St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

5% DEX. IN RINGER 1000CC

Facility

$9.92

Hospital Charge Code	40509790
Hospital Revenue Code	260
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.96
Rate for Payer: Aetna Government	$4.96
Rate for Payer: Brighton Health Commercial	$7.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.75
Rate for Payer: Group Health Inc Commercial	$4.96
Rate for Payer: Group Health Inc Medicare	$3.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.96
Rate for Payer: Hamaspik Choice Inc Medicare	$4.96
Rate for Payer: United Healthcare Commercial	$76.00

5% DEXTROSE 1000 CC

Facility

$4.61

Hospital Charge Code	40501100
Hospital Revenue Code	260
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.30
Rate for Payer: Aetna Government	$2.30
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	$3.13
Rate for Payer: Group Health Inc Commercial	$2.30
Rate for Payer: Group Health Inc Medicare	$1.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.30
Rate for Payer: Hamaspik Choice Inc Medicare	$2.30
Rate for Payer: United Healthcare Commercial	$76.00

5% DEXTROSE 100 CC

Facility

$6.03

Hospital Charge Code	40509782
Hospital Revenue Code	260
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.02
Rate for Payer: Aetna Government	$3.02
Rate for Payer: Brighton Health Commercial	$4.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.10
Rate for Payer: Group Health Inc Commercial	$3.02
Rate for Payer: Group Health Inc Medicare	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.02
Rate for Payer: Hamaspik Choice Inc Medicare	$3.02
Rate for Payer: United Healthcare Commercial	$76.00

5% DEXTROSE 250 CC

Facility

$3.90

Hospital Charge Code	40501102
Hospital Revenue Code	260
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.95
Rate for Payer: Aetna Government	$1.95
Rate for Payer: Brighton Health Commercial	$2.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.65
Rate for Payer: Group Health Inc Commercial	$1.95
Rate for Payer: Group Health Inc Medicare	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95
Rate for Payer: Hamaspik Choice Inc Medicare	$1.95
Rate for Payer: United Healthcare Commercial	$76.00

5% DEXTROSE 500 CC

Facility

$3.90

Hospital Charge Code	40501101
Hospital Revenue Code	260
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.95
Rate for Payer: Aetna Government	$1.95
Rate for Payer: Brighton Health Commercial	$2.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.65
Rate for Payer: Group Health Inc Commercial	$1.95
Rate for Payer: Group Health Inc Medicare	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95
Rate for Payer: Hamaspik Choice Inc Medicare	$1.95
Rate for Payer: United Healthcare Commercial	$76.00

5% DEXTROSE 50 CC

Facility

$6.03

Hospital Charge Code	40509781
Hospital Revenue Code	260
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.02
Rate for Payer: Aetna Government	$3.02
Rate for Payer: Brighton Health Commercial	$4.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.10
Rate for Payer: Group Health Inc Commercial	$3.02
Rate for Payer: Group Health Inc Medicare	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.02
Rate for Payer: Hamaspik Choice Inc Medicare	$3.02
Rate for Payer: United Healthcare Commercial	$76.00

5% DEXTROSE IN 45 NS 500 CC

Facility

$4.25

Hospital Charge Code	40509784
Hospital Revenue Code	260
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.12
Rate for Payer: Aetna Government	$2.12
Rate for Payer: Brighton Health Commercial	$3.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.89
Rate for Payer: Group Health Inc Commercial	$2.12
Rate for Payer: Group Health Inc Medicare	$1.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2.12
Rate for Payer: United Healthcare Commercial	$76.00

5% DEXTROSE IN H20-1000CCF

Facility

$8.51

Hospital Charge Code	40191100
Hospital Revenue Code	710
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$6.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.26
Rate for Payer: Aetna Government	$4.26
Rate for Payer: Brighton Health Commercial	$6.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.79
Rate for Payer: Group Health Inc Commercial	$4.26
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.26
Rate for Payer: Hamaspik Choice Inc Medicare	$4.26

