St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MICROSLIDE CONSULTATION

Facility

$101.25

Service Code	HCPCS 88321
Hospital Charge Code	40635462
Hospital Revenue Code	312
Min. Negotiated Rate	$32.47
Max. Negotiated Rate	$91.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.38
Rate for Payer: Aetna Government	$46.38
Rate for Payer: Affinity Essential Plan 1&2	$32.47
Rate for Payer: Affinity Essential Plan 3&4	$32.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$32.47
Rate for Payer: Brighton Health Commercial	$46.38
Rate for Payer: Cash Price	$46.38
Rate for Payer: Cash Price	$46.38
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$46.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$91.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.62
Rate for Payer: Elderplan Medicare Advantage	$46.38
Rate for Payer: EmblemHealth Commercial	$46.38
Rate for Payer: Fidelis Essential Plan Aliesa	$39.42
Rate for Payer: Fidelis Essential Plan QHP	$41.28
Rate for Payer: Fidelis Medicare Advantage	$46.38
Rate for Payer: Fidelis Qualified Health Plan	$41.28
Rate for Payer: Group Health Inc Commercial	$46.38
Rate for Payer: Group Health Inc Medicare	$46.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.62
Rate for Payer: Hamaspik Choice Inc Medicare	$46.38
Rate for Payer: Healthfirst Medicare Advantage	$46.38
Rate for Payer: Healthfirst QHP	$46.38
Rate for Payer: Humana Medicare	$47.31
Rate for Payer: Senior Whole Health Medicare Advantage	$46.38
Rate for Payer: United Healthcare Medicare Advantage	$46.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37.10
Rate for Payer: Wellcare Medicare	$41.74

MICROSURGERY ADD ON

Facility

$596.68

Service Code	HCPCS 69990
Hospital Charge Code	40019713
Hospital Revenue Code	360
Min. Negotiated Rate	$192.10
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$192.10
Rate for Payer: Aetna Government	$192.10
Rate for Payer: Brighton Health Commercial	$447.51
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$298.34
Rate for Payer: Group Health Inc Medicare	$208.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$298.34
Rate for Payer: Hamaspik Choice Inc Medicare	$298.34
Rate for Payer: United Healthcare Commercial	$1,113.00

MICROSURG NEEDLE HLDR 7

Facility

$374.18

Hospital Charge Code	64903600
Hospital Revenue Code	270
Min. Negotiated Rate	$130.96
Max. Negotiated Rate	$299.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$187.09
Rate for Payer: Aetna Government	$187.09
Rate for Payer: Brighton Health Commercial	$280.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$299.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$254.44
Rate for Payer: Group Health Inc Commercial	$187.09
Rate for Payer: Group Health Inc Medicare	$130.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.09
Rate for Payer: Hamaspik Choice Inc Medicare	$187.09

MIDAZOLAM 0.1 MG/ML INJ NEONATAL

Facility

$1.00

Service Code	HCPCS J2250
Hospital Charge Code	41655187
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

MIDAZOLAM 0.1 MG/ML INJ NEONATAL

Facility

$1.00

Service Code	HCPCS J2250
Hospital Charge Code	41645187
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

MIDAZOLAM 0.1 MG/ML INJ NEONATAL

Facility

$1.00

Service Code	HCPCS J2250
Hospital Charge Code	41645187
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.14
Rate for Payer: SOMOS Essential	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

MIDAZOLAM 0.1 MG/ML INJ NEONATAL

Facility

$1.00

Service Code	HCPCS J2250
Hospital Charge Code	41655187
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.14
Rate for Payer: SOMOS Essential	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

MIDAZOLAM 100 MG/100ML IV SOLN [174873]

Facility

$0.26

Service Code	NDC 69374031410
Hospital Charge Code	69374031410
Hospital Revenue Code	278
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13

MIDAZOLAM 100 MG/100ML IV SOLN [174873]

Facility

$0.26

Service Code	NDC 69374031410
Hospital Charge Code	69374031410
Hospital Revenue Code	278
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Fidelis Medicare Advantage	$0.28
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	$0.17

MIDAZOLAM 100MG D5W 100ML INF

Facility

$0.17

Service Code	HCPCS J2250
Hospital Charge Code	41657779
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09

MIDAZOLAM 100MG D5W 100ML INF

Facility

$0.17

Service Code	HCPCS J2250
Hospital Charge Code	41657779
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.14
Rate for Payer: SOMOS Essential	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

MIDAZOLAM 100MG D5W 100ML INF

Facility

$0.17

Service Code	HCPCS J2250
Hospital Charge Code	41647779
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09

MIDAZOLAM 100MG D5W 100ML INF

Facility

$0.17

Service Code	HCPCS J2250
Hospital Charge Code	41647779
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.14
Rate for Payer: SOMOS Essential	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

MIDAZOLAM 100MG/D5W 200ML INF-1MG

Facility

$0.31

Service Code	HCPCS J2250
Hospital Charge Code	41657171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
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	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.14
Rate for Payer: SOMOS Essential	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

MIDAZOLAM 100MG/D5W 200ML INF-1MG

Facility

$0.31

Service Code	HCPCS J2250
Hospital Charge Code	41657171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16

MIDAZOLAM 100MG/D5W 200ML INF-1MG

Facility

$0.31

Service Code	HCPCS J2250
Hospital Charge Code	41647171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16

MIDAZOLAM 100MG/D5W 200ML INF-1MG

Facility

$0.31

Service Code	HCPCS J2250
Hospital Charge Code	41647171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
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	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.14
Rate for Payer: SOMOS Essential	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

MIDAZOLAM 100MG NS 100ML INF

Facility

$0.17

Service Code	HCPCS J2250
Hospital Charge Code	41657783
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.14
Rate for Payer: SOMOS Essential	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

MIDAZOLAM 100MG NS 100ML INF

Facility

$0.17

Service Code	HCPCS J2250
Hospital Charge Code	41657783
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09

MIDAZOLAM 100MG NS 100ML INF

Facility

$0.17

Service Code	HCPCS J2250
Hospital Charge Code	41647783
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.14
Rate for Payer: SOMOS Essential	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

MIDAZOLAM 100MG NS 100ML INF

Facility

$0.17

Service Code	HCPCS J2250
Hospital Charge Code	41647783
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09

MIDAZOLAM 100MG/NS 200ML INF -1MG

Facility

$0.31

Service Code	HCPCS J2250
Hospital Charge Code	41647169
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16

MIDAZOLAM 100MG/NS 200ML INF -1MG

Facility

$0.31

Service Code	HCPCS J2250
Hospital Charge Code	41647169
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
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	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.14
Rate for Payer: SOMOS Essential	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

MIDAZOLAM 100MG/NS 200ML INF-1MG

Facility

$0.31

Service Code	HCPCS J2250
Hospital Charge Code	41657169
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
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	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.14
Rate for Payer: SOMOS Essential	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

MIDAZOLAM 100MG/NS 200ML INF-1MG

Facility

$0.31

Service Code	HCPCS J2250
Hospital Charge Code	41657169
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16

Know your out-of-pocket cost for care.

All Charges