St. Barnabas Hospital

All Charges

Charge

Type

Price

BUDESONIDE 0.125 MG/1 ML NEB SOLN

Facility OP

$5.00

Hospital Charge Code	41641904
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

BUDESONIDE 0.125 MG/1 ML NEB SOLN

Facility OP

$5.00

Hospital Charge Code	41651904
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

BUDESONIDE 0.25 MG/2 ML NEB SOLN

Facility IP

$13.58

Service Code	HCPCS J7626
Hospital Charge Code	41652677
Hospital Revenue Code	636
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$6.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.79
Rate for Payer: Hamaspik Choice Inc Medicare	$6.79

BUDESONIDE 0.25 MG/2 ML NEB SOLN

Facility IP

$13.58

Service Code	HCPCS J7626
Hospital Charge Code	41642677
Hospital Revenue Code	636
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$6.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.79
Rate for Payer: Hamaspik Choice Inc Medicare	$6.79

BUDESONIDE 0.25 MG/2 ML NEB SOLN

Facility OP

$13.58

Service Code	HCPCS J7626
Hospital Charge Code	41652677
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$8.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.79
Rate for Payer: Group Health Inc Commercial	$6.79
Rate for Payer: Group Health Inc Medicare	$4.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.79
Rate for Payer: Hamaspik Choice Inc Medicare	$6.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.28
Rate for Payer: SOMOS Essential	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.83

BUDESONIDE 0.25 MG/2 ML NEB SOLN

Facility OP

$13.58

Service Code	HCPCS J7626
Hospital Charge Code	41642677
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$8.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.79
Rate for Payer: Group Health Inc Commercial	$6.79
Rate for Payer: Group Health Inc Medicare	$4.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.79
Rate for Payer: Hamaspik Choice Inc Medicare	$6.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.28
Rate for Payer: SOMOS Essential	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.83

BUDESONIDE 0.5 MG/2 ML NEB SOLN

Facility OP

$14.61

Service Code	HCPCS J7626
Hospital Charge Code	41652918
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$9.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.79
Rate for Payer: Group Health Inc Commercial	$7.30
Rate for Payer: Group Health Inc Medicare	$5.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.30
Rate for Payer: Hamaspik Choice Inc Medicare	$7.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.28
Rate for Payer: SOMOS Essential	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.50

BUDESONIDE 0.5 MG/2 ML NEB SOLN

Facility OP

$14.61

Service Code	HCPCS J7626
Hospital Charge Code	41642918
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$9.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.79
Rate for Payer: Group Health Inc Commercial	$7.30
Rate for Payer: Group Health Inc Medicare	$5.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.30
Rate for Payer: Hamaspik Choice Inc Medicare	$7.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.28
Rate for Payer: SOMOS Essential	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.50

BUDESONIDE 0.5 MG/2 ML NEB SOLN

Facility IP

$14.61

Service Code	HCPCS J7626
Hospital Charge Code	41652918
Hospital Revenue Code	636
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$7.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.30
Rate for Payer: Hamaspik Choice Inc Medicare	$7.30

BUDESONIDE 0.5 MG/2 ML NEB SOLN

Facility IP

$14.61

Service Code	HCPCS J7626
Hospital Charge Code	41642918
Hospital Revenue Code	636
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$7.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.30
Rate for Payer: Hamaspik Choice Inc Medicare	$7.30

BUDESONIDE + FORMOTEROL 160 MCG/4.5 MCG

Facility OP

$136.76

Hospital Charge Code	41655595
Hospital Revenue Code	250
Min. Negotiated Rate	$47.87
Max. Negotiated Rate	$109.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.38
Rate for Payer: Aetna Government	$68.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$109.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.00
Rate for Payer: Group Health Inc Commercial	$68.38
Rate for Payer: Group Health Inc Medicare	$47.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.38
Rate for Payer: Hamaspik Choice Inc Medicare	$68.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.89

