St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GRAM STAIN

Facility

$10.68

Service Code	HCPCS 87205
Hospital Charge Code	40614225
Hospital Revenue Code	306
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$8.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.27
Rate for Payer: Aetna Government	$4.27
Rate for Payer: Affinity Essential Plan 1&2	$2.99
Rate for Payer: Affinity Essential Plan 3&4	$2.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.99
Rate for Payer: Brighton Health Commercial	$8.01
Rate for Payer: Cash Price	$4.27
Rate for Payer: Cash Price	$4.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.74
Rate for Payer: Elderplan Medicare Advantage	$4.27
Rate for Payer: EmblemHealth Commercial	$4.27
Rate for Payer: Fidelis Essential Plan Aliesa	$3.63
Rate for Payer: Fidelis Essential Plan QHP	$3.80
Rate for Payer: Fidelis Medicare Advantage	$4.27
Rate for Payer: Fidelis Qualified Health Plan	$3.80
Rate for Payer: Group Health Inc Commercial	$4.27
Rate for Payer: Group Health Inc Medicare	$4.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.34
Rate for Payer: Hamaspik Choice Inc Medicare	$4.27
Rate for Payer: Healthfirst Medicare Advantage	$4.27
Rate for Payer: Healthfirst QHP	$4.27
Rate for Payer: Humana Medicare	$4.36
Rate for Payer: Senior Whole Health Medicare Advantage	$4.27
Rate for Payer: United Healthcare Commercial	$5.41
Rate for Payer: United Healthcare Medicare Advantage	$4.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.42
Rate for Payer: Wellcare Medicare	$3.84

GRAM STAIN

Facility

$10.68

Service Code	HCPCS 87205
Hospital Charge Code	40614225
Hospital Revenue Code	306
Rate for Payer: Cash Price	$4.27

GRANISETRON 1000 MCG/ML INJ

Facility

$1.91

Service Code	HCPCS J1626
Hospital Charge Code	41642766
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

GRANISETRON 1000 MCG/ML INJ

Facility

$1.91

Service Code	HCPCS J1626
Hospital Charge Code	41642766
Hospital Revenue Code	636
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$1.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
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	$0.35
Rate for Payer: SOMOS Essential	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.24

GRANISETRON 1000 MCG/ML INJ

Facility

$1.91

Service Code	HCPCS J1626
Hospital Charge Code	41652766
Hospital Revenue Code	636
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$1.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
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	$0.35
Rate for Payer: SOMOS Essential	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.24

GRANISETRON 1000 MCG/ML INJ

Facility

$1.91

Service Code	HCPCS J1626
Hospital Charge Code	41652766
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

GRANISETRON 1 MG TAB

Facility

$52.78

Service Code	HCPCS Q0166
Hospital Charge Code	41655005
Hospital Revenue Code	636
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$34.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.98
Rate for Payer: Aetna Government	$2.98
Rate for Payer: Brighton Health Commercial	$31.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.35
Rate for Payer: Group Health Inc Commercial	$26.39
Rate for Payer: Group Health Inc Medicare	$18.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.39
Rate for Payer: Hamaspik Choice Inc Medicare	$26.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.31

GRANISETRON 1 MG TAB

Facility

$52.78

Service Code	HCPCS Q0166
Hospital Charge Code	41645005
Hospital Revenue Code	636
Min. Negotiated Rate	$26.39
Max. Negotiated Rate	$26.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.39
Rate for Payer: Hamaspik Choice Inc Medicare	$26.39

GRANISETRON 1 MG TAB

Facility

$52.78

Service Code	HCPCS Q0166
Hospital Charge Code	41645005
Hospital Revenue Code	636
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$34.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.98
Rate for Payer: Aetna Government	$2.98
Rate for Payer: Brighton Health Commercial	$31.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.35
Rate for Payer: Group Health Inc Commercial	$26.39
Rate for Payer: Group Health Inc Medicare	$18.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.39
Rate for Payer: Hamaspik Choice Inc Medicare	$26.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.31

GRANISETRON 1 MG TAB

Facility

$52.78

Service Code	HCPCS Q0166
Hospital Charge Code	41655005
Hospital Revenue Code	636
Min. Negotiated Rate	$26.39
Max. Negotiated Rate	$26.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.39
Rate for Payer: Hamaspik Choice Inc Medicare	$26.39

GRANISETRON HCL 1 MG/ML IV SOLN [12552]

Facility

$24.00

Service Code	HCPCS J1626
Hospital Charge Code	63323031801
Hospital Revenue Code	278
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$25.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$14.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.80
Rate for Payer: EmblemHealth Commercial	$12.00
Rate for Payer: Fidelis Medicare Advantage	$25.20
Rate for Payer: Group Health Inc Commercial	$12.00
Rate for Payer: Group Health Inc Medicare	$8.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.00
Rate for Payer: Hamaspik Choice Inc Medicare	$12.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.60

GRANISETRON HCL 1 MG/ML IV SOLN [12552]

Facility

$10.80

Service Code	HCPCS J1626
Hospital Charge Code	00143974410
Hospital Revenue Code	278
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.40
Rate for Payer: Hamaspik Choice Inc Medicare	$5.40

GRANISETRON HCL 1 MG/ML IV SOLN [12552]

Facility

$23.58

Service Code	HCPCS J1626
Hospital Charge Code	17478054602
Hospital Revenue Code	278
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$11.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.79
Rate for Payer: Hamaspik Choice Inc Medicare	$11.79

