St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN

Facility

$16.23

Service Code	NDC 7006915110
Hospital Charge Code	7006915110
Hospital Revenue Code	258
Min. Negotiated Rate	$8.12
Max. Negotiated Rate	$8.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.12

CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN

Facility

$16.39

Service Code	NDC 0409110301
Hospital Charge Code	0409110301
Hospital Revenue Code	258
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$13.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.20
Rate for Payer: Aetna Government	$8.20
Rate for Payer: Brighton Health Commercial	$12.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.15
Rate for Payer: EmblemHealth Commercial	$8.20
Rate for Payer: Group Health Inc Commercial	$8.20
Rate for Payer: Group Health Inc Medicare	$5.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.20
Rate for Payer: Hamaspik Choice Inc Medicare	$8.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.65

CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN

Facility

$16.23

Service Code	NDC 7006915110
Hospital Charge Code	7006915110
Hospital Revenue Code	258
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$12.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.12
Rate for Payer: Aetna Government	$8.12
Rate for Payer: Brighton Health Commercial	$12.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.04
Rate for Payer: EmblemHealth Commercial	$8.12
Rate for Payer: Group Health Inc Commercial	$8.12
Rate for Payer: Group Health Inc Medicare	$5.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.12
Rate for Payer: Hamaspik Choice Inc Medicare	$8.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.55

CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN

Facility

$16.39

Service Code	NDC 0409110301
Hospital Charge Code	0409110301
Hospital Revenue Code	258
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$8.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.20

CISPLATIN 100 MG/100ML IV SOLN

Facility

$0.43

Service Code	HCPCS J9060
Hospital Charge Code	1672928838
Hospital Revenue Code	258
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22

CISPLATIN 100 MG/100ML IV SOLN

Facility

$0.37

Service Code	HCPCS J9060
Hospital Charge Code	0143950501
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$0.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.25
Rate for Payer: EmblemHealth Commercial	$0.18
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.24

CISPLATIN 100 MG/100ML IV SOLN

Facility

$0.49

Service Code	HCPCS J9060
Hospital Charge Code	6332310365
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

CISPLATIN 100 MG/100ML IV SOLN

Facility

$0.48

Service Code	HCPCS J9060
Hospital Charge Code	0703574811
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$0.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: EmblemHealth Commercial	$0.24
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

CISPLATIN 100 MG/100ML IV SOLN

Facility

$0.43

Service Code	HCPCS J9060
Hospital Charge Code	1672928838
Hospital Revenue Code	258
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: EmblemHealth Commercial	$0.22
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

CISPLATIN 100 MG/100ML IV SOLN

Facility

$0.48

Service Code	HCPCS J9060
Hospital Charge Code	7226625301
Hospital Revenue Code	258
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24

CISPLATIN 100 MG/100ML IV SOLN

Facility

$0.48

Service Code	HCPCS J9060
Hospital Charge Code	0703574811
Hospital Revenue Code	258
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24

CISPLATIN 100 MG/100ML IV SOLN

Facility

$0.37

Service Code	HCPCS J9060
Hospital Charge Code	0143950501
Hospital Revenue Code	258
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18

CISPLATIN 100 MG/100ML IV SOLN

Facility

$0.48

Service Code	HCPCS J9060
Hospital Charge Code	7226625301
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$0.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: EmblemHealth Commercial	$0.24
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

CISPLATIN 100 MG/100ML IV SOLN

Facility

$0.49

Service Code	HCPCS J9060
Hospital Charge Code	6332310365
Hospital Revenue Code	258
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25

CISPLATIN 200 MG/200ML IV SOLN

Facility

$0.49

Service Code	HCPCS J9060
Hospital Charge Code	6332310364
Hospital Revenue Code	258
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25

CISPLATIN 200 MG/200ML IV SOLN

Facility

$0.49

Service Code	HCPCS J9060
Hospital Charge Code	6332310364
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

CISPLATIN 50 MG/50ML IV SOLN

Facility

$0.45

Service Code	HCPCS J9060
Hospital Charge Code	1672928811
Hospital Revenue Code	258
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23

CISPLATIN 50 MG/50ML IV SOLN

Facility

$0.37

Service Code	HCPCS J9060
Hospital Charge Code	0143950401
Hospital Revenue Code	258
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18

CISPLATIN 50 MG/50ML IV SOLN

Facility

$0.49

Service Code	HCPCS J9060
Hospital Charge Code	6332310351
Hospital Revenue Code	258
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25

CISPLATIN 50 MG/50ML IV SOLN

Facility

$0.49

Service Code	HCPCS J9060
Hospital Charge Code	6332310351
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

CISPLATIN 50 MG/50ML IV SOLN

Facility

$0.37

Service Code	HCPCS J9060
Hospital Charge Code	0143950401
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$0.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.25
Rate for Payer: EmblemHealth Commercial	$0.18
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.24

CISPLATIN 50 MG/50ML IV SOLN

Facility

$0.45

Service Code	HCPCS J9060
Hospital Charge Code	1672928811
Hospital Revenue Code	258
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: EmblemHealth Commercial	$0.23
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

CITALOPRAM HYDROBROMIDE 10 MG PO TABS

Facility

$2.43

Service Code	NDC 6586200501
Hospital Charge Code	6586200501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.22
Rate for Payer: Aetna Government	$1.22
Rate for Payer: Brighton Health Commercial	$1.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.65
Rate for Payer: EmblemHealth Commercial	$1.22
Rate for Payer: Group Health Inc Commercial	$1.22
Rate for Payer: Group Health Inc Medicare	$0.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.58

CITALOPRAM HYDROBROMIDE 10 MG PO TABS

Facility

$2.58

Service Code	NDC 1366800901
Hospital Charge Code	1366800901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.29

CITALOPRAM HYDROBROMIDE 10 MG PO TABS

Facility

$2.58

Service Code	NDC 1366800901
Hospital Charge Code	1366800901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$2.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.29
Rate for Payer: Aetna Government	$1.29
Rate for Payer: Brighton Health Commercial	$1.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.75
Rate for Payer: EmblemHealth Commercial	$1.29
Rate for Payer: Group Health Inc Commercial	$1.29
Rate for Payer: Group Health Inc Medicare	$0.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.29
Rate for Payer: Hamaspik Choice Inc Medicare	$1.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.68

Know your out-of-pocket cost for care.

All Charges