St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

AMINO ACID 2.7%/D5W/LYTES/CA 1L

Facility

$52.73

Service Code	HCPCS J3490
Hospital Charge Code	41658564
Hospital Revenue Code	636
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$34.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.36
Rate for Payer: Aetna Government	$26.36
Rate for Payer: Brighton Health Commercial	$31.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.32
Rate for Payer: Group Health Inc Commercial	$26.36
Rate for Payer: Group Health Inc Medicare	$18.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.36
Rate for Payer: Hamaspik Choice Inc Medicare	$26.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.27

AMINO ACID 2.7%/D5W/LYTES/CA 1L

Facility

$52.73

Service Code	HCPCS J3490
Hospital Charge Code	41658564
Hospital Revenue Code	636
Min. Negotiated Rate	$26.36
Max. Negotiated Rate	$26.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.36
Rate for Payer: Hamaspik Choice Inc Medicare	$26.36

AMINO ACID 8%/D10W

Facility

$100.20

Service Code	HCPCS J3490
Hospital Charge Code	41640370
Hospital Revenue Code	636
Min. Negotiated Rate	$50.10
Max. Negotiated Rate	$50.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.10
Rate for Payer: Hamaspik Choice Inc Medicare	$50.10

AMINO ACID 8%/D10W

Facility

$100.20

Service Code	HCPCS J3490
Hospital Charge Code	41650370
Hospital Revenue Code	636
Min. Negotiated Rate	$50.10
Max. Negotiated Rate	$50.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.10
Rate for Payer: Hamaspik Choice Inc Medicare	$50.10

AMINO ACID 8%/D10W

Facility

$100.20

Service Code	HCPCS J3490
Hospital Charge Code	41650370
Hospital Revenue Code	636
Min. Negotiated Rate	$35.07
Max. Negotiated Rate	$65.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.10
Rate for Payer: Aetna Government	$50.10
Rate for Payer: Brighton Health Commercial	$60.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.62
Rate for Payer: Group Health Inc Commercial	$50.10
Rate for Payer: Group Health Inc Medicare	$35.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.10
Rate for Payer: Hamaspik Choice Inc Medicare	$50.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.13

AMINO ACID 8%/D10W

Facility

$100.20

Service Code	HCPCS J3490
Hospital Charge Code	41640370
Hospital Revenue Code	636
Min. Negotiated Rate	$35.07
Max. Negotiated Rate	$65.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.10
Rate for Payer: Aetna Government	$50.10
Rate for Payer: Brighton Health Commercial	$60.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.62
Rate for Payer: Group Health Inc Commercial	$50.10
Rate for Payer: Group Health Inc Medicare	$35.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.10
Rate for Payer: Hamaspik Choice Inc Medicare	$50.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.13

AMINO ACID 8% + E/D10W

Facility

$28.73

Service Code	HCPCS J3490
Hospital Charge Code	41640199
Hospital Revenue Code	636
Min. Negotiated Rate	$14.36
Max. Negotiated Rate	$14.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.36
Rate for Payer: Hamaspik Choice Inc Medicare	$14.36

AMINO ACID 8% + E/D10W

Facility

$28.73

Service Code	HCPCS J3490
Hospital Charge Code	41650199
Hospital Revenue Code	636
Min. Negotiated Rate	$10.06
Max. Negotiated Rate	$18.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.36
Rate for Payer: Aetna Government	$14.36
Rate for Payer: Brighton Health Commercial	$17.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.52
Rate for Payer: Group Health Inc Commercial	$14.36
Rate for Payer: Group Health Inc Medicare	$10.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.36
Rate for Payer: Hamaspik Choice Inc Medicare	$14.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.67

AMINO ACID 8% + E/D10W

Facility

$28.73

Service Code	HCPCS J3490
Hospital Charge Code	41640199
Hospital Revenue Code	636
Min. Negotiated Rate	$10.06
Max. Negotiated Rate	$18.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.36
Rate for Payer: Aetna Government	$14.36
Rate for Payer: Brighton Health Commercial	$17.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.52
Rate for Payer: Group Health Inc Commercial	$14.36
Rate for Payer: Group Health Inc Medicare	$10.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.36
Rate for Payer: Hamaspik Choice Inc Medicare	$14.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.67

AMINO ACID 8% + E/D10W

Facility

$28.73

Service Code	HCPCS J3490
Hospital Charge Code	41650199
Hospital Revenue Code	636
Min. Negotiated Rate	$14.36
Max. Negotiated Rate	$14.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.36
Rate for Payer: Hamaspik Choice Inc Medicare	$14.36

AMINO ACID-DEXT 4.25/10 + ELE 2L

Facility

$39.44

Hospital Charge Code	41648147
Hospital Revenue Code	250
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$31.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.72
Rate for Payer: Aetna Government	$19.72
Rate for Payer: Brighton Health Commercial	$29.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.82
Rate for Payer: Group Health Inc Commercial	$19.72
Rate for Payer: Group Health Inc Medicare	$13.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.72
Rate for Payer: Hamaspik Choice Inc Medicare	$19.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.64

AMINO ACID-DEXT 4.25/10 +ELE 2L

Facility

$39.44

Hospital Charge Code	41658147
Hospital Revenue Code	250
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$31.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.72
Rate for Payer: Aetna Government	$19.72
Rate for Payer: Brighton Health Commercial	$29.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.82
Rate for Payer: Group Health Inc Commercial	$19.72
Rate for Payer: Group Health Inc Medicare	$13.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.72
Rate for Payer: Hamaspik Choice Inc Medicare	$19.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.64

