St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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 0.125% + FENTANYL 1 MCG/ML E

Facility

$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: Brighton Health Commercial	$9.00
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

$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: Brighton Health Commercial	$9.00
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

$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: Brighton Health Commercial	$12.00
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

$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: Brighton Health Commercial	$12.00
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

$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: Brighton Health Commercial	$9.00
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

$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: Brighton Health Commercial	$9.00
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

$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 10 ML

Facility

$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: Brighton Health Commercial	$2.63
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

$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

$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: Brighton Health Commercial	$2.63
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 30 ML

Facility

$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: Brighton Health Commercial	$1.84
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

$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

$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

$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: Brighton Health Commercial	$1.84
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

$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 0.5% INJ 30 ML PF

Facility

$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: Brighton Health Commercial	$1.84
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

$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: Brighton Health Commercial	$1.84
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

$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 0.75% INJ 30 ML

Facility

$5.24

Service Code	HCPCS J3490
Hospital Charge Code	41641497
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

$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: Brighton Health Commercial	$3.14
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

BUPIVACAINE 0.75% INJ 30 ML

Facility

$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

$5.24

Service Code	HCPCS J3490
Hospital Charge Code	41641497
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: Brighton Health Commercial	$3.14
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

BUPIVACAINE-EPINEPHRINE 0.25% -1:200000 IJ SOLN [9317]

Facility

$0.29

Service Code	NDC 00409381201
Hospital Charge Code	00409381201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

BUPIVACAINE-EPINEPHRINE 0.5% -1:200000 IJ SOLN [9318]

Facility

$0.39

Service Code	NDC 00409175550
Hospital Charge Code	00409175550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

Know your out-of-pocket cost for care.

All Charges