St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DOCETAXEL 80 MG/2 ML INJ

Facility

$9.35

Service Code	HCPCS J9171
Hospital Charge Code	41641740
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$6.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$5.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.38
Rate for Payer: Group Health Inc Commercial	$4.68
Rate for Payer: Group Health Inc Medicare	$3.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.68
Rate for Payer: Hamaspik Choice Inc Medicare	$4.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.92
Rate for Payer: SOMOS Essential	$0.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.08

DOCETAXEL 80 MG/2 ML INJ

Facility

$9.35

Service Code	HCPCS J9171
Hospital Charge Code	41651740
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$6.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$5.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.38
Rate for Payer: Group Health Inc Commercial	$4.68
Rate for Payer: Group Health Inc Medicare	$3.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.68
Rate for Payer: Hamaspik Choice Inc Medicare	$4.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.92
Rate for Payer: SOMOS Essential	$0.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.08

DOCETAXEL 80 MG/2 ML INJ

Facility

$9.35

Service Code	HCPCS J9171
Hospital Charge Code	41651740
Hospital Revenue Code	636
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$4.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.68
Rate for Payer: Hamaspik Choice Inc Medicare	$4.68

DOCETAXEL 80 MG/4ML IV CONC [108122]

Facility

$83.74

Service Code	HCPCS J9171
Hospital Charge Code	00409036701
Hospital Revenue Code	278
Min. Negotiated Rate	$41.87
Max. Negotiated Rate	$41.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.87
Rate for Payer: Hamaspik Choice Inc Medicare	$41.87

DOCETAXEL 80 MG/4ML IV CONC [108122]

Facility

$365.15

Service Code	HCPCS J9171
Hospital Charge Code	16729026764
Hospital Revenue Code	278
Min. Negotiated Rate	$182.58
Max. Negotiated Rate	$182.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.58
Rate for Payer: Hamaspik Choice Inc Medicare	$182.58

DOCETAXEL 80 MG/4ML IV CONC [108122]

Facility

$365.15

Service Code	HCPCS J9171
Hospital Charge Code	16729026764
Hospital Revenue Code	278
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$383.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$200.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$219.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$182.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$209.96
Rate for Payer: EmblemHealth Commercial	$182.58
Rate for Payer: Fidelis Medicare Advantage	$383.41
Rate for Payer: Group Health Inc Commercial	$182.58
Rate for Payer: Group Health Inc Medicare	$127.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.58
Rate for Payer: Hamaspik Choice Inc Medicare	$182.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$237.35

DOCETAXEL 80 MG/4ML IV CONC [108122]

Facility

$83.74

Service Code	HCPCS J9171
Hospital Charge Code	00409036701
Hospital Revenue Code	278
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$87.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$50.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.15
Rate for Payer: EmblemHealth Commercial	$41.87
Rate for Payer: Fidelis Medicare Advantage	$87.93
Rate for Payer: Group Health Inc Commercial	$41.87
Rate for Payer: Group Health Inc Medicare	$29.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.87
Rate for Payer: Hamaspik Choice Inc Medicare	$41.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$54.43

DOCETAXEL 80 MG/4ML IV CONC [108122]

Facility

$240.00

Service Code	HCPCS J9171
Hospital Charge Code	45963076552
Hospital Revenue Code	278
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$252.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$144.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$138.00
Rate for Payer: EmblemHealth Commercial	$120.00
Rate for Payer: Fidelis Medicare Advantage	$252.00
Rate for Payer: Group Health Inc Commercial	$120.00
Rate for Payer: Group Health Inc Medicare	$84.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.00
Rate for Payer: Hamaspik Choice Inc Medicare	$120.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$156.00

DOCETAXEL 80 MG/4ML IV CONC [108122]

Facility

$240.00

Service Code	HCPCS J9171
Hospital Charge Code	45963076552
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.00
Rate for Payer: Hamaspik Choice Inc Medicare	$120.00

DOCETAXEL 80 MG/8ML IV SOLN [108907]

Facility

$41.25

Service Code	HCPCS J9171
Hospital Charge Code	67457053208
Hospital Revenue Code	278
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$20.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.62
Rate for Payer: Hamaspik Choice Inc Medicare	$20.62

DOCETAXEL 80 MG/8ML IV SOLN [108907]

Facility

$41.25

Service Code	HCPCS J9171
Hospital Charge Code	67457053208
Hospital Revenue Code	278
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$43.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$24.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.72
Rate for Payer: EmblemHealth Commercial	$20.62
Rate for Payer: Fidelis Medicare Advantage	$43.31
Rate for Payer: Group Health Inc Commercial	$20.62
Rate for Payer: Group Health Inc Medicare	$14.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.62
Rate for Payer: Hamaspik Choice Inc Medicare	$20.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.81

DOC PT UNABLE COMM

Facility

$0.01

Service Code	HCPCS G2183
Hospital Charge Code	30300311
Hospital Revenue Code	929
Max. Negotiated Rate	$94.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$94.00

DOCUM OF VIRAL LOAD => 200COPIES

Facility

$0.01

Service Code	HCPCS G9242
Hospital Charge Code	30300370
Hospital Revenue Code	969
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

DOCUM OF VIRAL LOAD > 200 COPIES

Facility

$0.01

Service Code	HCPCS G9243
Hospital Charge Code	30300371
Hospital Revenue Code	969
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

DOCUSATE SODIUM 100 MG/10 ML LIQ

Facility

$0.62

Hospital Charge Code	41643359
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.42
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.40

DOCUSATE SODIUM 100 MG/10 ML LIQ

Facility

$0.62

Hospital Charge Code	41653359
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.42
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.40

DOCUSATE SODIUM 100 MG/10ML PO LIQD [182753]

Facility

$0.14

Service Code	NDC 00904727966
Hospital Charge Code	00904727966
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

DOCUSATE SODIUM 100 MG/10ML PO LIQD [182753]

Facility

$0.22

Service Code	NDC 00121187010
Hospital Charge Code	00121187010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

DOCUSATE SODIUM 100MG/25ML UD LIQ

Facility

$1.00

Hospital Charge Code	41647038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

DOCUSATE SODIUM 100MG/25ML UD LIQ

Facility

$1.00

Hospital Charge Code	41657038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

DOCUSATE SODIUM 100 MG CAP

Facility

$1.00

Hospital Charge Code	41640034
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

DOCUSATE SODIUM 100 MG CAP

Facility

$1.00

Hospital Charge Code	41650034
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

DOCUSATE SODIUM 100 MG PO CAPS [2566]

Facility

$0.02

Service Code	NDC 00904699880
Hospital Charge Code	00904699880
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

DOCUSATE SODIUM 100 MG PO CAPS [2566]

Facility

$0.06

Service Code	NDC 00904718361
Hospital Charge Code	00904718361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

DOCUSATE SODIUM 100 MG PO CAPS [2566]

Facility

$0.22

Service Code	NDC 60687012901
Hospital Charge Code	60687012901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

Know your out-of-pocket cost for care.

All Charges