St. Barnabas Hospital

All Charges

Charge

Type

Price

DOPAMINE 200 MG/D5W INFUSION 250 ML PREM

Facility OP

$4.00

Service Code	HCPCS J1265
Hospital Charge Code	41654676
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.63
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

DOPAMINE 200 MG/D5W INFUSION 250 ML PREM

Facility OP

$4.00

Service Code	HCPCS J1265
Hospital Charge Code	41644676
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.63
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

DOPAMINE 200 MG/D5W INFUSION 250 ML PREM

Facility IP

$4.00

Service Code	HCPCS J1265
Hospital Charge Code	41654676
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00

DOPAMINE 200 MG/D5W INFUSION 250 ML PREM

Facility IP

$4.00

Service Code	HCPCS J1265
Hospital Charge Code	41644676
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00

DOPAMINE 40MGML, 10ML INJ

Facility IP

$0.15

Service Code	HCPCS J1265
Hospital Charge Code	41648173
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08

DOPAMINE 40MGML, 10ML INJ

Facility OP

$0.15

Service Code	HCPCS J1265
Hospital Charge Code	41658173
Hospital Revenue Code	636
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.63
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

DOPAMINE 40MGML, 10ML INJ

Facility OP

$0.15

Service Code	HCPCS J1265
Hospital Charge Code	41648173
Hospital Revenue Code	636
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.63
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

DOPAMINE 40MGML, 10ML INJ

Facility IP

$0.15

Service Code	HCPCS J1265
Hospital Charge Code	41658173
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08

DOPAMINE 40 MG/ML INJ 5 ML

Facility OP

$0.70

Service Code	HCPCS J1265
Hospital Charge Code	41642547
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.63
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

DOPAMINE 40 MG/ML INJ 5 ML

Facility IP

$0.70

Service Code	HCPCS J1265
Hospital Charge Code	41652547
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35

DOPAMINE 40 MG/ML INJ 5 ML

Facility OP

$0.70

Service Code	HCPCS J1265
Hospital Charge Code	41652547
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.63
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

DOPAMINE 40 MG/ML INJ 5 ML

Facility IP

$0.70

Service Code	HCPCS J1265
Hospital Charge Code	41642547
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35

DOPAMINE 800 MG/D5W INFUSION 250 ML PREM

Facility OP

$0.94

Service Code	HCPCS J1265
Hospital Charge Code	41652291
Hospital Revenue Code	636
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.63
Rate for Payer: Group Health Inc Commercial	$0.47
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.61

DOPAMINE 800 MG/D5W INFUSION 250 ML PREM

Facility OP

$0.94

Service Code	HCPCS J1265
Hospital Charge Code	41642291
Hospital Revenue Code	636
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.63
Rate for Payer: Group Health Inc Commercial	$0.47
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.61

DOPAMINE 800 MG/D5W INFUSION 250 ML PREM

Facility IP

$0.94

Service Code	HCPCS J1265
Hospital Charge Code	41652291
Hospital Revenue Code	636
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47

DOPAMINE 800 MG/D5W INFUSION 250 ML PREM

Facility IP

$0.94

Service Code	HCPCS J1265
Hospital Charge Code	41642291
Hospital Revenue Code	636
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47

DOPPLER FLOW TESTING

Facility OP

$339.45

Service Code	HCPCS 93990 TC
Hospital Charge Code	41301532
Hospital Revenue Code	921
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$137.44
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.71

DORAVIRINE TABLET

Facility OP

$231.99

Hospital Charge Code	41640376
Hospital Revenue Code	250
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$185.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$116.00
Rate for Payer: Aetna Government	$116.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.75
Rate for Payer: Group Health Inc Commercial	$116.00
Rate for Payer: Group Health Inc Medicare	$81.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.00
Rate for Payer: Hamaspik Choice Inc Medicare	$116.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$150.79

