St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DEXMEDETOMIDINE 100 MCG/ML INJ

Facility

$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: Brighton Health Commercial	$89.25
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

$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: Brighton Health Commercial	$89.25
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 200MCG/NS 50ML

Facility

$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: Brighton Health Commercial	$1.16
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

$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: Brighton Health Commercial	$1.16
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

$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: Brighton Health Commercial	$2.31
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

$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: Brighton Health Commercial	$2.31
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 HCL 200 MCG/2ML IV SOLN [123049]

Facility

$23.76

Service Code	NDC 63323042102
Hospital Charge Code	63323042102
Hospital Revenue Code	278
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$11.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.88
Rate for Payer: Hamaspik Choice Inc Medicare	$11.88

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123049]

Facility

$11.45

Service Code	NDC 16729023993
Hospital Charge Code	16729023993
Hospital Revenue Code	278
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$5.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.73
Rate for Payer: Hamaspik Choice Inc Medicare	$5.73

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123049]

Facility

$11.45

Service Code	NDC 16729023993
Hospital Charge Code	16729023993
Hospital Revenue Code	278
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$12.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.73
Rate for Payer: Aetna Government	$5.73
Rate for Payer: Brighton Health Commercial	$6.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.59
Rate for Payer: EmblemHealth Commercial	$5.73
Rate for Payer: Fidelis Medicare Advantage	$12.03
Rate for Payer: Group Health Inc Commercial	$5.73
Rate for Payer: Group Health Inc Medicare	$4.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.73
Rate for Payer: Hamaspik Choice Inc Medicare	$5.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.45

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123049]

Facility

$23.76

Service Code	NDC 63323042102
Hospital Charge Code	63323042102
Hospital Revenue Code	278
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$24.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.88
Rate for Payer: Aetna Government	$11.88
Rate for Payer: Brighton Health Commercial	$14.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.66
Rate for Payer: EmblemHealth Commercial	$11.88
Rate for Payer: Fidelis Medicare Advantage	$24.95
Rate for Payer: Group Health Inc Commercial	$11.88
Rate for Payer: Group Health Inc Medicare	$8.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.88
Rate for Payer: Hamaspik Choice Inc Medicare	$11.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.44

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123049]

Facility

$3.60

Service Code	NDC 00409163802
Hospital Charge Code	00409163802
Hospital Revenue Code	278
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1.80

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123049]

Facility

$3.60

Service Code	NDC 00409163802
Hospital Charge Code	00409163802
Hospital Revenue Code	278
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$3.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.80
Rate for Payer: Aetna Government	$1.80
Rate for Payer: Brighton Health Commercial	$2.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: EmblemHealth Commercial	$1.80
Rate for Payer: Fidelis Medicare Advantage	$3.78
Rate for Payer: Group Health Inc Commercial	$1.80
Rate for Payer: Group Health Inc Medicare	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.34

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123049]

Facility

$4.32

Service Code	NDC 55150020902
Hospital Charge Code	55150020902
Hospital Revenue Code	278
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$4.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.16
Rate for Payer: Aetna Government	$2.16
Rate for Payer: Brighton Health Commercial	$2.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.48
Rate for Payer: EmblemHealth Commercial	$2.16
Rate for Payer: Fidelis Medicare Advantage	$4.54
Rate for Payer: Group Health Inc Commercial	$2.16
Rate for Payer: Group Health Inc Medicare	$1.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.16
Rate for Payer: Hamaspik Choice Inc Medicare	$2.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.81

DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123049]

Facility

$4.32

Service Code	NDC 55150020902
Hospital Charge Code	55150020902
Hospital Revenue Code	278
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$2.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.16
Rate for Payer: Hamaspik Choice Inc Medicare	$2.16

DEXMEDETOMIDINE HCL-DEXTROSE 400MCG/100ML -5% IV SOLN [164816]

Facility

$0.43

Service Code	NDC 44567060324
Hospital Charge Code	44567060324
Hospital Revenue Code	278
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22

DEXMEDETOMIDINE HCL-DEXTROSE 400MCG/100ML -5% IV SOLN [164816]

Facility

$0.43

Service Code	NDC 44567060324
Hospital Charge Code	44567060324
Hospital Revenue Code	278
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.25
Rate for Payer: EmblemHealth Commercial	$0.22
Rate for Payer: Fidelis Medicare Advantage	$0.45
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN [121732]

Facility

$0.96

Service Code	NDC 43066056512
Hospital Charge Code	43066056512
Hospital Revenue Code	278
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48

DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN [121732]

Facility

$0.96

Service Code	NDC 43066056512
Hospital Charge Code	43066056512
Hospital Revenue Code	278
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$1.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.55
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Fidelis Medicare Advantage	$1.01
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

DEXTRAN 40 IN 0.9% SODIUM CHLORIDE INFUS

Facility

$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: Brighton Health Commercial	$16.80
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

$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

$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

$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: Brighton Health Commercial	$16.80
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 SALINE 10-0.9 % IV SOLN [23876]

Facility

$0.10

Service Code	NDC 00409741903
Hospital Charge Code	00409741903
Hospital Revenue Code	278
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05

DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN [23876]

Facility

$0.10

Service Code	NDC 00409741914
Hospital Charge Code	00409741914
Hospital Revenue Code	278
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05

DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN [23876]

Facility

$0.10

Service Code	NDC 00409741914
Hospital Charge Code	00409741914
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Fidelis Medicare Advantage	$0.10
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

Know your out-of-pocket cost for care.

All Charges