St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR [26371]

Facility

$1.74

Service Code	NDC 51079092320
Hospital Charge Code	51079092320
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.87
Rate for Payer: Aetna Government	$0.87
Rate for Payer: Brighton Health Commercial	$1.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.18
Rate for Payer: Group Health Inc Commercial	$0.87
Rate for Payer: Group Health Inc Medicare	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87
Rate for Payer: Hamaspik Choice Inc Medicare	$0.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.13

CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR [26371]

Facility

$1.81

Service Code	NDC 62756045788
Hospital Charge Code	62756045788
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.90
Rate for Payer: Aetna Government	$0.90
Rate for Payer: Brighton Health Commercial	$1.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.23
Rate for Payer: Group Health Inc Commercial	$0.90
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.17

CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR [26371]

Facility

$1.74

Service Code	NDC 51079092301
Hospital Charge Code	51079092301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.87
Rate for Payer: Aetna Government	$0.87
Rate for Payer: Brighton Health Commercial	$1.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.18
Rate for Payer: Group Health Inc Commercial	$0.87
Rate for Payer: Group Health Inc Medicare	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87
Rate for Payer: Hamaspik Choice Inc Medicare	$0.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.13

CARBON ROD 300MM

Facility

$1,066.00

Service Code	HCPCS C1713
Hospital Charge Code	40201236
Hospital Revenue Code	278
Min. Negotiated Rate	$533.00
Max. Negotiated Rate	$533.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$533.00
Rate for Payer: Hamaspik Choice Inc Medicare	$533.00

CARBON ROD 300MM

Facility

$1,066.00

Service Code	HCPCS C1713
Hospital Charge Code	40201236
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,119.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$586.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$639.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$533.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.95
Rate for Payer: EmblemHealth Commercial	$533.00
Rate for Payer: Fidelis Medicare Advantage	$1,119.30
Rate for Payer: Group Health Inc Commercial	$533.00
Rate for Payer: Group Health Inc Medicare	$373.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$533.00
Rate for Payer: Hamaspik Choice Inc Medicare	$533.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$692.90

CARBOPLATIN 10 MG/ML INJ 15 ML

Facility

$4.07

Service Code	HCPCS J9045
Hospital Charge Code	41643725
Hospital Revenue Code	636
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$3.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$2.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.34
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.95
Rate for Payer: SOMOS Essential	$3.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.65

CARBOPLATIN 10 MG/ML INJ 15 ML

Facility

$4.07

Service Code	HCPCS J9045
Hospital Charge Code	41653725
Hospital Revenue Code	636
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$3.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$2.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.34
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.95
Rate for Payer: SOMOS Essential	$3.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.65

CARBOPLATIN 10 MG/ML INJ 15 ML

Facility

$4.07

Service Code	HCPCS J9045
Hospital Charge Code	41653725
Hospital Revenue Code	636
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04

CARBOPLATIN 10 MG/ML INJ 15 ML

Facility

$4.07

Service Code	HCPCS J9045
Hospital Charge Code	41643725
Hospital Revenue Code	636
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04

CARBOPLATIN 10 MG/ML INJ 45 ML

Facility

$6.24

Service Code	HCPCS J9045
Hospital Charge Code	41654417
Hospital Revenue Code	636
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$4.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$3.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.59
Rate for Payer: Group Health Inc Commercial	$3.12
Rate for Payer: Group Health Inc Medicare	$2.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.95
Rate for Payer: SOMOS Essential	$3.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.06

CARBOPLATIN 10 MG/ML INJ 45 ML

Facility

$6.24

Service Code	HCPCS J9045
Hospital Charge Code	41644417
Hospital Revenue Code	636
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$4.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$3.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.59
Rate for Payer: Group Health Inc Commercial	$3.12
Rate for Payer: Group Health Inc Medicare	$2.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.95
Rate for Payer: SOMOS Essential	$3.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.06

CARBOPLATIN 10 MG/ML INJ 45 ML

Facility

$6.24

Service Code	HCPCS J9045
Hospital Charge Code	41644417
Hospital Revenue Code	636
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12

CARBOPLATIN 10 MG/ML INJ 45 ML

Facility

$6.24

Service Code	HCPCS J9045
Hospital Charge Code	41654417
Hospital Revenue Code	636
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12

CARBOPLATIN 10 MG/ML INJ 5 ML

Facility

$6.78

Service Code	HCPCS J9045
Hospital Charge Code	41643724
Hospital Revenue Code	636
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$3.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.39
Rate for Payer: Hamaspik Choice Inc Medicare	$3.39

