St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CISPLATIN 100 MG/100ML IV SOLN [88377]

Facility

$0.43

Service Code	HCPCS J9060
Hospital Charge Code	16729028838
Hospital Revenue Code	278
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22

CISPLATIN 100 MG/100ML IV SOLN [88377]

Facility

$0.49

Service Code	HCPCS J9060
Hospital Charge Code	63323010365
Hospital Revenue Code	278
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25

CISPLATIN 100 MG INJ

Facility

$1.92

Service Code	HCPCS J9060
Hospital Charge Code	41652873
Hospital Revenue Code	636
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.96
Rate for Payer: Hamaspik Choice Inc Medicare	$0.96

CISPLATIN 100 MG INJ

Facility

$1.92

Service Code	HCPCS J9060
Hospital Charge Code	41652873
Hospital Revenue Code	636
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$3.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$1.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.10
Rate for Payer: Group Health Inc Commercial	$0.96
Rate for Payer: Group Health Inc Medicare	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.96
Rate for Payer: Hamaspik Choice Inc Medicare	$0.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.47
Rate for Payer: SOMOS Essential	$3.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.25

CISPLATIN 100 MG INJ

Facility

$1.92

Service Code	HCPCS J9060
Hospital Charge Code	41642873
Hospital Revenue Code	636
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$3.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$1.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.10
Rate for Payer: Group Health Inc Commercial	$0.96
Rate for Payer: Group Health Inc Medicare	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.96
Rate for Payer: Hamaspik Choice Inc Medicare	$0.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.47
Rate for Payer: SOMOS Essential	$3.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.25

CISPLATIN 100 MG INJ

Facility

$1.92

Service Code	HCPCS J9060
Hospital Charge Code	41642873
Hospital Revenue Code	636
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.96
Rate for Payer: Hamaspik Choice Inc Medicare	$0.96

CISPLATIN 200 MG/200ML IV SOLN [88378]

Facility

$0.49

Service Code	HCPCS J9060
Hospital Charge Code	63323010364
Hospital Revenue Code	278
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25

CISPLATIN 200 MG/200ML IV SOLN [88378]

Facility

$0.49

Service Code	HCPCS J9060
Hospital Charge Code	63323010364
Hospital Revenue Code	278
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$1.77
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	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.28
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Fidelis Medicare Advantage	$0.52
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

CISPLATIN 50 MG/50ML IV SOLN [88376]

Facility

$0.37

Service Code	HCPCS J9060
Hospital Charge Code	00143950401
Hospital Revenue Code	278
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$1.77
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	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: EmblemHealth Commercial	$0.18
Rate for Payer: Fidelis Medicare Advantage	$0.39
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.24

CISPLATIN 50 MG/50ML IV SOLN [88376]

Facility

$0.45

Service Code	HCPCS J9060
Hospital Charge Code	16729028811
Hospital Revenue Code	278
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

CISPLATIN 50 MG/50ML IV SOLN [88376]

Facility

$0.49

Service Code	HCPCS J9060
Hospital Charge Code	63323010351
Hospital Revenue Code	278
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25

CISPLATIN 50 MG/50ML IV SOLN [88376]

Facility

$0.45

Service Code	HCPCS J9060
Hospital Charge Code	16729028811
Hospital Revenue Code	278
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$1.77
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	$0.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.26
Rate for Payer: EmblemHealth Commercial	$0.23
Rate for Payer: Fidelis Medicare Advantage	$0.47
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

CISPLATIN 50 MG/50ML IV SOLN [88376]

Facility

$0.49

Service Code	HCPCS J9060
Hospital Charge Code	63323010351
Hospital Revenue Code	278
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$1.77
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	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.28
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Fidelis Medicare Advantage	$0.52
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

CISPLATIN 50 MG/50ML IV SOLN [88376]

Facility

$0.37

Service Code	HCPCS J9060
Hospital Charge Code	00143950401
Hospital Revenue Code	278
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18

CISPLATIN 50 MG INJ

Facility

$3.89

Service Code	HCPCS J9060
Hospital Charge Code	41642872
Hospital Revenue Code	636
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$3.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$2.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.24
Rate for Payer: Group Health Inc Commercial	$1.94
Rate for Payer: Group Health Inc Medicare	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.47
Rate for Payer: SOMOS Essential	$3.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.53

CISPLATIN 50 MG INJ

Facility

$3.89

Service Code	HCPCS J9060
Hospital Charge Code	41652872
Hospital Revenue Code	636
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$3.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.77
Rate for Payer: Aetna Government	$1.77
Rate for Payer: Brighton Health Commercial	$2.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.24
Rate for Payer: Group Health Inc Commercial	$1.94
Rate for Payer: Group Health Inc Medicare	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.47
Rate for Payer: SOMOS Essential	$3.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.53

CISPLATIN 50 MG INJ

Facility

$3.89

Service Code	HCPCS J9060
Hospital Charge Code	41642872
Hospital Revenue Code	636
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$1.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1.94

CISPLATIN 50 MG INJ

Facility

$3.89

Service Code	HCPCS J9060
Hospital Charge Code	41652872
Hospital Revenue Code	636
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$1.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1.94

CITALOPRAM 10 MG TAB

Facility

$0.10

Hospital Charge Code	41644080
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

CITALOPRAM 10 MG TAB

Facility

$0.10

Hospital Charge Code	41654080
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

CITALOPRAM 20 MG TAB

Facility

$0.03

Hospital Charge Code	41644071
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

CITALOPRAM 20 MG TAB

Facility

$0.03

Hospital Charge Code	41654071
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

CITALOPRAM 40 MG TAB

Facility

$16.00

Hospital Charge Code	41644072
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$12.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Brighton Health Commercial	$12.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.88
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

CITALOPRAM 40 MG TAB

Facility

$16.00

Hospital Charge Code	41654072
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$12.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Brighton Health Commercial	$12.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.88
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

CITALOPRAM HYDROBROMIDE 10 MG PO TABS [30264]

Facility

$2.43

Service Code	NDC 00904608461
Hospital Charge Code	00904608461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.21
Rate for Payer: Aetna Government	$1.21
Rate for Payer: Brighton Health Commercial	$1.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.65
Rate for Payer: Group Health Inc Commercial	$1.21
Rate for Payer: Group Health Inc Medicare	$0.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.21
Rate for Payer: Hamaspik Choice Inc Medicare	$1.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.58

Know your out-of-pocket cost for care.

All Charges