St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

$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-DEXTROSE 400MCG/100ML -5% IV SOLN

Facility

$0.43

Service Code	NDC 4456760324
Hospital Charge Code	4456760324
Hospital Revenue Code	258
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22

DEXMEDETOMIDINE HCL-DEXTROSE 400MCG/100ML -5% IV SOLN

Facility

$0.43

Service Code	NDC 4456760324
Hospital Charge Code	4456760324
Hospital Revenue Code	258
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: EmblemHealth Commercial	$0.22
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN

Facility

$0.96

Service Code	NDC 5515029710
Hospital Charge Code	5515029710
Hospital Revenue Code	258
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

DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN

Facility

$0.96

Service Code	NDC 4306656512
Hospital Charge Code	4306656512
Hospital Revenue Code	258
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48

DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN

Facility

$0.96

Service Code	NDC 4306656512
Hospital Charge Code	4306656512
Hospital Revenue Code	258
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

DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN

Facility

$0.96

Service Code	NDC 5515029710
Hospital Charge Code	5515029710
Hospital Revenue Code	258
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48

DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN

Facility

$0.10

Service Code	NDC 0409741914
Hospital Charge Code	0409741914
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN

Facility

$0.10

Service Code	NDC 0409741903
Hospital Charge Code	0409741903
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN

Facility

$0.10

Service Code	NDC 0409741903
Hospital Charge Code	0409741903
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN

Facility

$0.10

Service Code	NDC 0409741914
Hospital Charge Code	0409741914
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

DEXTROMETHORPHAN-BENZOCAINE 5-7.5 MG MT LOZG

Facility

$0.18

Service Code	NDC 6382474416
Hospital Charge Code	6382474416
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

DEXTROMETHORPHAN-BENZOCAINE 5-7.5 MG MT LOZG

Facility

$0.18

Service Code	NDC 6382474416
Hospital Charge Code	6382474416
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: EmblemHealth Commercial	$0.09
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

DEXTROSE 10 % IV BOLUS

Facility

$0.01

Service Code	NDC 0338002304
Hospital Charge Code	0338002304
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	$0.01
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	$0.01

DEXTROSE 10 % IV BOLUS

Facility

$0.01

Service Code	NDC 0338002304
Hospital Charge Code	0338002304
Hospital Revenue Code	258
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

DEXTROSE 10 % IV BOLUS

Facility

$0.03

Service Code	NDC 0338002302
Hospital Charge Code	0338002302
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
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	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
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	$0.02

DEXTROSE 10 % IV BOLUS

Facility

$0.03

Service Code	NDC 0338002302
Hospital Charge Code	0338002302
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

DEXTROSE 10 % IV BOLUS

Facility

$0.01

Service Code	NDC 0338002303
Hospital Charge Code	0338002303
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

DEXTROSE 10 % IV BOLUS

Facility

$0.01

Service Code	NDC 0338002303
Hospital Charge Code	0338002303
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

DEXTROSE 10 % IV BOLUS

Facility

$0.01

Service Code	NDC 0264752000
Hospital Charge Code	0264752000
Hospital Revenue Code	258
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

DEXTROSE 10 % IV BOLUS

Facility

$0.01

Service Code	NDC 0264752000
Hospital Charge Code	0264752000
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

DEXTROSE 10 % IV SOLN

Facility

$0.03

Service Code	NDC 0338002302
Hospital Charge Code	0338002302
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

DEXTROSE 10 % IV SOLN

Facility

$0.01

Service Code	NDC 0338002303
Hospital Charge Code	0338002303
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

DEXTROSE 10 % IV SOLN

Facility

$0.01

Service Code	NDC 0338002304
Hospital Charge Code	0338002304
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	$0.01
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	$0.01

Know your out-of-pocket cost for care.

All Charges