St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OXACILLIN 2000 MG INJ

Facility

$5.02

Hospital Charge Code	41644273
Hospital Revenue Code	636
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$3.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Brighton Health Commercial	$3.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.89
Rate for Payer: Group Health Inc Commercial	$2.51
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51
Rate for Payer: Hamaspik Choice Inc Medicare	$2.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.26

OXACILLIN SODIUM 1 G IJ SOLR [5924]

Facility

$14.50

Service Code	HCPCS J2700
Hospital Charge Code	64679069801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$11.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.28
Rate for Payer: Aetna Government	$1.28
Rate for Payer: Brighton Health Commercial	$10.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.86
Rate for Payer: Group Health Inc Commercial	$7.25
Rate for Payer: Group Health Inc Medicare	$5.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7.25
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.12
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.19
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.19
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.42

OXACILLIN SODIUM 2 G IJ SOLR [5926]

Facility

$28.28

Service Code	HCPCS J2700
Hospital Charge Code	55150012824
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$22.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.28
Rate for Payer: Aetna Government	$1.28
Rate for Payer: Brighton Health Commercial	$21.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.23
Rate for Payer: Group Health Inc Commercial	$14.14
Rate for Payer: Group Health Inc Medicare	$9.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.14
Rate for Payer: Hamaspik Choice Inc Medicare	$14.14
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.12
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.19
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.19
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.38

OXALATE, QUANT, 24-HOUR URINE

Facility

$36.13

Service Code	HCPCS 83945
Hospital Charge Code	40609104
Hospital Revenue Code	300
Rate for Payer: Cash Price	$14.45

OXALATE, QUANT, 24-HOUR URINE

Facility

$36.13

Service Code	HCPCS 83945
Hospital Charge Code	40609104
Hospital Revenue Code	300
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$27.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.45
Rate for Payer: Aetna Government	$14.45
Rate for Payer: Affinity Essential Plan 1&2	$10.12
Rate for Payer: Affinity Essential Plan 3&4	$10.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.12
Rate for Payer: Brighton Health Commercial	$27.10
Rate for Payer: Cash Price	$14.45
Rate for Payer: Cash Price	$14.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$14.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.32
Rate for Payer: Elderplan Medicare Advantage	$14.45
Rate for Payer: EmblemHealth Commercial	$14.45
Rate for Payer: Fidelis Essential Plan Aliesa	$12.28
Rate for Payer: Fidelis Essential Plan QHP	$12.86
Rate for Payer: Fidelis Medicare Advantage	$14.45
Rate for Payer: Fidelis Qualified Health Plan	$12.86
Rate for Payer: Group Health Inc Commercial	$14.45
Rate for Payer: Group Health Inc Medicare	$14.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.06
Rate for Payer: Hamaspik Choice Inc Medicare	$14.45
Rate for Payer: Healthfirst Medicare Advantage	$14.45
Rate for Payer: Healthfirst QHP	$14.45
Rate for Payer: Humana Medicare	$14.74
Rate for Payer: Senior Whole Health Medicare Advantage	$14.45
Rate for Payer: United Healthcare Commercial	$16.31
Rate for Payer: United Healthcare Medicare Advantage	$14.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.56
Rate for Payer: Wellcare Medicare	$13.00

OXALIPLATIN 100 MG/20 ML INJ

Facility

$2.00

Service Code	HCPCS J9263
Hospital Charge Code	41654234
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

OXALIPLATIN 100 MG/20 ML INJ

Facility

$2.00

Service Code	HCPCS J9263
Hospital Charge Code	41644234
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

OXALIPLATIN 100 MG/20 ML INJ

Facility

$2.00

Service Code	HCPCS J9263
Hospital Charge Code	41644234
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
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: SOMOS CHP/HARP/Medicaid	$0.08
Rate for Payer: SOMOS Essential	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

OXALIPLATIN 100 MG/20 ML INJ

Facility

$2.00

Service Code	HCPCS J9263
Hospital Charge Code	41654234
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
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: SOMOS CHP/HARP/Medicaid	$0.08
Rate for Payer: SOMOS Essential	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

OXALIPLATIN 100 MG/20ML IV SOLN [99612]

Facility

$1.50

Service Code	HCPCS J9263
Hospital Charge Code	72266016201
Hospital Revenue Code	278
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75

OXALIPLATIN 100 MG/20ML IV SOLN [99612]