5% DEXTROSE IN NS 500CC

Facility

$3.90

Hospital Charge Code	40502101
Hospital Revenue Code	260
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.95
Rate for Payer: Aetna Government	$1.95
Rate for Payer: Brighton Health Commercial	$2.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.65
Rate for Payer: Group Health Inc Commercial	$1.95
Rate for Payer: Group Health Inc Medicare	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95
Rate for Payer: Hamaspik Choice Inc Medicare	$1.95
Rate for Payer: United Healthcare Commercial	$76.00

5% DEXTRSE IN 0.33 SC 500CC

Facility

$9.22

Hospital Charge Code	40502141
Hospital Revenue Code	260
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.61
Rate for Payer: Aetna Government	$4.61
Rate for Payer: Brighton Health Commercial	$6.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.27
Rate for Payer: Group Health Inc Commercial	$4.61
Rate for Payer: Group Health Inc Medicare	$3.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.61
Rate for Payer: Hamaspik Choice Inc Medicare	$4.61
Rate for Payer: United Healthcare Commercial	$76.00

5% DEXTRSE IN .2 NS 500 CC

Facility

$3.90

Hospital Charge Code	40502161
Hospital Revenue Code	260
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.95
Rate for Payer: Aetna Government	$1.95
Rate for Payer: Brighton Health Commercial	$2.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.65
Rate for Payer: Group Health Inc Commercial	$1.95
Rate for Payer: Group Health Inc Medicare	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95
Rate for Payer: Hamaspik Choice Inc Medicare	$1.95
Rate for Payer: United Healthcare Commercial	$76.00

5% DEXTRSE IN NRML SAL-1000CC

Facility

$10.28

Hospital Charge Code	40502100
Hospital Revenue Code	260
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.14
Rate for Payer: Aetna Government	$5.14
Rate for Payer: Brighton Health Commercial	$7.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.99
Rate for Payer: Group Health Inc Commercial	$5.14
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14
Rate for Payer: Hamaspik Choice Inc Medicare	$5.14
Rate for Payer: United Healthcare Commercial	$76.00

5% DXTRSE IN 33 NS 1000CC

Facility

$4.97

Hospital Charge Code	40509823
Hospital Revenue Code	260
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.48
Rate for Payer: Aetna Government	$2.48
Rate for Payer: Brighton Health Commercial	$3.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.38
Rate for Payer: Group Health Inc Commercial	$2.48
Rate for Payer: Group Health Inc Medicare	$1.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.48
Rate for Payer: Hamaspik Choice Inc Medicare	$2.48
Rate for Payer: United Healthcare Commercial	$76.00

5% DXTRSE IN 45 NS 1000CC

Facility

$4.97

Hospital Charge Code	40502120
Hospital Revenue Code	260
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.48
Rate for Payer: Aetna Government	$2.48
Rate for Payer: Brighton Health Commercial	$3.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.38
Rate for Payer: Group Health Inc Commercial	$2.48
Rate for Payer: Group Health Inc Medicare	$1.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.48
Rate for Payer: Hamaspik Choice Inc Medicare	$2.48
Rate for Payer: United Healthcare Commercial	$76.00

5% DXTRSE LACT. RINGERS 1L

Facility

$5.67

Hospital Charge Code	40503510
Hospital Revenue Code	260
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$4.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.86
Rate for Payer: Group Health Inc Commercial	$2.84
Rate for Payer: Group Health Inc Medicare	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.84
Rate for Payer: Hamaspik Choice Inc Medicare	$2.84
Rate for Payer: United Healthcare Commercial	$76.00

5-HIAA,QUANT.,24 HR URINE

Facility

$32.25

Service Code	HCPCS 83497
Hospital Charge Code	40609085
Hospital Revenue Code	300
Rate for Payer: Cash Price	$12.90

