St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BUNIONECTOMY OTHER

Facility

$8,291.05

Service Code	HCPCS 28292
Hospital Charge Code	40083194
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

BUNIONECTOMY OTHER

Facility

$8,291.05

Service Code	HCPCS 28292
Hospital Charge Code	40083194
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

BUPIV 0.03%+HYDROMOR 2500MCGNS250

Facility

$5.00

Service Code	HCPCS J3490
Hospital Charge Code	41655951
Hospital Revenue Code	636
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50

BUPIV 0.03%+HYDROMOR 2500MCGNS250

Facility

$5.00

Service Code	HCPCS J3490
Hospital Charge Code	41645951
Hospital Revenue Code	636
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$3.25
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: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.88
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

BUPIV 0.03%+HYDROMOR 2500MCGNS250

Facility

$5.00

Service Code	HCPCS J3490
Hospital Charge Code	41655951
Hospital Revenue Code	636
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$3.25
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: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.88
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

BUPIV 0.03%+HYDROMOR 2500MCGNS250

Facility

$5.00

Service Code	HCPCS J3490
Hospital Charge Code	41645951
Hospital Revenue Code	636
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50

BUPIV 0.08%+FENT 500MCG NS 250ML

Facility

$9.00

Service Code	HCPCS J3490
Hospital Charge Code	41645949
Hospital Revenue Code	636
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50

BUPIV 0.08%+FENT 500MCG NS 250ML

Facility

$9.00

Service Code	HCPCS J3490
Hospital Charge Code	41645949
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$5.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.18
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

BUPIV 0.08%+FENT 500MCG NS 250ML

Facility

$9.00

Service Code	HCPCS J3490
Hospital Charge Code	41655949
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$5.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.18
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

BUPIV 0.08%+FENT 500MCG NS 250ML

Facility

$9.00

Service Code	HCPCS J3490
Hospital Charge Code	41655949
Hospital Revenue Code	636
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50

BUPIV 0.08% NS 250ML

Facility

$7.00

Service Code	HCPCS J3490
Hospital Charge Code	41645953
Hospital Revenue Code	636
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$4.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$4.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.02
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

BUPIV 0.08% NS 250ML

Facility

$7.00

Service Code	HCPCS J3490
Hospital Charge Code	41655953
Hospital Revenue Code	636
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$4.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$4.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.02
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

BUPIV 0.08% NS 250ML

Facility

$7.00

Service Code	HCPCS J3490
Hospital Charge Code	41645953
Hospital Revenue Code	636
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50

BUPIV 0.08% NS 250ML

Facility

$7.00

Service Code	HCPCS J3490
Hospital Charge Code	41655953
Hospital Revenue Code	636
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50

BUPIV 0.2% NS 250ML

Facility

$12.00

Service Code	HCPCS J3490
Hospital Charge Code	41655947
Hospital Revenue Code	636
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$7.80
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: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
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

BUPIV 0.2% NS 250ML

Facility

$12.00

Service Code	HCPCS J3490
Hospital Charge Code	41645947
Hospital Revenue Code	636
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$7.80
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: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
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

BUPIV 0.2% NS 250ML

Facility

$12.00

Service Code	HCPCS J3490
Hospital Charge Code	41645947
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

BUPIV 0.2% NS 250ML

Facility

$12.00

Service Code	HCPCS J3490
Hospital Charge Code	41655947
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

BUPIVACAINE 0.0625%+FENTANYL 2MG

Facility

$11.24

Service Code	HCPCS J3490
Hospital Charge Code	41648461
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 0.0625%+FENTANYL 2MG

Facility

$11.24

Service Code	HCPCS J3490
Hospital Charge Code	41658461
Hospital Revenue Code	636
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.62
Rate for Payer: Aetna Government	$5.62
Rate for Payer: Brighton Health Commercial	$6.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.46
Rate for Payer: Group Health Inc Commercial	$5.62
Rate for Payer: Group Health Inc Medicare	$3.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.62
Rate for Payer: Hamaspik Choice Inc Medicare	$5.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.31

BUPIVACAINE 0.0625%+FENTANYL 2MG

Facility

$11.24

Service Code	HCPCS J3490
Hospital Charge Code	41648461
Hospital Revenue Code	636
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.62
Rate for Payer: Aetna Government	$5.62
Rate for Payer: Brighton Health Commercial	$6.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.46
Rate for Payer: Group Health Inc Commercial	$5.62
Rate for Payer: Group Health Inc Medicare	$3.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.62
Rate for Payer: Hamaspik Choice Inc Medicare	$5.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.31

BUPIVACAINE 0.0625%+FENTANYL 2MG

Facility

$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

$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: Brighton Health Commercial	$5.50
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

$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: Brighton Health Commercial	$5.50
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

$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

Know your out-of-pocket cost for care.

All Charges