Facility

$5.76

Service Code	HCPCS J9263
Hospital Charge Code	61703036322
Hospital Revenue Code	278
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$6.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$3.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.31
Rate for Payer: EmblemHealth Commercial	$2.88
Rate for Payer: Fidelis Medicare Advantage	$6.05
Rate for Payer: Group Health Inc Commercial	$2.88
Rate for Payer: Group Health Inc Medicare	$2.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.88
Rate for Payer: Hamaspik Choice Inc Medicare	$2.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.74

OXALIPLATIN 100 MG/20ML IV SOLN [99612]

Facility

$12.00

Service Code	HCPCS J9263
Hospital Charge Code	67457044220
Hospital Revenue Code	278
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

OXALIPLATIN 100 MG/20ML IV SOLN [99612]

Facility

$21.22

Service Code	HCPCS J9263
Hospital Charge Code	00781331780
Hospital Revenue Code	278
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$22.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$12.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.20
Rate for Payer: EmblemHealth Commercial	$10.61
Rate for Payer: Fidelis Medicare Advantage	$22.28
Rate for Payer: Group Health Inc Commercial	$10.61
Rate for Payer: Group Health Inc Medicare	$7.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.61
Rate for Payer: Hamaspik Choice Inc Medicare	$10.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.79

OXALIPLATIN 100 MG/20ML IV SOLN [99612]

Facility

$12.00

Service Code	HCPCS J9263
Hospital Charge Code	67457044220
Hospital Revenue Code	278
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$12.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
Rate for Payer: EmblemHealth Commercial	$6.00
Rate for Payer: Fidelis Medicare Advantage	$12.60
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

OXALIPLATIN 100 MG/20ML IV SOLN [99612]

Facility

$1.50

Service Code	HCPCS J9263
Hospital Charge Code	72266016201
Hospital Revenue Code	278
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$1.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: EmblemHealth Commercial	$0.75
Rate for Payer: Fidelis Medicare Advantage	$1.58
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.98

OXALIPLATIN 100 MG/20ML IV SOLN [99612]

Facility

$6.00

Service Code	HCPCS J9263
Hospital Charge Code	00703398601
Hospital Revenue Code	278
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00

OXALIPLATIN 100 MG/20ML IV SOLN [99612]

Facility

$5.76

Service Code	HCPCS J9263
Hospital Charge Code	61703036322
Hospital Revenue Code	278
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$2.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.88
Rate for Payer: Hamaspik Choice Inc Medicare	$2.88

OXALIPLATIN 100 MG/20ML IV SOLN [99612]

Facility

$6.00

Service Code	HCPCS J9263
Hospital Charge Code	00703398601
Hospital Revenue Code	278
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$6.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.45
Rate for Payer: EmblemHealth Commercial	$3.00
Rate for Payer: Fidelis Medicare Advantage	$6.30
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

OXALIPLATIN 100 MG/20ML IV SOLN [99612]

Facility

$21.22

Service Code	HCPCS J9263
Hospital Charge Code	00781331780
Hospital Revenue Code	278
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$10.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.61
Rate for Payer: Hamaspik Choice Inc Medicare	$10.61

OXALIPLATIN 50 MG/10 ML INJ

Facility

$2.00

Service Code	HCPCS J9263
Hospital Charge Code	41644237
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

OXALIPLATIN 50 MG/10 ML INJ

Facility

$2.00

Service Code	HCPCS J9263
Hospital Charge Code	41654237
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

OXALIPLATIN 50 MG/10 ML INJ

Facility

$2.00

Service Code	HCPCS J9263
Hospital Charge Code	41644237
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
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: SOMOS CHP/HARP/Medicaid	$0.08
Rate for Payer: SOMOS Essential	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

OXALIPLATIN 50 MG/10 ML INJ

Facility

$2.00

Service Code	HCPCS J9263
Hospital Charge Code	41654237
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
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: SOMOS CHP/HARP/Medicaid	$0.08
Rate for Payer: SOMOS Essential	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

OXALIPLATIN 50 MG/10ML IV SOLN [99610]

Facility

$3.00

Service Code	HCPCS J9263
Hospital Charge Code	25021023310
Hospital Revenue Code	278
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

OXALIPLATIN 50 MG/10ML IV SOLN [99610]

Facility

$21.22

Service Code	HCPCS J9263
Hospital Charge Code	50742040510
Hospital Revenue Code	278
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$10.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.61
Rate for Payer: Hamaspik Choice Inc Medicare	$10.61

Know your out-of-pocket cost for care.

All Charges