St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SODIUM HYPOCHLORITE 0.125 % EX SOLN

Facility

$0.04

Service Code	NDC 3932806412
Hospital Charge Code	3932806412
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

SODIUM HYPOCHLORITE 0.125 % EX SOLN

Facility

$0.04

Service Code	NDC 3932806412
Hospital Charge Code	3932806412
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
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	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$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

SODIUM HYPOCHLORITE 0.25 % EX SOLN

Facility

$0.03

Service Code	NDC 0436093616
Hospital Charge Code	0436093616
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	$0.01
Rate for Payer: Aetna Government	$0.01
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: EmblemHealth Commercial	$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	$0.02

SODIUM HYPOCHLORITE 0.25 % EX SOLN

Facility

$0.04

Service Code	NDC 3932806325
Hospital Charge Code	3932806325
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

SODIUM HYPOCHLORITE 0.25 % EX SOLN

Facility

$0.03

Service Code	NDC 0436093616
Hospital Charge Code	0436093616
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

SODIUM HYPOCHLORITE 0.25 % EX SOLN

Facility

$0.04

Service Code	NDC 3932806325
Hospital Charge Code	3932806325
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
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	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$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

SODIUM NITRITE 30 MG/ML IV SOLN

Facility

$11.60

Service Code	NDC 6026731110
Hospital Charge Code	6026731110
Hospital Revenue Code	258
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$5.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.80

SODIUM NITRITE 30 MG/ML IV SOLN

Facility

$11.60

Service Code	NDC 6026731110
Hospital Charge Code	6026731110
Hospital Revenue Code	258
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$9.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.80
Rate for Payer: Aetna Government	$5.80
Rate for Payer: Brighton Health Commercial	$8.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.89
Rate for Payer: EmblemHealth Commercial	$5.80
Rate for Payer: Group Health Inc Commercial	$5.80
Rate for Payer: Group Health Inc Medicare	$4.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.80
Rate for Payer: Hamaspik Choice Inc Medicare	$5.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.54

SODIUM PERTECHNETATE TC 99M INJECTION

Facility

$4.20

Service Code	HCPCS A9512
Hospital Charge Code	9999408445
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10

SODIUM PERTECHNETATE TC 99M INJECTION

Facility

$4.20

Service Code	HCPCS A9512
Hospital Charge Code	9999408445
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$3.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.32
Rate for Payer: Aetna Government	$1.32
Rate for Payer: Brighton Health Commercial	$3.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.86
Rate for Payer: EmblemHealth Commercial	$2.10
Rate for Payer: Group Health Inc Commercial	$2.10
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.73

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED)

Facility

$2.89

Service Code	NDC 6332388101
Hospital Charge Code	6332388101
Hospital Revenue Code	258
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.45
Rate for Payer: Aetna Government	$1.45
Rate for Payer: Brighton Health Commercial	$2.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.97
Rate for Payer: EmblemHealth Commercial	$1.45
Rate for Payer: Group Health Inc Commercial	$1.45
Rate for Payer: Group Health Inc Medicare	$1.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.88

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED)

Facility

$2.89

Service Code	NDC 6332388101
Hospital Charge Code	6332388101
Hospital Revenue Code	258
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED)

Facility

$1.46

Service Code	NDC 0409739182
Hospital Charge Code	0409739182
Hospital Revenue Code	258
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.73
Rate for Payer: Aetna Government	$0.73
Rate for Payer: Brighton Health Commercial	$1.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.99
Rate for Payer: EmblemHealth Commercial	$0.73
Rate for Payer: Group Health Inc Commercial	$0.73
Rate for Payer: Group Health Inc Medicare	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73
Rate for Payer: Hamaspik Choice Inc Medicare	$0.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.95

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED)

Facility

$1.46

Service Code	NDC 0409739182
Hospital Charge Code	0409739182
Hospital Revenue Code	258
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED)

Facility

$1.46

Service Code	NDC 0409739172
Hospital Charge Code	0409739172
Hospital Revenue Code	258
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.73
Rate for Payer: Aetna Government	$0.73
Rate for Payer: Brighton Health Commercial	$1.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.99
Rate for Payer: EmblemHealth Commercial	$0.73
Rate for Payer: Group Health Inc Commercial	$0.73
Rate for Payer: Group Health Inc Medicare	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73
Rate for Payer: Hamaspik Choice Inc Medicare	$0.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.95

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED)

Facility

$1.46

Service Code	NDC 0409739172
Hospital Charge Code	0409739172
Hospital Revenue Code	258
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED)

Facility

$3.87

Service Code	NDC 6332317005
Hospital Charge Code	6332317005
Hospital Revenue Code	258
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$1.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.94

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED)

Facility

$3.87

Service Code	NDC 6332317005
Hospital Charge Code	6332317005
Hospital Revenue Code	258
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$3.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.94
Rate for Payer: Aetna Government	$1.94
Rate for Payer: Brighton Health Commercial	$2.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.63
Rate for Payer: EmblemHealth Commercial	$1.94
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.52

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED)

Facility

$4.09

Service Code	NDC 6332388406
Hospital Charge Code	6332388406
Hospital Revenue Code	258
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED)

Facility

$4.09

Service Code	NDC 6332388401
Hospital Charge Code	6332388401
Hospital Revenue Code	258
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.04
Rate for Payer: Aetna Government	$2.04
Rate for Payer: Brighton Health Commercial	$3.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.78
Rate for Payer: EmblemHealth Commercial	$2.04
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.66

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED)

Facility

$4.09

Service Code	NDC 6332388406
Hospital Charge Code	6332388406
Hospital Revenue Code	258
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.04
Rate for Payer: Aetna Government	$2.04
Rate for Payer: Brighton Health Commercial	$3.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.78
Rate for Payer: EmblemHealth Commercial	$2.04
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.66

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED)

Facility

$4.09

Service Code	NDC 6332388401
Hospital Charge Code	6332388401
Hospital Revenue Code	258
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04

SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP

Facility

$0.52

Service Code	NDC 4628700660
Hospital Charge Code	4628700660
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26

SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP

Facility

$0.52

Service Code	NDC 4628700660
Hospital Charge Code	4628700660
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: EmblemHealth Commercial	$0.26
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

SODIUM POLYSTYRENE SULFONATE PO POWD

Facility

$0.90

Service Code	NDC 1070203615
Hospital Charge Code	1070203615
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45

Know your out-of-pocket cost for care.

All Charges