5-HIAA,QUANT.,24 HR URINE

Facility

$32.25

Service Code	HCPCS 83497
Hospital Charge Code	40609085
Hospital Revenue Code	300
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$24.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.90
Rate for Payer: Aetna Government	$12.90
Rate for Payer: Affinity Essential Plan 1&2	$9.03
Rate for Payer: Affinity Essential Plan 3&4	$9.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.03
Rate for Payer: Brighton Health Commercial	$24.19
Rate for Payer: Cash Price	$12.90
Rate for Payer: Cash Price	$12.90
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.34
Rate for Payer: Elderplan Medicare Advantage	$12.90
Rate for Payer: EmblemHealth Commercial	$12.90
Rate for Payer: Fidelis Essential Plan Aliesa	$10.96
Rate for Payer: Fidelis Essential Plan QHP	$11.48
Rate for Payer: Fidelis Medicare Advantage	$12.90
Rate for Payer: Fidelis Qualified Health Plan	$11.48
Rate for Payer: Group Health Inc Commercial	$12.90
Rate for Payer: Group Health Inc Medicare	$12.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.12
Rate for Payer: Hamaspik Choice Inc Medicare	$12.90
Rate for Payer: Healthfirst Medicare Advantage	$12.90
Rate for Payer: Healthfirst QHP	$12.90
Rate for Payer: Humana Medicare	$13.16
Rate for Payer: Senior Whole Health Medicare Advantage	$12.90
Rate for Payer: United Healthcare Commercial	$16.33
Rate for Payer: United Healthcare Medicare Advantage	$12.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.32
Rate for Payer: Wellcare Medicare	$11.61

5HLE L PLTE 2MM ADVMT100D LFT GSP

Facility

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40201092
Hospital Revenue Code	278
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$329.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$188.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$157.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$180.55
Rate for Payer: EmblemHealth Commercial	$157.00
Rate for Payer: Fidelis Medicare Advantage	$329.70
Rate for Payer: Group Health Inc Commercial	$157.00
Rate for Payer: Group Health Inc Medicare	$109.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.10

5HLE L PLTE 2MM ADVMT100D LFT GSP

Facility

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40201092
Hospital Revenue Code	278
Min. Negotiated Rate	$157.00
Max. Negotiated Rate	$157.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00

5HLE L PLTE2MM ADVMT100D LFT MAL

Facility

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40201096
Hospital Revenue Code	278
Min. Negotiated Rate	$157.00
Max. Negotiated Rate	$157.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00

5HLE L PLTE2MM ADVMT100D LFT MAL

Facility

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40201096
Hospital Revenue Code	278
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$329.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$188.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$157.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$180.55
Rate for Payer: EmblemHealth Commercial	$157.00
Rate for Payer: Fidelis Medicare Advantage	$329.70
Rate for Payer: Group Health Inc Commercial	$157.00
Rate for Payer: Group Health Inc Medicare	$109.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.10

5HLE L PLTE 2MM ADVMT100D LFT STD

Facility

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40201093
Hospital Revenue Code	278
Min. Negotiated Rate	$157.00
Max. Negotiated Rate	$157.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00

5HLE L PLTE 2MM ADVMT100D LFT STD

Facility

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40201093
Hospital Revenue Code	278
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$329.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$188.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$157.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$180.55
Rate for Payer: EmblemHealth Commercial	$157.00
Rate for Payer: Fidelis Medicare Advantage	$329.70
Rate for Payer: Group Health Inc Commercial	$157.00
Rate for Payer: Group Health Inc Medicare	$109.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.10

5HLE L PLTE2MM ADVMT100D RGHT GSP

Facility

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40201094
Hospital Revenue Code	278
Min. Negotiated Rate	$157.00
Max. Negotiated Rate	$157.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00

5HLE L PLTE2MM ADVMT100D RGHT GSP

Facility

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40201094
Hospital Revenue Code	278
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$329.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$188.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$157.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$180.55
Rate for Payer: EmblemHealth Commercial	$157.00
Rate for Payer: Fidelis Medicare Advantage	$329.70
Rate for Payer: Group Health Inc Commercial	$157.00
Rate for Payer: Group Health Inc Medicare	$109.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.10

Know your out-of-pocket cost for care.

All Charges