KETAMINE HCL 100 MG/ML IJ SOLN

Facility

$3.06

Service Code	NDC 0143950910
Hospital Charge Code	0143950910
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.53
Rate for Payer: Aetna Government	$1.53
Rate for Payer: Brighton Health Commercial	$2.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.08
Rate for Payer: EmblemHealth Commercial	$1.53
Rate for Payer: Group Health Inc Commercial	$1.53
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.99

KETAMINE HCL 100 MG/ML IJ SOLN

Facility

$4.50

Service Code	NDC 9999123440
Hospital Charge Code	9999123440
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.25

KETAMINE HCL 100 MG/ML IJ SOLN

Facility

$3.06

Service Code	NDC 0143950901
Hospital Charge Code	0143950901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.53
Rate for Payer: Aetna Government	$1.53
Rate for Payer: Brighton Health Commercial	$2.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.08
Rate for Payer: EmblemHealth Commercial	$1.53
Rate for Payer: Group Health Inc Commercial	$1.53
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.99

KETAMINE HCL 100 MG/ML IJ SOLN

Facility

$4.50

Service Code	NDC 9999123440
Hospital Charge Code	9999123440
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$3.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.25
Rate for Payer: Aetna Government	$2.25
Rate for Payer: Brighton Health Commercial	$3.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.06
Rate for Payer: EmblemHealth Commercial	$2.25
Rate for Payer: Group Health Inc Commercial	$2.25
Rate for Payer: Group Health Inc Medicare	$1.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.92

KETAMINE HCL 100 MG/ML IJ SOLN

Facility

$3.06

Service Code	NDC 0143950901
Hospital Charge Code	0143950901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$1.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.53

KETAMINE HCL 100 MG/ML IJ SOLN

Facility

$3.06

Service Code	NDC 0143950910
Hospital Charge Code	0143950910
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$1.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.53

KETAMINE HCL 10 MG/ML IJ SOLN

Facility

$1.19

Service Code	NDC 4202311310
Hospital Charge Code	4202311310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59

KETAMINE HCL 10 MG/ML IJ SOLN

Facility

$1.19

Service Code	NDC 4202311310
Hospital Charge Code	4202311310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.59
Rate for Payer: Aetna Government	$0.59
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.81
Rate for Payer: EmblemHealth Commercial	$0.59
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

KETAMINE HCL 10 MG/ML IJ SOLN

Facility

$0.96

Service Code	NDC 6937430805
Hospital Charge Code	6937430805
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.65
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

KETAMINE HCL 10 MG/ML IJ SOLN

Facility

$1.21

Service Code	NDC 5515043801
Hospital Charge Code	5515043801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.60
Rate for Payer: Aetna Government	$0.60
Rate for Payer: Brighton Health Commercial	$0.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.82
Rate for Payer: EmblemHealth Commercial	$0.60
Rate for Payer: Group Health Inc Commercial	$0.60
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60
Rate for Payer: Hamaspik Choice Inc Medicare	$0.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.78

KETAMINE HCL 10 MG/ML IJ SOLN

Facility

$1.21

Service Code	NDC 5515043801
Hospital Charge Code	5515043801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60

KETAMINE HCL 10 MG/ML IJ SOLN

Facility

$0.96

Service Code	NDC 6937430805
Hospital Charge Code	6937430805
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48

KETAMINE HCL 30 MG/3ML IJ SOSY

Facility

$1.60

Service Code	NDC 6937498233
Hospital Charge Code	6937498233
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80

KETAMINE HCL 30 MG/3ML IJ SOSY

Facility

$1.60

Service Code	NDC 6937498233
Hospital Charge Code	6937498233
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: EmblemHealth Commercial	$0.80
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.04

KETAMINE HCL 50 MG/ML IJ SOLN

Facility

$1.14

Service Code	NDC 2502168310
Hospital Charge Code	2502168310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Brighton Health Commercial	$0.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: EmblemHealth Commercial	$0.57
Rate for Payer: Group Health Inc Commercial	$0.57
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57
Rate for Payer: Hamaspik Choice Inc Medicare	$0.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.74

KETAMINE HCL 50 MG/ML IJ SOLN

Facility

$0.84

Service Code	NDC 4202311410
Hospital Charge Code	4202311410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

KETAMINE HCL 50 MG/ML IJ SOLN

Facility

$0.55

Service Code	NDC 7257232001
Hospital Charge Code	7257232001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28

Know your out-of-pocket cost for care.

All Charges