St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DMNDBK 360 2.00 SLD CRX145CM OAS

Facility

$10,790.00

Hospital Charge Code	40005131
Hospital Revenue Code	272
Min. Negotiated Rate	$3,776.50
Max. Negotiated Rate	$8,632.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,934.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,395.00
Rate for Payer: Aetna Government	$5,395.00
Rate for Payer: Brighton Health Commercial	$8,092.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,632.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,337.20
Rate for Payer: Group Health Inc Commercial	$5,395.00
Rate for Payer: Group Health Inc Medicare	$3,776.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,395.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,395.00

DNA AB (DS) CRITHIDIA W/RFX

Facility

$30.13

Service Code	HCPCS 86255
Hospital Charge Code	40728095
Hospital Revenue Code	302
Rate for Payer: Cash Price	$12.05

DNA AB (DS) CRITHIDIA W/RFX

Facility

$30.13

Service Code	HCPCS 86255
Hospital Charge Code	40728095
Hospital Revenue Code	302
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$22.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$22.60
Rate for Payer: Cash Price	$12.05
Rate for Payer: Cash Price	$12.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.20
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.06
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$15.26
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.64
Rate for Payer: Wellcare Medicare	$10.84

DNA/RNA AMPLIFIED PROB

Facility

$87.73

Service Code	HCPCS 87150
Hospital Charge Code	40614325
Hospital Revenue Code	300
Min. Negotiated Rate	$24.56
Max. Negotiated Rate	$65.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.09
Rate for Payer: Aetna Government	$35.09
Rate for Payer: Affinity Essential Plan 1&2	$24.56
Rate for Payer: Affinity Essential Plan 3&4	$24.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$24.56
Rate for Payer: Brighton Health Commercial	$65.80
Rate for Payer: Cash Price	$35.09
Rate for Payer: Cash Price	$35.09
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$35.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.20
Rate for Payer: Elderplan Medicare Advantage	$35.09
Rate for Payer: EmblemHealth Commercial	$35.09
Rate for Payer: Fidelis Essential Plan Aliesa	$29.83
Rate for Payer: Fidelis Essential Plan QHP	$31.23
Rate for Payer: Fidelis Medicare Advantage	$35.09
Rate for Payer: Fidelis Qualified Health Plan	$31.23
Rate for Payer: Group Health Inc Commercial	$35.09
Rate for Payer: Group Health Inc Medicare	$35.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.86
Rate for Payer: Hamaspik Choice Inc Medicare	$35.09
Rate for Payer: Healthfirst Medicare Advantage	$35.09
Rate for Payer: Healthfirst QHP	$35.09
Rate for Payer: Humana Medicare	$35.79
Rate for Payer: Senior Whole Health Medicare Advantage	$35.09
Rate for Payer: United Healthcare Commercial	$44.45
Rate for Payer: United Healthcare Medicare Advantage	$35.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28.07
Rate for Payer: Wellcare Medicare	$31.58

DNA/RNA AMPLIFIED PROB

Facility

$87.73

Service Code	HCPCS 87150
Hospital Charge Code	40614325
Hospital Revenue Code	300
Rate for Payer: Cash Price	$35.09

DOBUTAMINE 1000 MG/D5W INFUSION 250 ML P

Facility

$13.80

Service Code	HCPCS J1250
Hospital Charge Code	41652290
Hospital Revenue Code	636
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$9.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.21
Rate for Payer: Aetna Government	$8.21
Rate for Payer: Brighton Health Commercial	$8.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.94
Rate for Payer: Group Health Inc Commercial	$6.90
Rate for Payer: Group Health Inc Medicare	$4.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.90
Rate for Payer: Hamaspik Choice Inc Medicare	$6.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.82
Rate for Payer: SOMOS Essential	$9.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.97

DOBUTAMINE 1000 MG/D5W INFUSION 250 ML P

Facility

$13.80

Service Code	HCPCS J1250
Hospital Charge Code	41652290
Hospital Revenue Code	636
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.90
Rate for Payer: Hamaspik Choice Inc Medicare	$6.90

DOBUTAMINE 1000 MG/D5W INFUSION 250 ML P

Facility

$13.80

Service Code	HCPCS J1250
Hospital Charge Code	41642290
Hospital Revenue Code	636
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.90
Rate for Payer: Hamaspik Choice Inc Medicare	$6.90

DOBUTAMINE 1000 MG/D5W INFUSION 250 ML P

Facility

$13.80

Service Code	HCPCS J1250
Hospital Charge Code	41642290
Hospital Revenue Code	636
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$9.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.21
Rate for Payer: Aetna Government	$8.21
Rate for Payer: Brighton Health Commercial	$8.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.94
Rate for Payer: Group Health Inc Commercial	$6.90
Rate for Payer: Group Health Inc Medicare	$4.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.90
Rate for Payer: Hamaspik Choice Inc Medicare	$6.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.82
Rate for Payer: SOMOS Essential	$9.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.97

DOBUTAMINE 12.5 MG/ML INJ

Facility

$6.14

Service Code	HCPCS J1250
Hospital Charge Code	41654410
Hospital Revenue Code	636
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$9.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.21
Rate for Payer: Aetna Government	$8.21
Rate for Payer: Brighton Health Commercial	$3.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.53
Rate for Payer: Group Health Inc Commercial	$3.07
Rate for Payer: Group Health Inc Medicare	$2.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.07
Rate for Payer: Hamaspik Choice Inc Medicare	$3.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.82
Rate for Payer: SOMOS Essential	$9.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.99

