St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN

Facility

$3.46

Service Code	HCPCS J1100
Hospital Charge Code	6332316501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$2.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$2.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.35
Rate for Payer: EmblemHealth Commercial	$1.73
Rate for Payer: Group Health Inc Commercial	$1.73
Rate for Payer: Group Health Inc Medicare	$1.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.73
Rate for Payer: Hamaspik Choice Inc Medicare	$1.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.25

DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN

Facility

$1.16

Service Code	HCPCS J1100
Hospital Charge Code	0641614525
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58

DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN

Facility

$3.46

Service Code	HCPCS J1100
Hospital Charge Code	6332316502
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$1.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.73

DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN

Facility

$3.46

Service Code	HCPCS J1100
Hospital Charge Code	6332316502
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$2.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$2.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.35
Rate for Payer: EmblemHealth Commercial	$1.73
Rate for Payer: Group Health Inc Commercial	$1.73
Rate for Payer: Group Health Inc Medicare	$1.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.73
Rate for Payer: Hamaspik Choice Inc Medicare	$1.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.25

DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN

Facility

$0.99

Service Code	HCPCS J1100
Hospital Charge Code	6745742312
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN

Facility

$6.29

Service Code	HCPCS J1100
Hospital Charge Code	7006902101
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.15

DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN

Facility

$6.29

Service Code	HCPCS J1100
Hospital Charge Code	7006902101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$5.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$4.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.28
Rate for Payer: EmblemHealth Commercial	$3.15
Rate for Payer: Group Health Inc Commercial	$3.15
Rate for Payer: Group Health Inc Medicare	$2.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.15
Rate for Payer: Hamaspik Choice Inc Medicare	$3.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.09

DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN

Facility

$6.29

Service Code	HCPCS J1100
Hospital Charge Code	9999123465
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$5.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$4.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.28
Rate for Payer: EmblemHealth Commercial	$3.14
Rate for Payer: Group Health Inc Commercial	$3.14
Rate for Payer: Group Health Inc Medicare	$2.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.14
Rate for Payer: Hamaspik Choice Inc Medicare	$3.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.09

DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN

Facility

$1.65

Service Code	HCPCS J1100
Hospital Charge Code	7248511801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.83

DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN

Facility

$6.29

Service Code	HCPCS J1100
Hospital Charge Code	9999123465
Hospital Revenue Code	250
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$3.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.14

DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN

Facility

$6.29

Service Code	HCPCS J1100
Hospital Charge Code	7006902125
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$5.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$4.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.28
Rate for Payer: EmblemHealth Commercial	$3.14
Rate for Payer: Group Health Inc Commercial	$3.14
Rate for Payer: Group Health Inc Medicare	$2.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.14
Rate for Payer: Hamaspik Choice Inc Medicare	$3.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.09

DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN

Facility

$6.29

Service Code	HCPCS J1100
Hospital Charge Code	7006902125
Hospital Revenue Code	250
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$3.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.14

DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN

Facility

$1.65

Service Code	HCPCS J1100
Hospital Charge Code	7248511801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.12
Rate for Payer: EmblemHealth Commercial	$0.83
Rate for Payer: Group Health Inc Commercial	$0.83
Rate for Payer: Group Health Inc Medicare	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.83
Rate for Payer: Hamaspik Choice Inc Medicare	$0.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.07

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN

Facility

$11.45

Service Code	NDC 1672923993
Hospital Charge Code	1672923993
Hospital Revenue Code	258
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$5.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.73

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN

Facility

$3.24

Service Code	NDC 7128850502
Hospital Charge Code	7128850502
Hospital Revenue Code	258
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$2.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.62
Rate for Payer: Aetna Government	$1.62
Rate for Payer: Brighton Health Commercial	$2.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.20
Rate for Payer: EmblemHealth Commercial	$1.62
Rate for Payer: Group Health Inc Commercial	$1.62
Rate for Payer: Group Health Inc Medicare	$1.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.11

