St. Barnabas Hospital

All Charges

Charge

Type

Price

BUPIVACAINE 0.0625%+FENTANYL 2MG

Facility IP

$11.24

Service Code	HCPCS J3490
Hospital Charge Code	41658461
Hospital Revenue Code	636
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$5.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.62
Rate for Payer: Hamaspik Choice Inc Medicare	$5.62

BUPIVACAINE 0.08% 200ML NS

Facility OP

$9.16

Service Code	HCPCS J3490
Hospital Charge Code	41648460
Hospital Revenue Code	636
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$5.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.58
Rate for Payer: Aetna Government	$4.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.27
Rate for Payer: Group Health Inc Commercial	$4.58
Rate for Payer: Group Health Inc Medicare	$3.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.58
Rate for Payer: Hamaspik Choice Inc Medicare	$4.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.95

BUPIVACAINE 0.08% 200ML NS

Facility IP

$9.16

Service Code	HCPCS J3490
Hospital Charge Code	41658460
Hospital Revenue Code	636
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$4.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.58
Rate for Payer: Hamaspik Choice Inc Medicare	$4.58

BUPIVACAINE 0.08% 200ML NS

Facility OP

$9.16

Service Code	HCPCS J3490
Hospital Charge Code	41658460
Hospital Revenue Code	636
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$5.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.58
Rate for Payer: Aetna Government	$4.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.27
Rate for Payer: Group Health Inc Commercial	$4.58
Rate for Payer: Group Health Inc Medicare	$3.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.58
Rate for Payer: Hamaspik Choice Inc Medicare	$4.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.95

BUPIVACAINE 0.08% 200ML NS

Facility IP

$9.16

Service Code	HCPCS J3490
Hospital Charge Code	41648460
Hospital Revenue Code	636
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$4.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.58
Rate for Payer: Hamaspik Choice Inc Medicare	$4.58

BUPIVACAINE 0.125% + FENTANYL 1 MCG/ML E

Facility OP

$12.00

Hospital Charge Code	41655453
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.00
Rate for Payer: Aetna Government	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

BUPIVACAINE 0.125% + FENTANYL 1 MCG/ML E

Facility OP

$12.00

Hospital Charge Code	41645453
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.00
Rate for Payer: Aetna Government	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

BUPIVACAINE 0.125 %+ FENTANYL 4 MCG/ML E

Facility OP

$16.00

Hospital Charge Code	41644741
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$12.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.88
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

BUPIVACAINE 0.125 %+ FENTANYL 4 MCG/ML E

Facility OP

$16.00

Hospital Charge Code	41654741
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$12.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.88
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

BUPIVACAINE 0.25% EPIDURAL INFUSION 200

Facility OP

$12.00

Hospital Charge Code	41654740
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.00
Rate for Payer: Aetna Government	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

BUPIVACAINE 0.25% EPIDURAL INFUSION 200

Facility OP

$12.00

Hospital Charge Code	41644740
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.00
Rate for Payer: Aetna Government	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

BUPIVACAINE 0.25% INJ 10 ML

Facility IP

$4.39

Service Code	HCPCS J3490
Hospital Charge Code	41644435
Hospital Revenue Code	636
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$2.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.20
Rate for Payer: Hamaspik Choice Inc Medicare	$2.20

BUPIVACAINE 0.25% INJ 10 ML

Facility OP

$4.39

Service Code	HCPCS J3490
Hospital Charge Code	41644435
Hospital Revenue Code	636
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$2.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.20
Rate for Payer: Aetna Government	$2.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.52
Rate for Payer: Group Health Inc Commercial	$2.20
Rate for Payer: Group Health Inc Medicare	$1.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.20
Rate for Payer: Hamaspik Choice Inc Medicare	$2.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.85

BUPIVACAINE 0.25% INJ 10 ML

Facility OP

$4.39

Service Code	HCPCS J3490
Hospital Charge Code	41654435
Hospital Revenue Code	636
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$2.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.20
Rate for Payer: Aetna Government	$2.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.52
Rate for Payer: Group Health Inc Commercial	$2.20
Rate for Payer: Group Health Inc Medicare	$1.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.20
Rate for Payer: Hamaspik Choice Inc Medicare	$2.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.85

BUPIVACAINE 0.25% INJ 10 ML

Facility IP

$4.39

Service Code	HCPCS J3490
Hospital Charge Code	41654435
Hospital Revenue Code	636
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$2.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.20
Rate for Payer: Hamaspik Choice Inc Medicare	$2.20

BUPIVACAINE 0.25% INJ 30 ML

Facility IP

$3.07

Service Code	HCPCS J3490
Hospital Charge Code	41650123
Hospital Revenue Code	636
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1.54

BUPIVACAINE 0.25% INJ 30 ML

Facility OP

$3.07

Service Code	HCPCS J3490
Hospital Charge Code	41650123
Hospital Revenue Code	636
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.54
Rate for Payer: Aetna Government	$1.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.77
Rate for Payer: Group Health Inc Commercial	$1.54
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.00

BUPIVACAINE 0.25% INJ 30 ML

Facility IP

$3.07

Service Code	HCPCS J3490
Hospital Charge Code	41640123
Hospital Revenue Code	636
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1.54

BUPIVACAINE 0.25% INJ 30 ML

Facility OP

$3.07

Service Code	HCPCS J3490
Hospital Charge Code	41640123
Hospital Revenue Code	636
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.54
Rate for Payer: Aetna Government	$1.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.77
Rate for Payer: Group Health Inc Commercial	$1.54
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.00

BUPIVACAINE 0.5% INJ 30 ML PF

Facility OP

$3.07

Service Code	HCPCS S0020
Hospital Charge Code	41640149
Hospital Revenue Code	636
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.77
Rate for Payer: Group Health Inc Commercial	$1.54
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.00

BUPIVACAINE 0.5% INJ 30 ML PF

Facility IP

$3.07

Service Code	HCPCS S0020
Hospital Charge Code	41640149
Hospital Revenue Code	636
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1.54

BUPIVACAINE 0.5% INJ 30 ML PF

Facility OP

$3.07

Service Code	HCPCS S0020
Hospital Charge Code	41650149
Hospital Revenue Code	636
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.77
Rate for Payer: Group Health Inc Commercial	$1.54
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.00

BUPIVACAINE 0.5% INJ 30 ML PF

Facility IP

$3.07

Service Code	HCPCS S0020
Hospital Charge Code	41650149
Hospital Revenue Code	636
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1.54

BUPIVACAINE 0.75% INJ 30 ML

Facility IP

$5.24

Service Code	HCPCS J3490
Hospital Charge Code	41651497
Hospital Revenue Code	636
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$2.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2.62

BUPIVACAINE 0.75% INJ 30 ML

Facility OP

$5.24

Service Code	HCPCS J3490
Hospital Charge Code	41651497
Hospital Revenue Code	636
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$3.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.62
Rate for Payer: Aetna Government	$2.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.01
Rate for Payer: Group Health Inc Commercial	$2.62
Rate for Payer: Group Health Inc Medicare	$1.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.41

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