St. Barnabas Hospital

All Charges

Charge

Type

Price

DEXAMETHASONE 4MG/ML ORAL LIQ

Facility OP

$0.05

Service Code	HCPCS J8540
Hospital Charge Code	41656609
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.09
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.07
Rate for Payer: SOMOS Essential	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

DEXAMETHASONE 4MG/ML ORAL LIQ

Facility OP

$0.05

Service Code	HCPCS J8540
Hospital Charge Code	41646609
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.09
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.07
Rate for Payer: SOMOS Essential	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

DEXAMETHASONE 4MG/ML ORAL LIQ

Facility IP

$0.05

Service Code	HCPCS J8540
Hospital Charge Code	41646609
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03

DEXAMETHASONE 4 MG TAB

Facility OP

$0.02

Service Code	HCPCS J8540
Hospital Charge Code	41650367
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.09
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.07
Rate for Payer: SOMOS Essential	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

DEXAMETHASONE 4 MG TAB

Facility OP

$0.02

Service Code	HCPCS J8540
Hospital Charge Code	41640367
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.09
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.07
Rate for Payer: SOMOS Essential	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

DEXAMETHASONE 4 MG TAB

Facility IP

$0.02

Service Code	HCPCS J8540
Hospital Charge Code	41640367
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

DEXAMETHASONE 4 MG TAB

Facility IP

$0.02

Service Code	HCPCS J8540
Hospital Charge Code	41650367
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

DEXAMETHASONE 8MG/D5W 50ML

Facility OP

$0.29

Service Code	HCPCS J1100
Hospital Charge Code	41655889
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.11
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: Healthfirst CHP/FHP/Medicaid	$0.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.12
Rate for Payer: SOMOS Essential	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

DEXAMETHASONE 8MG/D5W 50ML

Facility IP

$0.29

Service Code	HCPCS J1100
Hospital Charge Code	41655889
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15

DEXAMETHASONE 8MG/D5W 50ML

Facility IP

$0.29

Service Code	HCPCS J1100
Hospital Charge Code	41645889
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15

DEXAMETHASONE 8MG/D5W 50ML

Facility OP

$0.29

Service Code	HCPCS J1100
Hospital Charge Code	41645889
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.11
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: Healthfirst CHP/FHP/Medicaid	$0.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.12
Rate for Payer: SOMOS Essential	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

DEXAMETHASONE, SERUM

Facility OP

$105.00

Service Code	HCPCS 80375
Hospital Charge Code	40609860
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$84.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.40
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

DEXAMETHASONE SUPP(8AM 4,11PM)

Facility OP

$40.75

Service Code	HCPCS 82533
Hospital Charge Code	40609844
Hospital Revenue Code	301
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$25.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.30
Rate for Payer: Aetna Government	$16.30
Rate for Payer: Cash Price	$16.30
Rate for Payer: Cash Price	$16.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.93
Rate for Payer: Elderplan Medicare Advantage	$16.30
Rate for Payer: EmblemHealth Commercial	$16.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14.67
Rate for Payer: Fidelis Essential Plan Aliesa	$13.86
Rate for Payer: Fidelis Essential Plan QHP	$14.51
Rate for Payer: Fidelis Medicare Advantage	$16.30
Rate for Payer: Fidelis Qualified Health Plan	$14.51
Rate for Payer: Group Health Inc Commercial	$16.30
Rate for Payer: Group Health Inc Medicare	$16.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.38
Rate for Payer: Hamaspik Choice Inc Medicare	$16.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.30
Rate for Payer: Healthfirst Medicare Advantage	$16.30
Rate for Payer: Healthfirst QHP	$16.30
Rate for Payer: Senior Whole Health Medicare Advantage	$16.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.04
Rate for Payer: Wellcare Medicare	$14.67

DEXAMETHASONE-TOBRAMYCIN OPHTHALMIC OINT

Facility OP

$259.00

Hospital Charge Code	41640401
Hospital Revenue Code	250
Min. Negotiated Rate	$90.65
Max. Negotiated Rate	$207.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$129.50
Rate for Payer: Aetna Government	$129.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$207.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$176.12
Rate for Payer: Group Health Inc Commercial	$129.50
Rate for Payer: Group Health Inc Medicare	$90.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.50
Rate for Payer: Hamaspik Choice Inc Medicare	$129.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.35