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN

Facility

$3.15

Service Code	NDC 6679423002
Hospital Charge Code	6679423002
Hospital Revenue Code	258
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.57

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN

Facility

$11.45

Service Code	NDC 1672923993
Hospital Charge Code	1672923993
Hospital Revenue Code	258
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$9.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.73
Rate for Payer: Aetna Government	$5.73
Rate for Payer: Brighton Health Commercial	$8.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.79
Rate for Payer: EmblemHealth Commercial	$5.73
Rate for Payer: Group Health Inc Commercial	$5.73
Rate for Payer: Group Health Inc Medicare	$4.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.73
Rate for Payer: Hamaspik Choice Inc Medicare	$5.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.45

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN

Facility

$23.76

Service Code	NDC 6332342102
Hospital Charge Code	6332342102
Hospital Revenue Code	258
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$11.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.88

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN

Facility

$3.60

Service Code	NDC 0409163802
Hospital Charge Code	0409163802
Hospital Revenue Code	258
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN

Facility

$4.32

Service Code	NDC 5515020902
Hospital Charge Code	5515020902
Hospital Revenue Code	258
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$3.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.16
Rate for Payer: Aetna Government	$2.16
Rate for Payer: Brighton Health Commercial	$3.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.94
Rate for Payer: EmblemHealth Commercial	$2.16
Rate for Payer: Group Health Inc Commercial	$2.16
Rate for Payer: Group Health Inc Medicare	$1.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.16
Rate for Payer: Hamaspik Choice Inc Medicare	$2.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.81

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN

Facility

$23.76

Service Code	NDC 6332342102
Hospital Charge Code	6332342102
Hospital Revenue Code	258
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$19.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.88
Rate for Payer: Aetna Government	$11.88
Rate for Payer: Brighton Health Commercial	$17.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.16
Rate for Payer: EmblemHealth Commercial	$11.88
Rate for Payer: Group Health Inc Commercial	$11.88
Rate for Payer: Group Health Inc Medicare	$8.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.88
Rate for Payer: Hamaspik Choice Inc Medicare	$11.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.44

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN

Facility

$3.60

Service Code	NDC 0409163802
Hospital Charge Code	0409163802
Hospital Revenue Code	258
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.80
Rate for Payer: Aetna Government	$1.80
Rate for Payer: Brighton Health Commercial	$2.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.45
Rate for Payer: EmblemHealth Commercial	$1.80
Rate for Payer: Group Health Inc Commercial	$1.80
Rate for Payer: Group Health Inc Medicare	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.34

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN

Facility

$3.15

Service Code	NDC 6679423042
Hospital Charge Code	6679423042
Hospital Revenue Code	258
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.57

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN

Facility

$3.15

Service Code	NDC 6679423002
Hospital Charge Code	6679423002
Hospital Revenue Code	258
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$2.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.57
Rate for Payer: Aetna Government	$1.57
Rate for Payer: Brighton Health Commercial	$2.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.14
Rate for Payer: EmblemHealth Commercial	$1.57
Rate for Payer: Group Health Inc Commercial	$1.57
Rate for Payer: Group Health Inc Medicare	$1.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.57
Rate for Payer: Hamaspik Choice Inc Medicare	$1.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.05

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN

Facility

$3.15

Service Code	NDC 6679423042
Hospital Charge Code	6679423042
Hospital Revenue Code	258
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$2.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.57
Rate for Payer: Aetna Government	$1.57
Rate for Payer: Brighton Health Commercial	$2.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.14
Rate for Payer: EmblemHealth Commercial	$1.57
Rate for Payer: Group Health Inc Commercial	$1.57
Rate for Payer: Group Health Inc Medicare	$1.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.57
Rate for Payer: Hamaspik Choice Inc Medicare	$1.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.05

Know your out-of-pocket cost for care.

All Charges