CARBOPLATIN 10 MG/ML INJ 5 ML

Facility

$6.78

Service Code	HCPCS J9045
Hospital Charge Code	41653724
Hospital Revenue Code	636
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$3.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.39
Rate for Payer: Hamaspik Choice Inc Medicare	$3.39

CARBOPLATIN 10 MG/ML INJ 5 ML

Facility

$6.78

Service Code	HCPCS J9045
Hospital Charge Code	41653724
Hospital Revenue Code	636
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$4.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$4.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.90
Rate for Payer: Group Health Inc Commercial	$3.39
Rate for Payer: Group Health Inc Medicare	$2.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.39
Rate for Payer: Hamaspik Choice Inc Medicare	$3.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.95
Rate for Payer: SOMOS Essential	$3.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.41

CARBOPLATIN 10 MG/ML INJ 5 ML

Facility

$6.78

Service Code	HCPCS J9045
Hospital Charge Code	41643724
Hospital Revenue Code	636
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$4.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$4.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.90
Rate for Payer: Group Health Inc Commercial	$3.39
Rate for Payer: Group Health Inc Medicare	$2.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.39
Rate for Payer: Hamaspik Choice Inc Medicare	$3.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.95
Rate for Payer: SOMOS Essential	$3.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.41

CARBOPLATIN 150 MG/15ML IV SOLN [39266]

Facility

$1.83

Service Code	HCPCS J9045
Hospital Charge Code	16729029533
Hospital Revenue Code	278
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.92
Rate for Payer: Hamaspik Choice Inc Medicare	$0.92

CARBOPLATIN 150 MG/15ML IV SOLN [39266]

Facility

$1.86

Service Code	HCPCS J9045
Hospital Charge Code	61703033922
Hospital Revenue Code	278
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$0.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.93
Rate for Payer: Hamaspik Choice Inc Medicare	$0.93

CARBOPLATIN 150 MG/15ML IV SOLN [39266]

Facility

$1.83

Service Code	HCPCS J9045
Hospital Charge Code	16729029533
Hospital Revenue Code	278
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$2.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$1.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.05
Rate for Payer: EmblemHealth Commercial	$0.92
Rate for Payer: Fidelis Medicare Advantage	$1.92
Rate for Payer: Group Health Inc Commercial	$0.92
Rate for Payer: Group Health Inc Medicare	$0.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.92
Rate for Payer: Hamaspik Choice Inc Medicare	$0.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.19

CARBOPLATIN 150 MG/15ML IV SOLN [39266]

Facility

$1.86

Service Code	HCPCS J9045
Hospital Charge Code	61703033922
Hospital Revenue Code	278
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$1.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.07
Rate for Payer: EmblemHealth Commercial	$0.93
Rate for Payer: Fidelis Medicare Advantage	$1.95
Rate for Payer: Group Health Inc Commercial	$0.93
Rate for Payer: Group Health Inc Medicare	$0.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.93
Rate for Payer: Hamaspik Choice Inc Medicare	$0.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.21

CARBOPLATIN 450 MG/45ML IV SOLN [39267]

Facility

$1.26

Service Code	HCPCS J9045
Hospital Charge Code	61703033950
Hospital Revenue Code	278
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$2.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.72
Rate for Payer: EmblemHealth Commercial	$0.63
Rate for Payer: Fidelis Medicare Advantage	$1.32
Rate for Payer: Group Health Inc Commercial	$0.63
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.82

CARBOPLATIN 450 MG/45ML IV SOLN [39267]

Facility

$1.14

Service Code	HCPCS J9045
Hospital Charge Code	55150033501
Hospital Revenue Code	278
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$2.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.66
Rate for Payer: EmblemHealth Commercial	$0.57
Rate for Payer: Fidelis Medicare Advantage	$1.20
Rate for Payer: Group Health Inc Commercial	$0.57
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57
Rate for Payer: Hamaspik Choice Inc Medicare	$0.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.74

CARBOPLATIN 450 MG/45ML IV SOLN [39267]

Facility

$1.26

Service Code	HCPCS J9045
Hospital Charge Code	61703033950
Hospital Revenue Code	278
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63

CARBOPLATIN 450 MG/45ML IV SOLN [39267]

Facility

$1.14

Service Code	HCPCS J9045
Hospital Charge Code	55150033501
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57
Rate for Payer: Hamaspik Choice Inc Medicare	$0.57

Know your out-of-pocket cost for care.

All Charges