DEXAMETHASONE-TOBRAMYCIN OPHTHALMIC OINT

Facility OP

$259.00

Hospital Charge Code	41650401
Hospital Revenue Code	250
Min. Negotiated Rate	$90.65
Max. Negotiated Rate	$207.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$129.50
Rate for Payer: Aetna Government	$129.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$207.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$176.12
Rate for Payer: Group Health Inc Commercial	$129.50
Rate for Payer: Group Health Inc Medicare	$90.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.50
Rate for Payer: Hamaspik Choice Inc Medicare	$129.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.35

DEXAMETHASONE-TOBRAMYCIN OPHTHALMIC SUSP

Facility OP

$71.00

Hospital Charge Code	41650337
Hospital Revenue Code	250
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$56.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.50
Rate for Payer: Aetna Government	$35.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.28
Rate for Payer: Group Health Inc Commercial	$35.50
Rate for Payer: Group Health Inc Medicare	$24.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.50
Rate for Payer: Hamaspik Choice Inc Medicare	$35.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.15

DEXAMETHASONE-TOBRAMYCIN OPHTHALMIC SUSP

Facility OP

$71.00

Hospital Charge Code	41640337
Hospital Revenue Code	250
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$56.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.50
Rate for Payer: Aetna Government	$35.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.28
Rate for Payer: Group Health Inc Commercial	$35.50
Rate for Payer: Group Health Inc Medicare	$24.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.50
Rate for Payer: Hamaspik Choice Inc Medicare	$35.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.15

DEXAMETHSONE 4MG/D5W 50ML

Facility OP

$0.24

Service Code	HCPCS J1100
Hospital Charge Code	41655885
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.11
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.12
Rate for Payer: SOMOS Essential	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

DEXAMETHSONE 4MG/D5W 50ML

Facility IP

$0.24

Service Code	HCPCS J1100
Hospital Charge Code	41655885
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12

DEXAMTHASONE .2MG/ML INJ PED 1MG

Facility IP

$3.00

Service Code	HCPCS J1100
Hospital Charge Code	41647082
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

DEXAMTHASONE .2MG/ML INJ PED 1MG

Facility OP

$3.00

Service Code	HCPCS J1100
Hospital Charge Code	41647082
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.11
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: Healthfirst CHP/FHP/Medicaid	$0.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.12
Rate for Payer: SOMOS Essential	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

DEXAMTHOSONE 200MG/5ML INJ -1MG

Facility OP

$0.01

Service Code	HCPCS J1100
Hospital Charge Code	41648161
Hospital Revenue Code	636
Max. Negotiated Rate	$0.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.11
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.12
Rate for Payer: SOMOS Essential	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

DEXAMTHOSONE 200MG/5ML INJ -1MG

Facility IP

$0.01

Service Code	HCPCS J1100
Hospital Charge Code	41648161
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

DEXMEDETOMIDINE 100 MCG/ML INJ

Facility OP

$119.00

Hospital Charge Code	41654378
Hospital Revenue Code	250
Min. Negotiated Rate	$41.65
Max. Negotiated Rate	$95.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.50
Rate for Payer: Aetna Government	$59.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.92
Rate for Payer: Group Health Inc Commercial	$59.50
Rate for Payer: Group Health Inc Medicare	$41.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.50
Rate for Payer: Hamaspik Choice Inc Medicare	$59.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$77.35

DEXMEDETOMIDINE 100 MCG/ML INJ

Facility OP

$119.00

Hospital Charge Code	41644378
Hospital Revenue Code	250
Min. Negotiated Rate	$41.65
Max. Negotiated Rate	$95.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.50
Rate for Payer: Aetna Government	$59.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.92
Rate for Payer: Group Health Inc Commercial	$59.50
Rate for Payer: Group Health Inc Medicare	$41.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.50
Rate for Payer: Hamaspik Choice Inc Medicare	$59.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$77.35

Price Transparency.

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