St. Barnabas Hospital

All Charges

Charge

Type

Price

VIAL2BAG DC BLUE

Facility OP

$5.71

Hospital Charge Code	64902120
Hospital Revenue Code	270
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$4.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.86
Rate for Payer: Aetna Government	$2.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.88
Rate for Payer: Group Health Inc Commercial	$2.86
Rate for Payer: Group Health Inc Medicare	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.86
Rate for Payer: Hamaspik Choice Inc Medicare	$2.86

VIAL2BAG DC BLUE 20MM

Facility OP

$4.88

Hospital Charge Code	64902180
Hospital Revenue Code	270
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$3.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.44
Rate for Payer: Aetna Government	$2.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.32
Rate for Payer: Group Health Inc Commercial	$2.44
Rate for Payer: Group Health Inc Medicare	$1.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.44
Rate for Payer: Hamaspik Choice Inc Medicare	$2.44

VIAL2BAG DC ORANGE 13MM

Facility OP

$4.88

Hospital Charge Code	64902178
Hospital Revenue Code	270
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$3.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.44
Rate for Payer: Aetna Government	$2.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.32
Rate for Payer: Group Health Inc Commercial	$2.44
Rate for Payer: Group Health Inc Medicare	$1.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.44
Rate for Payer: Hamaspik Choice Inc Medicare	$2.44

VIAL2BAG ORANGE 13MM

Facility OP

$285.46

Hospital Charge Code	64902115
Hospital Revenue Code	270
Min. Negotiated Rate	$99.91
Max. Negotiated Rate	$228.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$142.73
Rate for Payer: Aetna Government	$142.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$228.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$194.11
Rate for Payer: Group Health Inc Commercial	$142.73
Rate for Payer: Group Health Inc Medicare	$99.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.73
Rate for Payer: Hamaspik Choice Inc Medicare	$142.73

VIAL 2 BAG PROG

Facility OP

$6.22

Hospital Charge Code	64901571
Hospital Revenue Code	270
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$4.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.11
Rate for Payer: Aetna Government	$3.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.23
Rate for Payer: Group Health Inc Commercial	$3.11
Rate for Payer: Group Health Inc Medicare	$2.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.11
Rate for Payer: Hamaspik Choice Inc Medicare	$3.11

VIDEO/SPEECH EVAL

Facility OP

$705.83

Service Code	HCPCS 70371 TC
Hospital Charge Code	30304096
Hospital Revenue Code	320
Min. Negotiated Rate	$75.38
Max. Negotiated Rate	$564.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$352.92
Rate for Payer: Aetna Government	$352.92
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$75.38
Rate for Payer: Group Health Inc Commercial	$352.92
Rate for Payer: Group Health Inc Medicare	$247.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$352.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$83.75

VINBLASTINE 10 MG INJ

Facility IP

$1.96

Service Code	HCPCS J9360
Hospital Charge Code	41652886
Hospital Revenue Code	636
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98

VINBLASTINE 10 MG INJ

Facility OP

$1.96

Service Code	HCPCS J9360
Hospital Charge Code	41652886
Hospital Revenue Code	636
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.35
Rate for Payer: Aetna Government	$3.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.56
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.32
Rate for Payer: SOMOS Essential	$5.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.27

VINBLASTINE 10 MG INJ

Facility IP

$1.96

Service Code	HCPCS J9360
Hospital Charge Code	41642886
Hospital Revenue Code	636
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98

VINBLASTINE 10 MG INJ

Facility OP

$1.96

Service Code	HCPCS J9360
Hospital Charge Code	41642886
Hospital Revenue Code	636
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.35
Rate for Payer: Aetna Government	$3.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.56
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.32
Rate for Payer: SOMOS Essential	$5.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.27

VINCRISTINE 1 MG/ML INJ 1 ML

Facility OP

$6.11

Service Code	HCPCS J9370
Hospital Charge Code	41644133
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$8.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.03
Rate for Payer: Aetna Government	$5.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.74
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.39
Rate for Payer: SOMOS Essential	$8.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.97

