St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DEXTROSE 5% WATER INFUSION 1000 ML

Facility

$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: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: 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

$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

$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: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: 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

$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: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: 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

$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

$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 150 ML

Facility

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41641444
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: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: 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

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41641444
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 150 ML

Facility

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41651444
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 150 ML

Facility

$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: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: 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 250 ML

Facility

$3.81

Service Code	HCPCS J7060
Hospital Charge Code	41651445
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$2.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.74
Rate for Payer: Aetna Government	$1.74
Rate for Payer: Brighton Health Commercial	$2.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.19
Rate for Payer: Group Health Inc Commercial	$1.90
Rate for Payer: Group Health Inc Medicare	$1.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1.90
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	$2.48

DEXTROSE 5% WATER INFUSION 250 ML

Facility

$3.81

Service Code	HCPCS J7060
Hospital Charge Code	41651445
Hospital Revenue Code	636
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$1.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1.90

DEXTROSE 5% WATER INFUSION 250 ML

Facility

$3.81

Service Code	HCPCS J7060
Hospital Charge Code	41641445
Hospital Revenue Code	636
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$1.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1.90

DEXTROSE 5% WATER INFUSION 250 ML

Facility

$3.81

Service Code	HCPCS J7060
Hospital Charge Code	41641445
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$2.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.74
Rate for Payer: Aetna Government	$1.74
Rate for Payer: Brighton Health Commercial	$2.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.19
Rate for Payer: Group Health Inc Commercial	$1.90
Rate for Payer: Group Health Inc Medicare	$1.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1.90
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	$2.48

DEXTROSE 5% WATER INFUSION 25 ML

Facility

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41651448
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 25 ML

Facility

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41641448
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: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: 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 25 ML

Facility

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41641448
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 25 ML

Facility

$3.00

Service Code	HCPCS J7060
Hospital Charge Code	41651448
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: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: 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 500 ML

Facility

$2.00

Service Code	HCPCS J7060
Hospital Charge Code	41651446
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% WATER INFUSION 500 ML

Facility

$2.00

Service Code	HCPCS J7060
Hospital Charge Code	41651446
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.74
Rate for Payer: Aetna Government	$1.74
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
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: 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	$1.30

DEXTROSE 5% WATER INFUSION 500 ML

Facility

$2.00

Service Code	HCPCS J7060
Hospital Charge Code	41641446
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.74
Rate for Payer: Aetna Government	$1.74
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
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: 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	$1.30

DEXTROSE 5% WATER INFUSION 500 ML

Facility

$2.00

Service Code	HCPCS J7060
Hospital Charge Code	41641446
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% WATER INFUSION 50 ML

Facility

$2.00

Service Code	HCPCS J7060
Hospital Charge Code	41641449
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% WATER INFUSION 50 ML

Facility

$2.00

Service Code	HCPCS J7060
Hospital Charge Code	41641449
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.74
Rate for Payer: Aetna Government	$1.74
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
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: 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	$1.30

DEXTROSE 5% WATER INFUSION 50 ML

Facility

$2.00

Service Code	HCPCS J7060
Hospital Charge Code	41651449
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.74
Rate for Payer: Aetna Government	$1.74
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
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: 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	$1.30

Know your out-of-pocket cost for care.

All Charges