St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DONUT PESSARY 3, 76MM

Facility

$144.83

Hospital Charge Code	64905203
Hospital Revenue Code	270
Min. Negotiated Rate	$50.69
Max. Negotiated Rate	$115.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.42
Rate for Payer: Aetna Government	$72.42
Rate for Payer: Brighton Health Commercial	$108.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.48
Rate for Payer: Group Health Inc Commercial	$72.42
Rate for Payer: Group Health Inc Medicare	$50.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.42
Rate for Payer: Hamaspik Choice Inc Medicare	$72.42

DONUT PESSARY SIZE 2

Facility

$144.83

Hospital Charge Code	64905603
Hospital Revenue Code	270
Min. Negotiated Rate	$50.69
Max. Negotiated Rate	$115.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.42
Rate for Payer: Aetna Government	$72.42
Rate for Payer: Brighton Health Commercial	$108.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.48
Rate for Payer: Group Health Inc Commercial	$72.42
Rate for Payer: Group Health Inc Medicare	$50.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.42
Rate for Payer: Hamaspik Choice Inc Medicare	$72.42

DOPAMINE 200 MG/D5W INFUSION 250 ML PREM

Facility

$4.00

Service Code	HCPCS J1265
Hospital Charge Code	41644676
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$2.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$2.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

DOPAMINE 200 MG/D5W INFUSION 250 ML PREM

Facility

$4.00

Service Code	HCPCS J1265
Hospital Charge Code	41654676
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$2.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$2.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

DOPAMINE 200 MG/D5W INFUSION 250 ML PREM

Facility

$4.00

Service Code	HCPCS J1265
Hospital Charge Code	41644676
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00

DOPAMINE 200 MG/D5W INFUSION 250 ML PREM

Facility

$4.00

Service Code	HCPCS J1265
Hospital Charge Code	41654676
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00

DOPAMINE 40MGML, 10ML INJ

Facility

$0.15

Service Code	HCPCS J1265
Hospital Charge Code	41658173
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08

DOPAMINE 40MGML, 10ML INJ

Facility

$0.15

Service Code	HCPCS J1265
Hospital Charge Code	41648173
Hospital Revenue Code	636
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

DOPAMINE 40MGML, 10ML INJ

Facility

$0.15

Service Code	HCPCS J1265
Hospital Charge Code	41658173
Hospital Revenue Code	636
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

DOPAMINE 40MGML, 10ML INJ

Facility

$0.15

Service Code	HCPCS J1265
Hospital Charge Code	41648173
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08

DOPAMINE 40 MG/ML INJ 5 ML

Facility

$0.70

Service Code	HCPCS J1265
Hospital Charge Code	41652547
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

DOPAMINE 40 MG/ML INJ 5 ML

Facility

$0.70

Service Code	HCPCS J1265
Hospital Charge Code	41652547
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35

DOPAMINE 40 MG/ML INJ 5 ML

Facility

$0.70

Service Code	HCPCS J1265
Hospital Charge Code	41642547
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35

DOPAMINE 40 MG/ML INJ 5 ML

Facility

$0.70

Service Code	HCPCS J1265
Hospital Charge Code	41642547
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

DOPAMINE 800 MG/D5W INFUSION 250 ML PREM

Facility

$0.94

Service Code	HCPCS J1265
Hospital Charge Code	41652291
Hospital Revenue Code	636
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47

DOPAMINE 800 MG/D5W INFUSION 250 ML PREM

Facility

$0.94

Service Code	HCPCS J1265
Hospital Charge Code	41642291
Hospital Revenue Code	636
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$0.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.54
Rate for Payer: Group Health Inc Commercial	$0.47
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.61

DOPAMINE 800 MG/D5W INFUSION 250 ML PREM

Facility

$0.94

Service Code	HCPCS J1265
Hospital Charge Code	41642291
Hospital Revenue Code	636
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47

DOPAMINE 800 MG/D5W INFUSION 250 ML PREM

Facility

$0.94

Service Code	HCPCS J1265
Hospital Charge Code	41652291
Hospital Revenue Code	636
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$0.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.54
Rate for Payer: Group Health Inc Commercial	$0.47
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.61

DOPAMINE-DEXTROSE 0.8-5 MG/ML-% IV SOLN [14844]

Facility

$0.06

Service Code	HCPCS J1265
Hospital Charge Code	00338100502
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03

DOPAMINE-DEXTROSE 0.8-5 MG/ML-% IV SOLN [14844]

Facility

$0.06

Service Code	HCPCS J1265
Hospital Charge Code	00338100502
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Fidelis Medicare Advantage	$0.06
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

DOPAMINE-DEXTROSE 3.2-5 MG/ML-% IV SOLN [14846]

Facility

$0.10

Service Code	HCPCS J1265
Hospital Charge Code	00338100902
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

DOPAMINE-DEXTROSE 3.2-5 MG/ML-% IV SOLN [14846]

Facility

$0.10

Service Code	HCPCS J1265
Hospital Charge Code	00409781022
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

DOPAMINE-DEXTROSE 3.2-5 MG/ML-% IV SOLN [14846]

Facility

$0.10

Service Code	HCPCS J1265
Hospital Charge Code	00409781022
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
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

DOPAMINE-DEXTROSE 3.2-5 MG/ML-% IV SOLN [14846]

Facility

$0.10

Service Code	HCPCS J1265
Hospital Charge Code	00338100902
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
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	$0.05
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

DOPAMINE HCL 40 MG/ML IV SOLN [2595]

Facility

$0.91

Service Code	HCPCS J1265
Hospital Charge Code	00409582011
Hospital Revenue Code	278
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: EmblemHealth Commercial	$0.46
Rate for Payer: Fidelis Medicare Advantage	$0.96
Rate for Payer: Group Health Inc Commercial	$0.46
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

Know your out-of-pocket cost for care.

All Charges