St. Barnabas Hospital

All Charges

Charge

Type

Price

DEXTROSE 50% INJ SYR

Facility OP

$10.49

Service Code	HCPCS J7799
Hospital Charge Code	41653824
Hospital Revenue Code	636
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$6.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.24
Rate for Payer: Aetna Government	$5.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.03
Rate for Payer: Group Health Inc Commercial	$5.24
Rate for Payer: Group Health Inc Medicare	$3.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.24
Rate for Payer: Hamaspik Choice Inc Medicare	$5.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.82

DEXTROSE 50% INJ SYR

Facility IP

$10.49

Service Code	HCPCS J7799
Hospital Charge Code	41643824
Hospital Revenue Code	636
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$5.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.24
Rate for Payer: Hamaspik Choice Inc Medicare	$5.24

DEXTROSE 50% INJ SYR

Facility OP

$10.49

Service Code	HCPCS J7799
Hospital Charge Code	41643824
Hospital Revenue Code	636
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$6.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.24
Rate for Payer: Aetna Government	$5.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.03
Rate for Payer: Group Health Inc Commercial	$5.24
Rate for Payer: Group Health Inc Medicare	$3.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.24
Rate for Payer: Hamaspik Choice Inc Medicare	$5.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.82

DEXTROSE 50% INJ SYR

Facility IP

$10.49

Service Code	HCPCS J7799
Hospital Charge Code	41653824
Hospital Revenue Code	636
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$5.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.24
Rate for Payer: Hamaspik Choice Inc Medicare	$5.24

DEXTROSE 50% INJ VIAL

Facility IP

$2.84

Service Code	HCPCS J7799
Hospital Charge Code	41653952
Hospital Revenue Code	636
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1.42

DEXTROSE 50% INJ VIAL

Facility OP

$2.84

Service Code	HCPCS J7799
Hospital Charge Code	41653952
Hospital Revenue Code	636
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.42
Rate for Payer: Aetna Government	$1.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.63
Rate for Payer: Group Health Inc Commercial	$1.42
Rate for Payer: Group Health Inc Medicare	$0.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.85

DEXTROSE 50% INJ VIAL

Facility OP

$2.84

Service Code	HCPCS J7799
Hospital Charge Code	41643952
Hospital Revenue Code	636
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.42
Rate for Payer: Aetna Government	$1.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.63
Rate for Payer: Group Health Inc Commercial	$1.42
Rate for Payer: Group Health Inc Medicare	$0.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.85

DEXTROSE 50% INJ VIAL

Facility IP

$2.84

Service Code	HCPCS J7799
Hospital Charge Code	41643952
Hospital Revenue Code	636
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1.42

DEXTROSE 5% + LACTATED RINGERS + 20 MEQ

Facility OP

$3.40

Service Code	HCPCS J7120
Hospital Charge Code	41642176
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$2.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.15
Rate for Payer: Group Health Inc Commercial	$1.70
Rate for Payer: Group Health Inc Medicare	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.39
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2.43
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$2.57
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$2.57
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$2.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.21

DEXTROSE 5% + LACTATED RINGERS + 20 MEQ

Facility OP

$3.40

Service Code	HCPCS J7120
Hospital Charge Code	41652176
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$2.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.15
Rate for Payer: Group Health Inc Commercial	$1.70
Rate for Payer: Group Health Inc Medicare	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.39
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2.43
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$2.57
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$2.57
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$2.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.21

DEXTROSE 5% + LACTATED RINGERS INFUSION

Facility OP

$2.00

Service Code	HCPCS J7120
Hospital Charge Code	41653328
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$2.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.15
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: Healthfirst CHP/FHP/Medicaid	$2.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.57
Rate for Payer: SOMOS Essential	$2.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

DEXTROSE 5% + LACTATED RINGERS INFUSION

Facility IP

$2.00

Service Code	HCPCS J7120
Hospital Charge Code	41643328
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

DEXTROSE 5% + LACTATED RINGERS INFUSION

Facility IP

$2.00

Service Code	HCPCS J7120
Hospital Charge Code	41653328
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

DEXTROSE 5% + LACTATED RINGERS INFUSION

Facility OP

$2.00

Service Code	HCPCS J7120
Hospital Charge Code	41643328
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$2.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.15
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: Healthfirst CHP/FHP/Medicaid	$2.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.57
Rate for Payer: SOMOS Essential	$2.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

DEXTROSE 5% + RINGERS INFUSION 1000 ML

Facility OP

$2.00

Hospital Charge Code	41641442
Hospital Revenue Code	250
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 5% + RINGERS INFUSION 1000 ML

Facility OP

$2.00

Hospital Charge Code	41651442
Hospital Revenue Code	250
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 5% WATER INFUSION 1000 ML

Facility OP

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41651447
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.74
Rate for Payer: Aetna Government	$1.74
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	$1.63
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	$1.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.91
Rate for Payer: SOMOS Essential	$1.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

DEXTROSE 5% WATER INFUSION 1000 ML

Facility IP

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41641447
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

DEXTROSE 5% WATER INFUSION 1000 ML

Facility OP

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41641447
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.74
Rate for Payer: Aetna Government	$1.74
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	$1.63
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	$1.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.91
Rate for Payer: SOMOS Essential	$1.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

DEXTROSE 5% WATER INFUSION 1000 ML

Facility IP

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41651447
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

DEXTROSE 5% WATER INFUSION 100 ML

Facility IP

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41641450
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

DEXTROSE 5% WATER INFUSION 100 ML

Facility OP

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41641450
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.74
Rate for Payer: Aetna Government	$1.74
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	$1.63
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	$1.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.91
Rate for Payer: SOMOS Essential	$1.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

DEXTROSE 5% WATER INFUSION 100 ML

Facility IP

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41651450
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

DEXTROSE 5% WATER INFUSION 100 ML

Facility OP

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41651450
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.74
Rate for Payer: Aetna Government	$1.74
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	$1.63
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	$1.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.91
Rate for Payer: SOMOS Essential	$1.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

DEXTROSE 5% WATER INFUSION 150 ML

Facility OP

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41651444
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.74
Rate for Payer: Aetna Government	$1.74
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	$1.63
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	$1.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.91
Rate for Payer: SOMOS Essential	$1.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

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