St. Barnabas Hospital

All Charges

Charge

Type

Price

DEXMEDETOMIDINE 200MCG/NS 50ML

Facility OP

$1.54

Hospital Charge Code	41648417
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$1.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.77
Rate for Payer: Aetna Government	$0.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.05
Rate for Payer: Group Health Inc Commercial	$0.77
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.00

DEXMEDETOMIDINE 200MCG/NS 50ML

Facility OP

$1.54

Hospital Charge Code	41658417
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$1.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.77
Rate for Payer: Aetna Government	$0.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.05
Rate for Payer: Group Health Inc Commercial	$0.77
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.00

DEXMEDETOMIDINE 400MCG/NS 100ML

Facility OP

$3.08

Hospital Charge Code	41648418
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$2.46
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	$2.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.09
Rate for Payer: Group Health Inc Commercial	$1.54
Rate for Payer: Group Health Inc Medicare	$1.08
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

DEXMEDETOMIDINE 400MCG/NS 100ML

Facility OP

$3.08

Hospital Charge Code	41658418
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$2.46
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	$2.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.09
Rate for Payer: Group Health Inc Commercial	$1.54
Rate for Payer: Group Health Inc Medicare	$1.08
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

DEXTRAN 40 IN 0.9% SODIUM CHLORIDE INFUS

Facility IP

$28.00

Service Code	HCPCS J7100
Hospital Charge Code	41641020
Hospital Revenue Code	636
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00

DEXTRAN 40 IN 0.9% SODIUM CHLORIDE INFUS

Facility IP

$28.00

Service Code	HCPCS J7100
Hospital Charge Code	41651020
Hospital Revenue Code	636
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00

DEXTRAN 40 IN 0.9% SODIUM CHLORIDE INFUS

Facility OP

$28.00

Service Code	HCPCS J7100
Hospital Charge Code	41641020
Hospital Revenue Code	636
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$22.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.07
Rate for Payer: Aetna Government	$22.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.10
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.20

DEXTRAN 40 IN 0.9% SODIUM CHLORIDE INFUS

Facility OP

$28.00

Service Code	HCPCS J7100
Hospital Charge Code	41651020
Hospital Revenue Code	636
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$22.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.07
Rate for Payer: Aetna Government	$22.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.10
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.20

DEXTROMETHORPHAN + GUAIFENESIN 10 MG-100

Facility OP

$1.00

Hospital Charge Code	41643012
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

DEXTROMETHORPHAN + GUAIFENESIN 10 MG-100

Facility OP

$1.00

Hospital Charge Code	41653012
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

DEXTROMETHORPHAN + GUAIFENESIN 10 MG-100

Facility OP

$10.00

Hospital Charge Code	41642277
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.50

DEXTROMETHORPHAN + GUAIFENESIN 10 MG-100

Facility OP

$10.00

Hospital Charge Code	41652277
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.50

DEXTROSE 10% + 0.45% NACL INFUSION 1000

Facility IP

$8.07

Service Code	HCPCS J7799
Hospital Charge Code	41654451
Hospital Revenue Code	636
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$4.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.04
Rate for Payer: Hamaspik Choice Inc Medicare	$4.04

DEXTROSE 10% + 0.45% NACL INFUSION 1000

Facility IP

$8.07

Service Code	HCPCS J7799
Hospital Charge Code	41644451
Hospital Revenue Code	636
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$4.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.04
Rate for Payer: Hamaspik Choice Inc Medicare	$4.04

DEXTROSE 10% + 0.45% NACL INFUSION 1000

Facility OP

$8.07

Service Code	HCPCS J7799
Hospital Charge Code	41654451
Hospital Revenue Code	636
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$5.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.04
Rate for Payer: Aetna Government	$4.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.64
Rate for Payer: Group Health Inc Commercial	$4.04
Rate for Payer: Group Health Inc Medicare	$2.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.04
Rate for Payer: Hamaspik Choice Inc Medicare	$4.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.25

DEXTROSE 10% + 0.45% NACL INFUSION 1000

Facility OP

$8.07

Service Code	HCPCS J7799
Hospital Charge Code	41644451
Hospital Revenue Code	636
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$5.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.04
Rate for Payer: Aetna Government	$4.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.64
Rate for Payer: Group Health Inc Commercial	$4.04
Rate for Payer: Group Health Inc Medicare	$2.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.04
Rate for Payer: Hamaspik Choice Inc Medicare	$4.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.25

DEXTROSE 10% WATER INFUSION 1000 ML

Facility OP

$3.00

Service Code	HCPCS J7799
Hospital Charge Code	41655585
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

DEXTROSE 10% WATER INFUSION 1000 ML

Facility OP

$3.00

Service Code	HCPCS J7799
Hospital Charge Code	41645585
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

DEXTROSE 10% WATER INFUSION 250 ML

Facility OP

$7.00

Service Code	HCPCS J7799
Hospital Charge Code	41651827
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
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: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
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

DEXTROSE 10% WATER INFUSION 250 ML

Facility OP

$7.00

Service Code	HCPCS J7799
Hospital Charge Code	41641827
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
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: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
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

DEXTROSE 10% WATER INFUSION 500 ML

Facility OP

$2.00

Service Code	HCPCS J7799
Hospital Charge Code	41651770
Hospital Revenue Code	258
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

DEXTROSE 10% WATER INFUSION 500 ML

Facility OP

$2.00

Service Code	HCPCS J7799
Hospital Charge Code	41641770
Hospital Revenue Code	258
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

DEXTROSE 25% INJ SYR

Facility OP

$9.46

Service Code	HCPCS J7799
Hospital Charge Code	41642710
Hospital Revenue Code	636
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$6.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.73
Rate for Payer: Aetna Government	$4.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.44
Rate for Payer: Group Health Inc Commercial	$4.73
Rate for Payer: Group Health Inc Medicare	$3.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.73
Rate for Payer: Hamaspik Choice Inc Medicare	$4.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.15

DEXTROSE 25% INJ SYR

Facility IP

$9.46

Service Code	HCPCS J7799
Hospital Charge Code	41652710
Hospital Revenue Code	636
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$4.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.73
Rate for Payer: Hamaspik Choice Inc Medicare	$4.73

DEXTROSE 25% INJ SYR

Facility IP

$9.46

Service Code	HCPCS J7799
Hospital Charge Code	41642710
Hospital Revenue Code	636
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$4.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.73
Rate for Payer: Hamaspik Choice Inc Medicare	$4.73

Price Transparency.

All Charges