DORAVIRINE TABLET

Facility OP

$231.99

Hospital Charge Code	41650376
Hospital Revenue Code	250
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$185.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$116.00
Rate for Payer: Aetna Government	$116.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.75
Rate for Payer: Group Health Inc Commercial	$116.00
Rate for Payer: Group Health Inc Medicare	$81.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.00
Rate for Payer: Hamaspik Choice Inc Medicare	$116.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$150.79

DORNASE ALFA 2.5MG/2.5ML

Facility OP

$109.45

Service Code	HCPCS J7639
Hospital Charge Code	41659601
Hospital Revenue Code	636
Min. Negotiated Rate	$38.31
Max. Negotiated Rate	$71.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.80
Rate for Payer: Aetna Government	$47.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$47.01
Rate for Payer: Group Health Inc Commercial	$54.72
Rate for Payer: Group Health Inc Medicare	$38.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.72
Rate for Payer: Hamaspik Choice Inc Medicare	$54.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$52.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55.16
Rate for Payer: SOMOS Essential	$55.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$71.14

DORNASE ALFA 2.5MG/2.5ML

Facility IP

$109.45

Service Code	HCPCS J7639
Hospital Charge Code	41659601
Hospital Revenue Code	636
Min. Negotiated Rate	$54.72
Max. Negotiated Rate	$54.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.72
Rate for Payer: Hamaspik Choice Inc Medicare	$54.72

DORNASE ALFA 2.5MG/2.5ML

Facility IP

$109.45

Service Code	HCPCS J7639
Hospital Charge Code	41649601
Hospital Revenue Code	636
Min. Negotiated Rate	$54.72
Max. Negotiated Rate	$54.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.72
Rate for Payer: Hamaspik Choice Inc Medicare	$54.72

DORNASE ALFA 2.5MG/2.5ML

Facility OP

$109.45

Service Code	HCPCS J7639
Hospital Charge Code	41649601
Hospital Revenue Code	636
Min. Negotiated Rate	$38.31
Max. Negotiated Rate	$71.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.80
Rate for Payer: Aetna Government	$47.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$47.01
Rate for Payer: Group Health Inc Commercial	$54.72
Rate for Payer: Group Health Inc Medicare	$38.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.72
Rate for Payer: Hamaspik Choice Inc Medicare	$54.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$52.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55.16
Rate for Payer: SOMOS Essential	$55.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$71.14

DORSAL SLIT

Facility OP

$5,365.58

Service Code	HCPCS 54001
Hospital Charge Code	40123110
Hospital Revenue Code	360
Min. Negotiated Rate	$152.13
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,355.42
Rate for Payer: Aetna Government	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,355.42
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	$2,355.42
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$152.13
Rate for Payer: Fidelis Essential Plan Aliesa	$2,002.11
Rate for Payer: Fidelis Essential Plan QHP	$2,096.32
Rate for Payer: Fidelis Medicare Advantage	$2,355.42
Rate for Payer: Fidelis Qualified Health Plan	$2,096.32
Rate for Payer: Group Health Inc Commercial	$2,355.42
Rate for Payer: Group Health Inc Medicare	$2,355.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,355.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$169.03
Rate for Payer: Healthfirst Medicare Advantage	$2,002.11
Rate for Payer: Healthfirst QHP	$2,355.42
Rate for Payer: Senior Whole Health Medicare Advantage	$2,355.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,355.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,884.34
Rate for Payer: Wellcare Medicare	$2,237.65

DORZOLAMIDE 2% OPHTHALMIC SOLN

Facility OP

$26.40

Hospital Charge Code	41644583
Hospital Revenue Code	250
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$21.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.20
Rate for Payer: Aetna Government	$13.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.95
Rate for Payer: Group Health Inc Commercial	$13.20
Rate for Payer: Group Health Inc Medicare	$9.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.20
Rate for Payer: Hamaspik Choice Inc Medicare	$13.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.16

Price Transparency.

All Charges