VINCRISTINE 1 MG/ML INJ 1 ML

Facility IP

$6.11

Service Code	HCPCS J9370
Hospital Charge Code	41654133
Hospital Revenue Code	636
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06

VINCRISTINE 1 MG/ML INJ 1 ML

Facility IP

$6.11

Service Code	HCPCS J9370
Hospital Charge Code	41644133
Hospital Revenue Code	636
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06

VINCRISTINE 1 MG/ML INJ 1 ML

Facility OP

$6.11

Service Code	HCPCS J9370
Hospital Charge Code	41654133
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$8.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.03
Rate for Payer: Aetna Government	$5.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.74
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.39
Rate for Payer: SOMOS Essential	$8.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.97

VINCRISTINE 1 MG/ML INJ 2 ML

Facility IP

$6.11

Service Code	HCPCS J9370
Hospital Charge Code	41640655
Hospital Revenue Code	636
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06

VINCRISTINE 1 MG/ML INJ 2 ML

Facility IP

$6.11

Service Code	HCPCS J9370
Hospital Charge Code	41650655
Hospital Revenue Code	636
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06

VINCRISTINE 1 MG/ML INJ 2 ML

Facility OP

$6.11

Service Code	HCPCS J9370
Hospital Charge Code	41650655
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$8.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.03
Rate for Payer: Aetna Government	$5.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.74
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.39
Rate for Payer: SOMOS Essential	$8.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.97

VINCRISTINE 1 MG/ML INJ 2 ML

Facility OP

$6.11

Service Code	HCPCS J9370
Hospital Charge Code	41640655
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$8.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.03
Rate for Payer: Aetna Government	$5.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.74
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.39
Rate for Payer: SOMOS Essential	$8.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.97

VINORELBINE 10 MG/ML INJ 1ML

Facility IP

$20.00

Service Code	HCPCS J9390
Hospital Charge Code	41644589
Hospital Revenue Code	636
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$10.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00

VINORELBINE 10 MG/ML INJ 1ML

Facility OP

$20.00

Service Code	HCPCS J9390
Hospital Charge Code	41644589
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$13.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.01
Rate for Payer: Aetna Government	$10.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.44
Rate for Payer: Group Health Inc Commercial	$10.00
Rate for Payer: Group Health Inc Medicare	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.01
Rate for Payer: SOMOS Essential	$9.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.00

VINORELBINE 10 MG/ML INJ 1ML

Facility OP

$20.00

Service Code	HCPCS J9390
Hospital Charge Code	41654589
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$13.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.01
Rate for Payer: Aetna Government	$10.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.44
Rate for Payer: Group Health Inc Commercial	$10.00
Rate for Payer: Group Health Inc Medicare	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.01
Rate for Payer: SOMOS Essential	$9.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.00

VINORELBINE 10 MG/ML INJ 1ML

Facility IP

$20.00

Service Code	HCPCS J9390
Hospital Charge Code	41654589
Hospital Revenue Code	636
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$10.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00

VINORELBINE 10 MG/ML INJ 5 ML

Facility IP

$14.82

Service Code	HCPCS J9390
Hospital Charge Code	41644335
Hospital Revenue Code	636
Min. Negotiated Rate	$7.41
Max. Negotiated Rate	$7.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.41
Rate for Payer: Hamaspik Choice Inc Medicare	$7.41

VINORELBINE 10 MG/ML INJ 5 ML

Facility IP

$14.82

Service Code	HCPCS J9390
Hospital Charge Code	41654335
Hospital Revenue Code	636
Min. Negotiated Rate	$7.41
Max. Negotiated Rate	$7.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.41
Rate for Payer: Hamaspik Choice Inc Medicare	$7.41

VINORELBINE 10 MG/ML INJ 5 ML

Facility OP

$14.82

Service Code	HCPCS J9390
Hospital Charge Code	41644335
Hospital Revenue Code	636
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$10.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.01
Rate for Payer: Aetna Government	$10.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.44
Rate for Payer: Group Health Inc Commercial	$7.41
Rate for Payer: Group Health Inc Medicare	$5.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.41
Rate for Payer: Hamaspik Choice Inc Medicare	$7.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.01
Rate for Payer: SOMOS Essential	$9.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.63

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