St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$0.29
Max. Negotiated Rate	$0.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

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	$0.57
Max. Negotiated Rate	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57

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	$0.19
Max. Negotiated Rate	$0.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.41
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

KETAMINE HCL 50 MG/ML IJ SOSY

Facility

$6.00

Service Code	NDC 6303713725
Hospital Charge Code	6303713725
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: EmblemHealth Commercial	$3.00
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

KETAMINE HCL 50 MG/ML IJ SOSY

Facility

$6.00

Service Code	NDC 6303713725
Hospital Charge Code	6303713725
Hospital Revenue Code	250
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00

KETAMINE HCL IN NACL 500 MG/110ML-% IV SOLN

Facility

$49.45

Service Code	NDC 9999123499
Hospital Charge Code	9999123499
Hospital Revenue Code	258
Min. Negotiated Rate	$24.73
Max. Negotiated Rate	$24.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.73

KETAMINE HCL IN NACL 500 MG/110ML-% IV SOLN

Facility

$49.45

Service Code	NDC 9999123499
Hospital Charge Code	9999123499
Hospital Revenue Code	258
Min. Negotiated Rate	$17.31
Max. Negotiated Rate	$39.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.73
Rate for Payer: Aetna Government	$24.73
Rate for Payer: Brighton Health Commercial	$37.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.63
Rate for Payer: EmblemHealth Commercial	$24.73
Rate for Payer: Group Health Inc Commercial	$24.73
Rate for Payer: Group Health Inc Medicare	$17.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.73
Rate for Payer: Hamaspik Choice Inc Medicare	$24.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.14

KETOCONAZOLE 200 MG PO TABS

Facility

$3.79

Service Code	NDC 3557343330
Hospital Charge Code	3557343330
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$3.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.90
Rate for Payer: Aetna Government	$1.90
Rate for Payer: Brighton Health Commercial	$2.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.58
Rate for Payer: EmblemHealth Commercial	$1.90
Rate for Payer: Group Health Inc Commercial	$1.90
Rate for Payer: Group Health Inc Medicare	$1.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.46

KETOCONAZOLE 200 MG PO TABS

Facility

$3.79

Service Code	NDC 3557343330
Hospital Charge Code	3557343330
Hospital Revenue Code	250
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$1.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.90

KETOCONAZOLE 2 % EX CREA

Facility

$4.62

Service Code	NDC 5167212983
Hospital Charge Code	5167212983
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$3.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.31
Rate for Payer: Aetna Government	$2.31
Rate for Payer: Brighton Health Commercial	$3.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.14
Rate for Payer: EmblemHealth Commercial	$2.31
Rate for Payer: Group Health Inc Commercial	$2.31
Rate for Payer: Group Health Inc Medicare	$1.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31
Rate for Payer: Hamaspik Choice Inc Medicare	$2.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.00

KETOCONAZOLE 2 % EX CREA

Facility

$6.95

Service Code	NDC 5167212982
Hospital Charge Code	5167212982
Hospital Revenue Code	250
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$3.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.47

KETOCONAZOLE 2 % EX CREA

Facility

$6.95

Service Code	NDC 5167212982
Hospital Charge Code	5167212982
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$5.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.47
Rate for Payer: Aetna Government	$3.47
Rate for Payer: Brighton Health Commercial	$5.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.72
Rate for Payer: EmblemHealth Commercial	$3.47
Rate for Payer: Group Health Inc Commercial	$3.47
Rate for Payer: Group Health Inc Medicare	$2.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.47
Rate for Payer: Hamaspik Choice Inc Medicare	$3.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.52

KETOCONAZOLE 2 % EX CREA

Facility

$1.32

Service Code	NDC 0168009960
Hospital Charge Code	0168009960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66

KETOCONAZOLE 2 % EX CREA

Facility

$1.32

Service Code	NDC 0168009960
Hospital Charge Code	0168009960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.66
Rate for Payer: Aetna Government	$0.66
Rate for Payer: Brighton Health Commercial	$0.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: EmblemHealth Commercial	$0.66
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.86

KETOCONAZOLE 2 % EX CREA

Facility

$4.62

Service Code	NDC 5167212983
Hospital Charge Code	5167212983
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31

KETOCONAZOLE 2 % EX CREA

Facility

$4.62

Service Code	NDC 2192202507
Hospital Charge Code	2192202507
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31

KETOCONAZOLE 2 % EX CREA

Facility

$2.06

Service Code	NDC 0168009915
Hospital Charge Code	0168009915
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.03

KETOCONAZOLE 2 % EX CREA

Facility

$4.62

Service Code	NDC 2192202507
Hospital Charge Code	2192202507
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$3.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.31
Rate for Payer: Aetna Government	$2.31
Rate for Payer: Brighton Health Commercial	$3.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.14
Rate for Payer: EmblemHealth Commercial	$2.31
Rate for Payer: Group Health Inc Commercial	$2.31
Rate for Payer: Group Health Inc Medicare	$1.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31
Rate for Payer: Hamaspik Choice Inc Medicare	$2.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.00

KETOCONAZOLE 2 % EX CREA

Facility

$2.06

Service Code	NDC 0168009915
Hospital Charge Code	0168009915
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.03
Rate for Payer: Aetna Government	$1.03
Rate for Payer: Brighton Health Commercial	$1.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.40
Rate for Payer: EmblemHealth Commercial	$1.03
Rate for Payer: Group Health Inc Commercial	$1.03
Rate for Payer: Group Health Inc Medicare	$0.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.03
Rate for Payer: Hamaspik Choice Inc Medicare	$1.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.34

KETOCONAZOLE 2 % EX SHAM

Facility

$0.25

Service Code	NDC 4580246564
Hospital Charge Code	4580246564
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

KETOCONAZOLE 2 % EX SHAM

Facility

$0.07

Service Code	NDC 7095466210
Hospital Charge Code	7095466210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

KETOCONAZOLE 2 % EX SHAM

Facility

$0.07

Service Code	NDC 7095466210
Hospital Charge Code	7095466210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

KETOCONAZOLE 2 % EX SHAM

Facility

$0.25

Service Code	NDC 4580246564
Hospital Charge Code	4580246564
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

KETOROLAC TROMETHAMINE 0.4 % OP SOLN

Facility

$67.96

Service Code	NDC 0023927705
Hospital Charge Code	0023927705
Hospital Revenue Code	250
Min. Negotiated Rate	$23.78
Max. Negotiated Rate	$54.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$33.98
Rate for Payer: Aetna Government	$33.98
Rate for Payer: Brighton Health Commercial	$50.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.21
Rate for Payer: EmblemHealth Commercial	$33.98
Rate for Payer: Group Health Inc Commercial	$33.98
Rate for Payer: Group Health Inc Medicare	$23.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.98
Rate for Payer: Hamaspik Choice Inc Medicare	$33.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.17

KETOROLAC TROMETHAMINE 0.4 % OP SOLN

Facility

$67.96

Service Code	NDC 0023927705
Hospital Charge Code	0023927705
Hospital Revenue Code	250
Min. Negotiated Rate	$33.98
Max. Negotiated Rate	$33.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.98

Know your out-of-pocket cost for care.

All Charges