DOBUTAMINE 12.5 MG/ML INJ

Facility

$6.14

Service Code	HCPCS J1250
Hospital Charge Code	41654410
Hospital Revenue Code	636
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$3.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.07
Rate for Payer: Hamaspik Choice Inc Medicare	$3.07

DOBUTAMINE 12.5 MG/ML INJ

Facility

$6.14

Service Code	HCPCS J1250
Hospital Charge Code	41644410
Hospital Revenue Code	636
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$3.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.07
Rate for Payer: Hamaspik Choice Inc Medicare	$3.07

DOBUTAMINE 12.5 MG/ML INJ

Facility

$6.14

Service Code	HCPCS J1250
Hospital Charge Code	41644410
Hospital Revenue Code	636
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$9.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.21
Rate for Payer: Aetna Government	$8.21
Rate for Payer: Brighton Health Commercial	$3.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.53
Rate for Payer: Group Health Inc Commercial	$3.07
Rate for Payer: Group Health Inc Medicare	$2.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.07
Rate for Payer: Hamaspik Choice Inc Medicare	$3.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.82
Rate for Payer: SOMOS Essential	$9.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.99

DOBUTAMINE 250 MG/D5W 250 ML PREMIX INFU

Facility

$8.79

Service Code	HCPCS J1250
Hospital Charge Code	41644675
Hospital Revenue Code	636
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$4.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.40
Rate for Payer: Hamaspik Choice Inc Medicare	$4.40

DOBUTAMINE 250 MG/D5W 250 ML PREMIX INFU

Facility

$8.79

Service Code	HCPCS J1250
Hospital Charge Code	41644675
Hospital Revenue Code	636
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$9.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.21
Rate for Payer: Aetna Government	$8.21
Rate for Payer: Brighton Health Commercial	$5.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.05
Rate for Payer: Group Health Inc Commercial	$4.40
Rate for Payer: Group Health Inc Medicare	$3.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.40
Rate for Payer: Hamaspik Choice Inc Medicare	$4.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.82
Rate for Payer: SOMOS Essential	$9.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.71

DOBUTAMINE 250 MG/D5W 250 ML PREMIX INFU

Facility

$8.79

Service Code	HCPCS J1250
Hospital Charge Code	41654675
Hospital Revenue Code	636
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$9.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.21
Rate for Payer: Aetna Government	$8.21
Rate for Payer: Brighton Health Commercial	$5.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.05
Rate for Payer: Group Health Inc Commercial	$4.40
Rate for Payer: Group Health Inc Medicare	$3.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.40
Rate for Payer: Hamaspik Choice Inc Medicare	$4.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.82
Rate for Payer: SOMOS Essential	$9.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.71

DOBUTAMINE 250 MG/D5W 250 ML PREMIX INFU

Facility

$8.79

Service Code	HCPCS J1250
Hospital Charge Code	41654675
Hospital Revenue Code	636
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$4.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.40
Rate for Payer: Hamaspik Choice Inc Medicare	$4.40

DOBUTAMINE 500MG/40ML VIAL-250MG

Facility

$16.14

Service Code	HCPCS J1250
Hospital Charge Code	41648401
Hospital Revenue Code	636
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.07
Rate for Payer: Hamaspik Choice Inc Medicare	$8.07

DOBUTAMINE 500MG/40ML VIAL-250MG

Facility

$16.14

Service Code	HCPCS J1250
Hospital Charge Code	41658401
Hospital Revenue Code	636
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$10.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.21
Rate for Payer: Aetna Government	$8.21
Rate for Payer: Brighton Health Commercial	$9.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.28
Rate for Payer: Group Health Inc Commercial	$8.07
Rate for Payer: Group Health Inc Medicare	$5.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.07
Rate for Payer: Hamaspik Choice Inc Medicare	$8.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.82
Rate for Payer: SOMOS Essential	$9.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.49

DOBUTAMINE 500MG/40ML VIAL-250MG

Facility

$16.14

Service Code	HCPCS J1250
Hospital Charge Code	41648401
Hospital Revenue Code	636
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$10.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.21
Rate for Payer: Aetna Government	$8.21
Rate for Payer: Brighton Health Commercial	$9.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.28
Rate for Payer: Group Health Inc Commercial	$8.07
Rate for Payer: Group Health Inc Medicare	$5.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.07
Rate for Payer: Hamaspik Choice Inc Medicare	$8.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.82
Rate for Payer: SOMOS Essential	$9.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.49

DOBUTAMINE 500MG/40ML VIAL-250MG

Facility

$16.14

Service Code	HCPCS J1250
Hospital Charge Code	41658401
Hospital Revenue Code	636
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.07
Rate for Payer: Hamaspik Choice Inc Medicare	$8.07

DOBUTAMINE-DEXTROSE 1-5 MG/ML-% IV SOLN [18314]

Facility

$0.11

Service Code	HCPCS J1250
Hospital Charge Code	00338107302
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

DOBUTAMINE-DEXTROSE 1-5 MG/ML-% IV SOLN [18314]

Facility

$0.11

Service Code	HCPCS J1250
Hospital Charge Code	00338107302
Hospital Revenue Code	278
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$8.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.21
Rate for Payer: Aetna Government	$8.21
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	$0.11
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
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	$0.07

DOBUTAMINE-DEXTROSE 4-5 MG/ML-% IV SOLN [18317]

Facility

$0.09

Service Code	NDC 00409372411
Hospital Charge Code	00409372411
Hospital Revenue Code	278
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04

DOBUTAMINE-DEXTROSE 4-5 MG/ML-% IV SOLN [18317]

Facility

$0.14

Service Code	NDC 00338107702
Hospital Charge Code	00338107702
Hospital Revenue Code	278
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07

Know your out-of-pocket cost for care.

All Charges