BUDESONIDE + FORMOTEROL 160 MCG/4.5 MCG

Facility OP

$136.76

Hospital Charge Code	41645595
Hospital Revenue Code	250
Min. Negotiated Rate	$47.87
Max. Negotiated Rate	$109.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.38
Rate for Payer: Aetna Government	$68.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$109.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.00
Rate for Payer: Group Health Inc Commercial	$68.38
Rate for Payer: Group Health Inc Medicare	$47.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.38
Rate for Payer: Hamaspik Choice Inc Medicare	$68.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.89

BUFFALO FILTER

Facility OP

$1,465.68

Hospital Charge Code	64907349
Hospital Revenue Code	279
Min. Negotiated Rate	$512.99
Max. Negotiated Rate	$1,172.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$806.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$732.84
Rate for Payer: Aetna Government	$732.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,172.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$996.66
Rate for Payer: Group Health Inc Commercial	$732.84
Rate for Payer: Group Health Inc Medicare	$512.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$732.84
Rate for Payer: Hamaspik Choice Inc Medicare	$732.84

BUILD UP BLOCK 13/15

Facility IP

$1,094.52

Service Code	HCPCS C1713
Hospital Charge Code	64907457
Hospital Revenue Code	278
Min. Negotiated Rate	$547.26
Max. Negotiated Rate	$547.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$547.26
Rate for Payer: Hamaspik Choice Inc Medicare	$547.26

BUILD UP BLOCK 13/15

Facility OP

$1,094.52

Service Code	HCPCS C1713
Hospital Charge Code	64907457
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,149.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$601.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$547.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$629.35
Rate for Payer: Fidelis Medicare Advantage	$1,149.25
Rate for Payer: Group Health Inc Commercial	$547.26
Rate for Payer: Group Health Inc Medicare	$383.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$547.26
Rate for Payer: Hamaspik Choice Inc Medicare	$547.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$711.44

BULB LARYNGSCOPE 2.5V LARGE

Facility OP

$17.44

Hospital Charge Code	64902980
Hospital Revenue Code	270
Min. Negotiated Rate	$6.10
Max. Negotiated Rate	$13.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.72
Rate for Payer: Aetna Government	$8.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.86
Rate for Payer: Group Health Inc Commercial	$8.72
Rate for Payer: Group Health Inc Medicare	$6.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.72
Rate for Payer: Hamaspik Choice Inc Medicare	$8.72

BULB LARYNGSCOPE SMALL 2.5V

Facility OP

$17.45

Hospital Charge Code	64902981
Hospital Revenue Code	270
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$13.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.72
Rate for Payer: Aetna Government	$8.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.87
Rate for Payer: Group Health Inc Commercial	$8.72
Rate for Payer: Group Health Inc Medicare	$6.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.72
Rate for Payer: Hamaspik Choice Inc Medicare	$8.72

BULKY BANDAGE 4X84

Facility OP

$3.12

Hospital Charge Code	41809549
Hospital Revenue Code	270
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$2.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.12
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

BULKY BANDAGE 4X84

Facility OP

$3.12

Hospital Charge Code	41709549
Hospital Revenue Code	270
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$2.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.12
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

BUMETANIDE 0.25 MG/ML INJ 10 ML

Facility OP

$4.00

Hospital Charge Code	41645570
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

BUMETANIDE 0.25 MG/ML INJ 10 ML

Facility OP

$4.00

Hospital Charge Code	41655570
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

BUMETANIDE 0.25 MG/ML INJ 2 ML

Facility OP

$3.00

Hospital Charge Code	41651071
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

BUMETANIDE 0.25 MG/ML INJ 2 ML

Facility OP

$3.00

Hospital Charge Code	41641071
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

BUMETANIDE 0.25 MG/ML INJ 4 ML

Facility OP

$3.00

Hospital Charge Code	41644542
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

BUMETANIDE 0.25 MG/ML INJ 4 ML

Facility OP

$3.00

Hospital Charge Code	41654542
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

Price Transparency.

All Charges