St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HYDROMORPHONE 100MG/D5W 100ML PCA

Facility

$26.00

Service Code	HCPCS J1170
Hospital Charge Code	41657172
Hospital Revenue Code	636
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$13.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.00
Rate for Payer: Hamaspik Choice Inc Medicare	$13.00

HYDROMORPHONE 100MG/D5W 100ML PCA

Facility

$26.00

Service Code	HCPCS J1170
Hospital Charge Code	41647172
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$16.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$15.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.95
Rate for Payer: Group Health Inc Commercial	$13.00
Rate for Payer: Group Health Inc Medicare	$9.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.00
Rate for Payer: Hamaspik Choice Inc Medicare	$13.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.04
Rate for Payer: SOMOS Essential	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.90

HYDROMORPHONE 100MG/D5W 100ML PCA

Facility

$26.00

Service Code	HCPCS J1170
Hospital Charge Code	41647172
Hospital Revenue Code	636
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$13.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.00
Rate for Payer: Hamaspik Choice Inc Medicare	$13.00

HYDROMORPHONE 100MG/NS 100ML PCA

Facility

$26.00

Service Code	HCPCS J1170
Hospital Charge Code	41657177
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$16.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$15.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.95
Rate for Payer: Group Health Inc Commercial	$13.00
Rate for Payer: Group Health Inc Medicare	$9.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.00
Rate for Payer: Hamaspik Choice Inc Medicare	$13.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.04
Rate for Payer: SOMOS Essential	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.90

HYDROMORPHONE 100MG/NS 100ML PCA

Facility

$26.00

Service Code	HCPCS J1170
Hospital Charge Code	41657177
Hospital Revenue Code	636
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$13.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.00
Rate for Payer: Hamaspik Choice Inc Medicare	$13.00

HYDROMORPHONE 100MG/NS 100ML PCA

Facility

$26.00

Service Code	HCPCS J1170
Hospital Charge Code	41647177
Hospital Revenue Code	636
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$13.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.00
Rate for Payer: Hamaspik Choice Inc Medicare	$13.00

HYDROMORPHONE 100MG/NS 100ML PCA

Facility

$26.00

Service Code	HCPCS J1170
Hospital Charge Code	41647177
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$16.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$15.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.95
Rate for Payer: Group Health Inc Commercial	$13.00
Rate for Payer: Group Health Inc Medicare	$9.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.00
Rate for Payer: Hamaspik Choice Inc Medicare	$13.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.04
Rate for Payer: SOMOS Essential	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.90

HYDROMORPHONE 10MG/1 ML

Facility

$1.48

Service Code	HCPCS J1170
Hospital Charge Code	41647100
Hospital Revenue Code	636
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$0.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.74
Rate for Payer: Hamaspik Choice Inc Medicare	$0.74

HYDROMORPHONE 10MG/1 ML

Facility

$1.48

Service Code	HCPCS J1170
Hospital Charge Code	41647100
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.85
Rate for Payer: Group Health Inc Commercial	$0.74
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.74
Rate for Payer: Hamaspik Choice Inc Medicare	$0.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.04
Rate for Payer: SOMOS Essential	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.96

HYDROMORPHONE 10MG/1ML VIAL

Facility

$1.00

Service Code	HCPCS J1170
Hospital Charge Code	41647911
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
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: SOMOS CHP/HARP/Medicaid	$5.04
Rate for Payer: SOMOS Essential	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

HYDROMORPHONE 10MG/1ML VIAL

Facility

$1.00

Service Code	HCPCS J1170
Hospital Charge Code	41657911
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

HYDROMORPHONE 10MG/1ML VIAL

Facility

$1.00

Service Code	HCPCS J1170
Hospital Charge Code	41647911
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

HYDROMORPHONE 10MG/1ML VIAL

Facility

$1.48

Service Code	HCPCS J1170
Hospital Charge Code	41657100
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.85
Rate for Payer: Group Health Inc Commercial	$0.74
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.74
Rate for Payer: Hamaspik Choice Inc Medicare	$0.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.04
Rate for Payer: SOMOS Essential	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.96

HYDROMORPHONE 10MG/1ML VIAL

Facility

$1.48

Service Code	HCPCS J1170
Hospital Charge Code	41657100
Hospital Revenue Code	636
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$0.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.74
Rate for Payer: Hamaspik Choice Inc Medicare	$0.74

HYDROMORPHONE 10MG/1ML VIAL

Facility

$1.00

Service Code	HCPCS J1170
Hospital Charge Code	41657911
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
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: SOMOS CHP/HARP/Medicaid	$5.04
Rate for Payer: SOMOS Essential	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

HYDROMORPHONE 10 MG/ML INJ 5 ML

Facility

$16.00

Service Code	HCPCS J1170
Hospital Charge Code	41655333
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$9.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.20
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.04
Rate for Payer: SOMOS Essential	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

HYDROMORPHONE 10 MG/ML INJ 5 ML

Facility

$16.00

Service Code	HCPCS J1170
Hospital Charge Code	41655333
Hospital Revenue Code	636
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00

HYDROMORPHONE 10 MG/ML INJ 5 ML

Facility

$16.00

Service Code	HCPCS J1170
Hospital Charge Code	41645333
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$9.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.20
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.04
Rate for Payer: SOMOS Essential	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

HYDROMORPHONE 10 MG/ML INJ 5 ML

Facility

$16.00

Service Code	HCPCS J1170
Hospital Charge Code	41645333
Hospital Revenue Code	636
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00

HYDROMORPHONE 1MG/1ML-UP TO 4MG

Facility

$3.00

Service Code	HCPCS J1170
Hospital Charge Code	41657145
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.04
Rate for Payer: SOMOS Essential	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

HYDROMORPHONE 1MG/1ML-UP TO 4MG

Facility

$3.00

Service Code	HCPCS J1170
Hospital Charge Code	41657145
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

HYDROMORPHONE 1MG/ML

Facility

$8.12

Hospital Charge Code	41647047
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$6.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.06
Rate for Payer: Aetna Government	$4.06
Rate for Payer: Brighton Health Commercial	$6.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.52
Rate for Payer: Group Health Inc Commercial	$4.06
Rate for Payer: Group Health Inc Medicare	$2.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.06
Rate for Payer: Hamaspik Choice Inc Medicare	$4.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.28

HYDROMORPHONE 1 MG/ML INJ CARTRIDGE

Facility

$10.94

Service Code	HCPCS J1170
Hospital Charge Code	41654161
Hospital Revenue Code	636
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$5.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.47
Rate for Payer: Hamaspik Choice Inc Medicare	$5.47

HYDROMORPHONE 1 MG/ML INJ CARTRIDGE

Facility

$10.94

Service Code	HCPCS J1170
Hospital Charge Code	41644161
Hospital Revenue Code	636
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$5.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.47
Rate for Payer: Hamaspik Choice Inc Medicare	$5.47

HYDROMORPHONE 1 MG/ML INJ CARTRIDGE

Facility

$10.94

Service Code	HCPCS J1170
Hospital Charge Code	41644161
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$7.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$6.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.29
Rate for Payer: Group Health Inc Commercial	$5.47
Rate for Payer: Group Health Inc Medicare	$3.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.47
Rate for Payer: Hamaspik Choice Inc Medicare	$5.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.04
Rate for Payer: SOMOS Essential	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.11

Know your out-of-pocket cost for care.

All Charges