St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DEWRAP COMPRESSION DRESSING

Facility

$38.72

Hospital Charge Code	41709550
Hospital Revenue Code	270
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$30.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.36
Rate for Payer: Aetna Government	$19.36
Rate for Payer: Brighton Health Commercial	$29.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.33
Rate for Payer: Group Health Inc Commercial	$19.36
Rate for Payer: Group Health Inc Medicare	$13.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.36
Rate for Payer: Hamaspik Choice Inc Medicare	$19.36

DEWRAP COMPRESSION DRESSING

Facility

$38.72

Hospital Charge Code	41809550
Hospital Revenue Code	270
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$30.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.36
Rate for Payer: Aetna Government	$19.36
Rate for Payer: Brighton Health Commercial	$29.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.33
Rate for Payer: Group Health Inc Commercial	$19.36
Rate for Payer: Group Health Inc Medicare	$13.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.36
Rate for Payer: Hamaspik Choice Inc Medicare	$19.36

DEXAMETHASONE 0.1 MG/ML SOLN

Facility

$1.00

Hospital Charge Code	41652026
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: Brighton Health Commercial	$0.75
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

DEXAMETHASONE 0.1 MG/ML SOLN

Facility

$1.00

Hospital Charge Code	41642026
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: Brighton Health Commercial	$0.75
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

DEXAMETHASONE 0.1% OPHTHALMIC SOLN

Facility

$32.26

Hospital Charge Code	41643414
Hospital Revenue Code	250
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$25.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.13
Rate for Payer: Aetna Government	$16.13
Rate for Payer: Brighton Health Commercial	$24.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.94
Rate for Payer: Group Health Inc Commercial	$16.13
Rate for Payer: Group Health Inc Medicare	$11.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.13
Rate for Payer: Hamaspik Choice Inc Medicare	$16.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.97

DEXAMETHASONE 0.1% OPHTHALMIC SOLN

Facility

$32.26

Hospital Charge Code	41653414
Hospital Revenue Code	250
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$25.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.13
Rate for Payer: Aetna Government	$16.13
Rate for Payer: Brighton Health Commercial	$24.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.94
Rate for Payer: Group Health Inc Commercial	$16.13
Rate for Payer: Group Health Inc Medicare	$11.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.13
Rate for Payer: Hamaspik Choice Inc Medicare	$16.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.97

DEXAMETHASONE 0.5 MG/5ML PO SOLN [2320]

Facility

$0.27

Service Code	NDC 00054317757
Hospital Charge Code	00054317757
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

DEXAMETHASONE 0.5 MG PO TABS [2322]

Facility

$0.21

Service Code	NDC 00054817925
Hospital Charge Code	00054817925
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

DEXAMETHASONE 0.5 MG TAB

Facility

$1.00

Service Code	HCPCS J8540
Hospital Charge Code	41651118
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

DEXAMETHASONE 0.5 MG TAB

Facility

$1.00

Service Code	HCPCS J8540
Hospital Charge Code	41641118
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

DEXAMETHASONE 0.5 MG TAB

Facility

$1.00

Service Code	HCPCS J8540
Hospital Charge Code	41651118
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
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: 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	$0.65

DEXAMETHASONE 0.5 MG TAB

Facility

$1.00

Service Code	HCPCS J8540
Hospital Charge Code	41641118
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
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: 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	$0.65

DEXAMETHASONE 0.75 MG TAB

Facility

$1.00

Service Code	HCPCS J8540
Hospital Charge Code	41641126
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

DEXAMETHASONE 0.75 MG TAB

Facility

$1.00

Service Code	HCPCS J8540
Hospital Charge Code	41641126
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
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: 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	$0.65

DEXAMETHASONE 0.75 MG TAB

Facility

$1.00

Service Code	HCPCS J8540
Hospital Charge Code	41651126
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

DEXAMETHASONE 0.75 MG TAB

Facility

$1.00

Service Code	HCPCS J8540
Hospital Charge Code	41651126
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
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: 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	$0.65

DEXAMETHASONE 10MG/D5W 50ML

Facility

$0.31

Service Code	HCPCS J1100
Hospital Charge Code	41655887
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16

DEXAMETHASONE 10MG/D5W 50ML

Facility

$0.31

Service Code	HCPCS J1100
Hospital Charge Code	41645887
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
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	$0.20

DEXAMETHASONE 10MG/D5W 50ML

Facility

$0.31

Service Code	HCPCS J1100
Hospital Charge Code	41645887
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16

DEXAMETHASONE 10MG/D5W 50ML

Facility

$0.31

Service Code	HCPCS J1100
Hospital Charge Code	41655887
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
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	$0.20

DEXAMETHASONE 10MG/ML-.25MG CROUP

Facility

$1.84

Service Code	HCPCS J8540
Hospital Charge Code	41648042
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$1.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.06
Rate for Payer: Group Health Inc Commercial	$0.92
Rate for Payer: Group Health Inc Medicare	$0.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.92
Rate for Payer: Hamaspik Choice Inc Medicare	$0.92
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	$1.20

DEXAMETHASONE 10MG/ML-.25MG CROUP

Facility

$1.84

Service Code	HCPCS J8540
Hospital Charge Code	41658042
Hospital Revenue Code	636
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.92
Rate for Payer: Hamaspik Choice Inc Medicare	$0.92

DEXAMETHASONE 10MG/ML-.25MG CROUP

Facility

$1.84

Service Code	HCPCS J8540
Hospital Charge Code	41658042
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$1.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.06
Rate for Payer: Group Health Inc Commercial	$0.92
Rate for Payer: Group Health Inc Medicare	$0.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.92
Rate for Payer: Hamaspik Choice Inc Medicare	$0.92
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	$1.20

DEXAMETHASONE 10MG/ML-.25MG CROUP

Facility

$1.84

Service Code	HCPCS J8540
Hospital Charge Code	41648042
Hospital Revenue Code	636
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.92
Rate for Payer: Hamaspik Choice Inc Medicare	$0.92

DEXAMETHASONE 10 MG/ML INJ

Facility

$0.22

Service Code	HCPCS J1100
Hospital Charge Code	41642495
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11

Know your out-of-pocket cost for care.

All Charges