GRANISETRON HCL 1 MG/ML IV SOLN [12552]

Facility

$10.80

Service Code	HCPCS J1626
Hospital Charge Code	00143974410
Hospital Revenue Code	278
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$11.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$6.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.21
Rate for Payer: EmblemHealth Commercial	$5.40
Rate for Payer: Fidelis Medicare Advantage	$11.34
Rate for Payer: Group Health Inc Commercial	$5.40
Rate for Payer: Group Health Inc Medicare	$3.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.40
Rate for Payer: Hamaspik Choice Inc Medicare	$5.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.02

GRANISETRON HCL 1 MG/ML IV SOLN [12552]

Facility

$23.58

Service Code	HCPCS J1626
Hospital Charge Code	17478054602
Hospital Revenue Code	278
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$24.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$14.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.56
Rate for Payer: EmblemHealth Commercial	$11.79
Rate for Payer: Fidelis Medicare Advantage	$24.76
Rate for Payer: Group Health Inc Commercial	$11.79
Rate for Payer: Group Health Inc Medicare	$8.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.79
Rate for Payer: Hamaspik Choice Inc Medicare	$11.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.33

GRANISETRON HCL 1 MG/ML IV SOLN [12552]

Facility

$12.00

Service Code	HCPCS J1626
Hospital Charge Code	67457086301
Hospital Revenue Code	278
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

GRANISETRON HCL 1 MG/ML IV SOLN [12552]

Facility

$12.00

Service Code	HCPCS J1626
Hospital Charge Code	67457086301
Hospital Revenue Code	278
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$12.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
Rate for Payer: EmblemHealth Commercial	$6.00
Rate for Payer: Fidelis Medicare Advantage	$12.60
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

GRANISETRON HCL 1 MG/ML IV SOLN [12552]

Facility

$24.00

Service Code	HCPCS J1626
Hospital Charge Code	63323031801
Hospital Revenue Code	278
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.00
Rate for Payer: Hamaspik Choice Inc Medicare	$12.00

GRANISETRON HCL 1 MG PO TABS [14720]

Facility

$59.05

Service Code	HCPCS Q0166
Hospital Charge Code	51991073599
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$47.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.98
Rate for Payer: Aetna Government	$2.98
Rate for Payer: Brighton Health Commercial	$44.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.16
Rate for Payer: Group Health Inc Commercial	$29.53
Rate for Payer: Group Health Inc Medicare	$20.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.53
Rate for Payer: Hamaspik Choice Inc Medicare	$29.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.39

GRANISETRON HCL 1 MG PO TABS [14720]

Facility

$59.05

Service Code	HCPCS Q0166
Hospital Charge Code	51991073520
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$47.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.98
Rate for Payer: Aetna Government	$2.98
Rate for Payer: Brighton Health Commercial	$44.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.16
Rate for Payer: Group Health Inc Commercial	$29.53
Rate for Payer: Group Health Inc Medicare	$20.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.53
Rate for Payer: Hamaspik Choice Inc Medicare	$29.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.39

GRANISETRON HCL 4 MG/4ML IV SOLN [92107]

Facility

$10.80

Service Code	HCPCS J1626
Hospital Charge Code	00143974501
Hospital Revenue Code	278
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.40
Rate for Payer: Hamaspik Choice Inc Medicare	$5.40

GRANISETRON HCL 4 MG/4ML IV SOLN [92107]

Facility

$10.80

Service Code	HCPCS J1626
Hospital Charge Code	00143974501
Hospital Revenue Code	278
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$11.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$6.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.21
Rate for Payer: EmblemHealth Commercial	$5.40
Rate for Payer: Fidelis Medicare Advantage	$11.34
Rate for Payer: Group Health Inc Commercial	$5.40
Rate for Payer: Group Health Inc Medicare	$3.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.40
Rate for Payer: Hamaspik Choice Inc Medicare	$5.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.02

GRANULES 20.0CC (2-4MM)

Facility

$10,186.00

Service Code	HCPCS C9359
Hospital Charge Code	40005113
Hospital Revenue Code	278
Min. Negotiated Rate	$5,093.00
Max. Negotiated Rate	$5,093.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,093.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,093.00

GRANULES 20.0CC (2-4MM)

Facility

$10,186.00

Service Code	HCPCS C9359
Hospital Charge Code	40005113
Hospital Revenue Code	278
Min. Negotiated Rate	$100.05
Max. Negotiated Rate	$10,695.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,602.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$100.05
Rate for Payer: Aetna Government	$100.05
Rate for Payer: Brighton Health Commercial	$6,111.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,093.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,856.95
Rate for Payer: EmblemHealth Commercial	$5,093.00
Rate for Payer: Fidelis Medicare Advantage	$10,695.30
Rate for Payer: Group Health Inc Commercial	$5,093.00
Rate for Payer: Group Health Inc Medicare	$3,565.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,093.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,093.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,620.90

GRANULES 20.0CC 2-4MM

Facility

$7,206.50

Service Code	HCPCS C1713
Hospital Charge Code	64905387
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,566.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,963.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,323.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,603.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,143.74
Rate for Payer: EmblemHealth Commercial	$3,603.25
Rate for Payer: Fidelis Medicare Advantage	$7,566.82
Rate for Payer: Group Health Inc Commercial	$3,603.25
Rate for Payer: Group Health Inc Medicare	$2,522.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,603.25
Rate for Payer: Hamaspik Choice Inc Medicare	$3,603.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,684.22

Know your out-of-pocket cost for care.

All Charges