St. Barnabas Hospital

All Charges

Charge

Type

Price

AMINOCAPROIC ACID 250MG/ML INJ

Facility IP

$1.45

Service Code	HCPCS J3490
Hospital Charge Code	41653993
Hospital Revenue Code	636
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73
Rate for Payer: Hamaspik Choice Inc Medicare	$0.73

AMINOCAPROIC ACID 250MG/ML INJ

Facility IP

$1.45

Service Code	HCPCS J3490
Hospital Charge Code	41643993
Hospital Revenue Code	636
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73
Rate for Payer: Hamaspik Choice Inc Medicare	$0.73

AMINOCAPROIC ACID 250MG/ML INJ

Facility OP

$1.45

Service Code	HCPCS J3490
Hospital Charge Code	41643993
Hospital Revenue Code	636
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.73
Rate for Payer: Aetna Government	$0.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.83
Rate for Payer: Group Health Inc Commercial	$0.73
Rate for Payer: Group Health Inc Medicare	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73
Rate for Payer: Hamaspik Choice Inc Medicare	$0.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.94

AMINOCAPROIC ACID 250MG/ML INJ

Facility OP

$1.45

Service Code	HCPCS J3490
Hospital Charge Code	41653993
Hospital Revenue Code	636
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.73
Rate for Payer: Aetna Government	$0.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.83
Rate for Payer: Group Health Inc Commercial	$0.73
Rate for Payer: Group Health Inc Medicare	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73
Rate for Payer: Hamaspik Choice Inc Medicare	$0.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.94

AMINOCAPROIC ACID 500 MG TAB

Facility OP

$2.17

Hospital Charge Code	41642849
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.48
Rate for Payer: Group Health Inc Commercial	$1.08
Rate for Payer: Group Health Inc Medicare	$0.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.41

AMINOCAPROIC ACID 500 MG TAB

Facility OP

$2.17

Hospital Charge Code	41652849
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.48
Rate for Payer: Group Health Inc Commercial	$1.08
Rate for Payer: Group Health Inc Medicare	$0.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.41

AMINOPHYLLINE 25 MG/ML INJ 10 ML

Facility IP

$3.41

Service Code	HCPCS J0280
Hospital Charge Code	41644140
Hospital Revenue Code	636
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70

AMINOPHYLLINE 25 MG/ML INJ 10 ML

Facility IP

$3.41

Service Code	HCPCS J0280
Hospital Charge Code	41654140
Hospital Revenue Code	636
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70

AMINOPHYLLINE 25 MG/ML INJ 10 ML

Facility OP

$3.41

Service Code	HCPCS J0280
Hospital Charge Code	41654140
Hospital Revenue Code	636
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$9.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.57
Rate for Payer: Aetna Government	$8.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.06
Rate for Payer: Group Health Inc Commercial	$1.70
Rate for Payer: Group Health Inc Medicare	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.37
Rate for Payer: SOMOS Essential	$9.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.22

AMINOPHYLLINE 25 MG/ML INJ 10 ML

Facility OP

$3.41

Service Code	HCPCS J0280
Hospital Charge Code	41644140
Hospital Revenue Code	636
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$9.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.57
Rate for Payer: Aetna Government	$8.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.06
Rate for Payer: Group Health Inc Commercial	$1.70
Rate for Payer: Group Health Inc Medicare	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.37
Rate for Payer: SOMOS Essential	$9.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.22

AMINOPHYLLINE 25 MG/ML INJ 20 ML

Facility IP

$2.00

Service Code	HCPCS J0280
Hospital Charge Code	41650996
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

AMINOPHYLLINE 25 MG/ML INJ 20 ML

Facility OP

$2.00

Service Code	HCPCS J0280
Hospital Charge Code	41640996
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$9.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.57
Rate for Payer: Aetna Government	$8.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.06
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: Healthfirst CHP/FHP/Medicaid	$4.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.37
Rate for Payer: SOMOS Essential	$9.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

AMINOPHYLLINE 25 MG/ML INJ 20 ML

Facility IP

$2.00

Service Code	HCPCS J0280
Hospital Charge Code	41640996
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

AMINOPHYLLINE 25 MG/ML INJ 20 ML

Facility OP

$2.00

Service Code	HCPCS J0280
Hospital Charge Code	41650996
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$9.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.57
Rate for Payer: Aetna Government	$8.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.06
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: Healthfirst CHP/FHP/Medicaid	$4.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.37
Rate for Payer: SOMOS Essential	$9.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

AMINOPHYLLINE 2.5 MG/ML INJ NEONTAL

Facility OP

$1.00

Hospital Charge Code	41641804
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

AMINOPHYLLINE 2.5 MG/ML INJ NEONTAL

Facility OP

$1.00

Hospital Charge Code	41651804
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

AMIODARONE 150MG/100ML IVPB

Facility OP

$8.43

Service Code	HCPCS J0282
Hospital Charge Code	41656603
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$5.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.85
Rate for Payer: Group Health Inc Commercial	$4.22
Rate for Payer: Group Health Inc Medicare	$2.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.22
Rate for Payer: Hamaspik Choice Inc Medicare	$4.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.48

AMIODARONE 150MG/100ML IVPB

Facility OP

$8.43

Service Code	HCPCS J0282
Hospital Charge Code	41646603
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$5.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.85
Rate for Payer: Group Health Inc Commercial	$4.22
Rate for Payer: Group Health Inc Medicare	$2.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.22
Rate for Payer: Hamaspik Choice Inc Medicare	$4.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.48

AMIODARONE 150MG/100ML IVPB

Facility IP

$8.43

Service Code	HCPCS J0282
Hospital Charge Code	41646603
Hospital Revenue Code	636
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.22
Rate for Payer: Hamaspik Choice Inc Medicare	$4.22

AMIODARONE 150MG/100ML IVPB

Facility IP

$8.43

Service Code	HCPCS J0282
Hospital Charge Code	41656603
Hospital Revenue Code	636
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.22
Rate for Payer: Hamaspik Choice Inc Medicare	$4.22

AMIODARONE 200 MG TAB

Facility OP

$0.23

Hospital Charge Code	41653887
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

AMIODARONE 200 MG TAB

Facility OP

$0.23

Hospital Charge Code	41643887
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

AMIODARONE 360MG/200ML IVPB

Facility OP

$3.92

Service Code	HCPCS J0282
Hospital Charge Code	41646602
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$2.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.25
Rate for Payer: Group Health Inc Commercial	$1.96
Rate for Payer: Group Health Inc Medicare	$1.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.96
Rate for Payer: Hamaspik Choice Inc Medicare	$1.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.55

AMIODARONE 360MG/200ML IVPB

Facility IP

$3.92

Service Code	HCPCS J0282
Hospital Charge Code	41656602
Hospital Revenue Code	636
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$1.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.96
Rate for Payer: Hamaspik Choice Inc Medicare	$1.96

AMIODARONE 360MG/200ML IVPB

Facility OP

$3.92

Service Code	HCPCS J0282
Hospital Charge Code	41656602
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$2.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.25
Rate for Payer: Group Health Inc Commercial	$1.96
Rate for Payer: Group Health Inc Medicare	$1.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.96
Rate for Payer: Hamaspik Choice Inc Medicare	$1.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.55

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