St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DEXTROSE 5% WATER INFUSION 50 ML

Facility

$2.00

Service Code	HCPCS J7060
Hospital Charge Code	41651449
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 70 % IV SOLN [2367]

Facility

$0.01

Service Code	NDC 00338071906
Hospital Charge Code	00338071906
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

DEXTROSE 70 % IV SOLN [2367]

Facility

$0.01

Service Code	NDC 00338071906
Hospital Charge Code	00338071906
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

DEXTROSE IN LACTATED RINGERS 5 % IV SOLN [9788]

Facility

$0.01

Service Code	NDC 00338012504
Hospital Charge Code	00338012504
Hospital Revenue Code	278
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00

DEXTROSE IN LACTATED RINGERS 5 % IV SOLN [9788]

Facility

$0.01

Service Code	NDC 00338012503
Hospital Charge Code	00338012503
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

DEXTROSE IN LACTATED RINGERS 5 % IV SOLN [9788]

Facility

$0.01

Service Code	NDC 00338012504
Hospital Charge Code	00338012504
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

DEXTROSE IN LACTATED RINGERS 5 % IV SOLN [9788]

Facility

$0.01

Service Code	NDC 00338012503
Hospital Charge Code	00338012503
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

DEXTROSE/NACL 5-0.2% 1000ML

Facility

$2.11

Service Code	HCPCS J7799
Hospital Charge Code	41658153
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$1.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.43
Rate for Payer: Group Health Inc Commercial	$1.06
Rate for Payer: Group Health Inc Medicare	$0.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.37

DEXTROSE/NACL 5-0.2% 1000ML

Facility

$2.11

Service Code	HCPCS J7799
Hospital Charge Code	41648153
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.06
Rate for Payer: Aetna Government	$1.06
Rate for Payer: Brighton Health Commercial	$1.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.43
Rate for Payer: Group Health Inc Commercial	$1.06
Rate for Payer: Group Health Inc Medicare	$0.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.37

DEXTROSE-SODIUM CHLORIDE 10-0.45 % IV SOLN [9809]

Facility

$0.01

Service Code	NDC 00264762200
Hospital Charge Code	00264762200
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

DEXTROSE-SODIUM CHLORIDE 10-0.45 % IV SOLN [9809]

Facility

$0.01

Service Code	NDC 00264762200
Hospital Charge Code	00264762200
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

DEXTROSE-SODIUM CHLORIDE 5-0.2 % IV SOLN [9812]

Facility

$0.01

Service Code	NDC 00338007704
Hospital Charge Code	00338007704
Hospital Revenue Code	278
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00

DEXTROSE-SODIUM CHLORIDE 5-0.2 % IV SOLN [9812]

Facility

$0.01

Service Code	NDC 00338007704
Hospital Charge Code	00338007704
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

DEXTROSE-SODIUM CHLORIDE 5-0.33 % IV SOLN [9813]

Facility

$0.01

Service Code	NDC 00338008103
Hospital Charge Code	00338008103
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

DEXTROSE-SODIUM CHLORIDE 5-0.33 % IV SOLN [9813]

Facility

$0.01

Service Code	NDC 00338008103
Hospital Charge Code	00338008103
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

DEXTROSE-SODIUM CHLORIDE 5-0.45 % IV SOLN [9814]

Facility

$0.01

Service Code	NDC 00338008503
Hospital Charge Code	00338008503
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

DEXTROSE-SODIUM CHLORIDE 5-0.45 % IV SOLN [9814]

Facility

$0.01

Service Code	NDC 00338008504
Hospital Charge Code	00338008504
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

DEXTROSE-SODIUM CHLORIDE 5-0.45 % IV SOLN [9814]

Facility

$0.01

Service Code	NDC 00338008503
Hospital Charge Code	00338008503
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

DEXTROSE-SODIUM CHLORIDE 5-0.45 % IV SOLN [9814]

Facility

$0.01

Service Code	NDC 00338008504
Hospital Charge Code	00338008504
Hospital Revenue Code	278
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00

DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN [9815]

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	00338008903
Hospital Revenue Code	278
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN [9815]

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	00338008903
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN [9815]

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	00338008904
Hospital Revenue Code	278
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN [9815]

Facility

$0.01

Service Code	HCPCS J3480
Hospital Charge Code	00338008904
Hospital Revenue Code	278
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00

DHEA SULFATE

Facility

$55.58

Service Code	HCPCS 82627
Hospital Charge Code	30303370
Hospital Revenue Code	301
Rate for Payer: Cash Price	$22.23

DHEA SULFATE

Facility

$55.58

Service Code	HCPCS 82627
Hospital Charge Code	30303370
Hospital Revenue Code	301
Min. Negotiated Rate	$15.56
Max. Negotiated Rate	$41.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.23
Rate for Payer: Aetna Government	$22.23
Rate for Payer: Affinity Essential Plan 1&2	$15.56
Rate for Payer: Affinity Essential Plan 3&4	$15.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$15.56
Rate for Payer: Brighton Health Commercial	$41.68
Rate for Payer: Cash Price	$22.23
Rate for Payer: Cash Price	$22.23
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$22.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.91
Rate for Payer: Elderplan Medicare Advantage	$22.23
Rate for Payer: EmblemHealth Commercial	$22.23
Rate for Payer: Fidelis Essential Plan Aliesa	$18.90
Rate for Payer: Fidelis Essential Plan QHP	$19.78
Rate for Payer: Fidelis Medicare Advantage	$22.23
Rate for Payer: Fidelis Qualified Health Plan	$19.78
Rate for Payer: Group Health Inc Commercial	$22.23
Rate for Payer: Group Health Inc Medicare	$22.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.79
Rate for Payer: Hamaspik Choice Inc Medicare	$22.23
Rate for Payer: Healthfirst Medicare Advantage	$22.23
Rate for Payer: Healthfirst QHP	$22.23
Rate for Payer: Humana Medicare	$22.67
Rate for Payer: Senior Whole Health Medicare Advantage	$22.23
Rate for Payer: United Healthcare Commercial	$28.16
Rate for Payer: United Healthcare Medicare Advantage	$22.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.78
Rate for Payer: Wellcare Medicare	$20.01

Know your out-of-pocket cost for care.

All Charges