AMINO ACID-DEXT 5/15 + ELE 1L

Facility

$23.82

Hospital Charge Code	41658149
Hospital Revenue Code	250
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$19.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.91
Rate for Payer: Aetna Government	$11.91
Rate for Payer: Brighton Health Commercial	$17.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.20
Rate for Payer: Group Health Inc Commercial	$11.91
Rate for Payer: Group Health Inc Medicare	$8.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.91
Rate for Payer: Hamaspik Choice Inc Medicare	$11.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.48

AMINO ACID-DEXT 5/15 + ELE 1L

Facility

$23.82

Hospital Charge Code	41648149
Hospital Revenue Code	250
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$19.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.91
Rate for Payer: Aetna Government	$11.91
Rate for Payer: Brighton Health Commercial	$17.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.20
Rate for Payer: Group Health Inc Commercial	$11.91
Rate for Payer: Group Health Inc Medicare	$8.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.91
Rate for Payer: Hamaspik Choice Inc Medicare	$11.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.48

AMINO ACID-DEXT 5/15+ELE 2L

Facility

$46.61

Hospital Charge Code	41658151
Hospital Revenue Code	250
Min. Negotiated Rate	$16.31
Max. Negotiated Rate	$37.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.30
Rate for Payer: Aetna Government	$23.30
Rate for Payer: Brighton Health Commercial	$34.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.69
Rate for Payer: Group Health Inc Commercial	$23.30
Rate for Payer: Group Health Inc Medicare	$16.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.30
Rate for Payer: Hamaspik Choice Inc Medicare	$23.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.30

AMINO ACID-DEXT 5/15 + ELE 2L

Facility

$46.61

Hospital Charge Code	41648151
Hospital Revenue Code	250
Min. Negotiated Rate	$16.31
Max. Negotiated Rate	$37.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.30
Rate for Payer: Aetna Government	$23.30
Rate for Payer: Brighton Health Commercial	$34.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.69
Rate for Payer: Group Health Inc Commercial	$23.30
Rate for Payer: Group Health Inc Medicare	$16.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.30
Rate for Payer: Hamaspik Choice Inc Medicare	$23.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.30

AMINO ACID PROFILE, QN, URINE

Facility

$42.18

Service Code	HCPCS 82139
Hospital Charge Code	40609874
Hospital Revenue Code	301
Min. Negotiated Rate	$11.81
Max. Negotiated Rate	$31.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.87
Rate for Payer: Aetna Government	$16.87
Rate for Payer: Affinity Essential Plan 1&2	$11.81
Rate for Payer: Affinity Essential Plan 3&4	$11.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.81
Rate for Payer: Brighton Health Commercial	$31.64
Rate for Payer: Cash Price	$16.87
Rate for Payer: Cash Price	$16.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.69
Rate for Payer: Elderplan Medicare Advantage	$16.87
Rate for Payer: EmblemHealth Commercial	$16.87
Rate for Payer: Fidelis Essential Plan Aliesa	$14.34
Rate for Payer: Fidelis Essential Plan QHP	$15.01
Rate for Payer: Fidelis Medicare Advantage	$16.87
Rate for Payer: Fidelis Qualified Health Plan	$15.01
Rate for Payer: Group Health Inc Commercial	$16.87
Rate for Payer: Group Health Inc Medicare	$16.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.09
Rate for Payer: Hamaspik Choice Inc Medicare	$16.87
Rate for Payer: Healthfirst Medicare Advantage	$16.87
Rate for Payer: Healthfirst QHP	$16.87
Rate for Payer: Humana Medicare	$17.21
Rate for Payer: Senior Whole Health Medicare Advantage	$16.87
Rate for Payer: United Healthcare Commercial	$21.37
Rate for Payer: United Healthcare Medicare Advantage	$16.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.50
Rate for Payer: Wellcare Medicare	$15.18

AMINO ACID PROFILE, QN, URINE

Facility

$42.18

Service Code	HCPCS 82139
Hospital Charge Code	40609874
Hospital Revenue Code	301
Rate for Payer: Cash Price	$16.87

AMINOCAPROIC ACID 250MG/ML INJ

Facility

$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: Brighton Health Commercial	$0.87
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

$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

$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: Brighton Health Commercial	$0.87
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

$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 250 MG/ML IV SOLN [403]

Facility

$0.57

Service Code	NDC 00517912025
Hospital Charge Code	00517912025
Hospital Revenue Code	278
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28

AMINOCAPROIC ACID 250 MG/ML IV SOLN [403]

Facility

$0.57

Service Code	NDC 00517912025
Hospital Charge Code	00517912025
Hospital Revenue Code	278
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.32
Rate for Payer: EmblemHealth Commercial	$0.28
Rate for Payer: Fidelis Medicare Advantage	$0.59
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.37

AMINOCAPROIC ACID 500 MG PO TABS [9063]

Facility

$22.40

Service Code	NDC 72205004930
Hospital Charge Code	72205004930
Hospital Revenue Code	250
Min. Negotiated Rate	$7.84
Max. Negotiated Rate	$17.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.20
Rate for Payer: Aetna Government	$11.20
Rate for Payer: Brighton Health Commercial	$16.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.23
Rate for Payer: Group Health Inc Commercial	$11.20
Rate for Payer: Group Health Inc Medicare	$7.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.20
Rate for Payer: Hamaspik Choice Inc Medicare	$11.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.56

Know your out-of-pocket cost for care.

All Charges