St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

SODIUM TETRADECYL SULFATE 1 % IV SOLN

Facility

$46.88

Service Code	NDC 6745716200
Hospital Charge Code	6745716200
Hospital Revenue Code	258
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$23.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.44

SODIUM TETRADECYL SULFATE 1 % IV SOLN

Facility

$46.88

Service Code	NDC 6745716202
Hospital Charge Code	6745716202
Hospital Revenue Code	258
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$23.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.44

SODIUM TETRADECYL SULFATE 1 % IV SOLN

Facility

$46.88

Service Code	NDC 6745716202
Hospital Charge Code	6745716202
Hospital Revenue Code	258
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$37.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.44
Rate for Payer: Aetna Government	$23.44
Rate for Payer: Brighton Health Commercial	$35.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.88
Rate for Payer: EmblemHealth Commercial	$23.44
Rate for Payer: Group Health Inc Commercial	$23.44
Rate for Payer: Group Health Inc Medicare	$16.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.44
Rate for Payer: Hamaspik Choice Inc Medicare	$23.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.47

SODIUM TETRADECYL SULFATE 1 % IV SOLN

Facility

$46.88

Service Code	NDC 6745716200
Hospital Charge Code	6745716200
Hospital Revenue Code	258
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$37.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.44
Rate for Payer: Aetna Government	$23.44
Rate for Payer: Brighton Health Commercial	$35.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.88
Rate for Payer: EmblemHealth Commercial	$23.44
Rate for Payer: Group Health Inc Commercial	$23.44
Rate for Payer: Group Health Inc Medicare	$16.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.44
Rate for Payer: Hamaspik Choice Inc Medicare	$23.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.47

SODIUM TETRADECYL SULFATE 3 % IV SOLN

Facility

$46.88

Service Code	NDC 6745716302
Hospital Charge Code	6745716302
Hospital Revenue Code	258
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$37.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.44
Rate for Payer: Aetna Government	$23.44
Rate for Payer: Brighton Health Commercial	$35.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.88
Rate for Payer: EmblemHealth Commercial	$23.44
Rate for Payer: Group Health Inc Commercial	$23.44
Rate for Payer: Group Health Inc Medicare	$16.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.44
Rate for Payer: Hamaspik Choice Inc Medicare	$23.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.47

SODIUM TETRADECYL SULFATE 3 % IV SOLN

Facility

$46.88

Service Code	NDC 6745716302
Hospital Charge Code	6745716302
Hospital Revenue Code	258
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$23.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.44

SODIUM THIOSULFATE 250 MG/ML IV SOLN

Facility

$2.32

Service Code	NDC 6026770550
Hospital Charge Code	6026770550
Hospital Revenue Code	258
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.16
Rate for Payer: Aetna Government	$1.16
Rate for Payer: Brighton Health Commercial	$1.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.58
Rate for Payer: EmblemHealth Commercial	$1.16
Rate for Payer: Group Health Inc Commercial	$1.16
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.51

SODIUM THIOSULFATE 250 MG/ML IV SOLN

Facility

$2.32

Service Code	NDC 6026770550
Hospital Charge Code	6026770550
Hospital Revenue Code	258
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16

SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PACK

Facility

$32.82

Service Code	NDC 0310111039
Hospital Charge Code	0310111039
Hospital Revenue Code	250
Min. Negotiated Rate	$11.49
Max. Negotiated Rate	$26.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.41
Rate for Payer: Aetna Government	$16.41
Rate for Payer: Brighton Health Commercial	$24.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.32
Rate for Payer: EmblemHealth Commercial	$16.41
Rate for Payer: Group Health Inc Commercial	$16.41
Rate for Payer: Group Health Inc Medicare	$11.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.41
Rate for Payer: Hamaspik Choice Inc Medicare	$16.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.33

SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PACK

Facility

$32.82

Service Code	NDC 0310111039
Hospital Charge Code	0310111039
Hospital Revenue Code	250
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$16.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.41

SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PACK

Facility

$32.82

Service Code	NDC 0310111030
Hospital Charge Code	0310111030
Hospital Revenue Code	250
Min. Negotiated Rate	$11.49
Max. Negotiated Rate	$26.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.41
Rate for Payer: Aetna Government	$16.41
Rate for Payer: Brighton Health Commercial	$24.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.32
Rate for Payer: EmblemHealth Commercial	$16.41
Rate for Payer: Group Health Inc Commercial	$16.41
Rate for Payer: Group Health Inc Medicare	$11.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.41
Rate for Payer: Hamaspik Choice Inc Medicare	$16.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.33

SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PACK

Facility

$32.82

Service Code	NDC 0310111030
Hospital Charge Code	0310111030
Hospital Revenue Code	250
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$16.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.41

SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PACK

Facility

$32.82

Service Code	NDC 0310111001
Hospital Charge Code	0310111001
Hospital Revenue Code	250
Min. Negotiated Rate	$11.49
Max. Negotiated Rate	$26.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.41
Rate for Payer: Aetna Government	$16.41
Rate for Payer: Brighton Health Commercial	$24.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.32
Rate for Payer: EmblemHealth Commercial	$16.41
Rate for Payer: Group Health Inc Commercial	$16.41
Rate for Payer: Group Health Inc Medicare	$11.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.41
Rate for Payer: Hamaspik Choice Inc Medicare	$16.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.33

SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PACK

Facility

$32.82

Service Code	NDC 0310111001
Hospital Charge Code	0310111001
Hospital Revenue Code	250
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$16.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.41

SOFOSBUVIR 400 MG PO TABS

Facility

$1.00

Service Code	NDC 6195815011
Hospital Charge Code	6195815011
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: EmblemHealth Commercial	$0.50
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

SOFOSBUVIR 400 MG PO TABS

Facility

$1.00

Service Code	NDC 6195815011
Hospital Charge Code	6195815011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

SORBITOL 70 % SOLN

Facility

$0.13

Service Code	NDC 4628750030
Hospital Charge Code	4628750030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
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	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.07
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	$0.08

SORBITOL 70 % SOLN

Facility

$0.13

Service Code	NDC 4628750030
Hospital Charge Code	4628750030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

SOTALOL HCL 80 MG PO TABS

Facility

$2.35

Service Code	NDC 6958484110
Hospital Charge Code	6958484110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$1.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.17
Rate for Payer: Aetna Government	$1.17
Rate for Payer: Brighton Health Commercial	$1.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.60
Rate for Payer: EmblemHealth Commercial	$1.17
Rate for Payer: Group Health Inc Commercial	$1.17
Rate for Payer: Group Health Inc Medicare	$0.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.17
Rate for Payer: Hamaspik Choice Inc Medicare	$1.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.53

SOTALOL HCL 80 MG PO TABS

Facility

$2.35

Service Code	NDC 6958484110
Hospital Charge Code	6958484110
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.17

SPEECH THERAPY AND EVALUATION

Facility

$211.07

Service Code	EAPG 00272
Min. Negotiated Rate	$152.74
Max. Negotiated Rate	$211.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.74
Rate for Payer: Healthfirst Commercial	$211.07

SPINAL DIAGNOSES AND INJURIES

Facility

$247.97

Service Code	EAPG 00520
Min. Negotiated Rate	$180.52
Max. Negotiated Rate	$247.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$180.52
Rate for Payer: Healthfirst Commercial	$247.97

Spinal disorders & injuries

Facility

$46,366.27

Service Code	APR-DRG 0401
Min. Negotiated Rate	$8,971.00
Max. Negotiated Rate	$46,366.27
Rate for Payer: Affinity Essential Plan 1&2	$46,366.27
Rate for Payer: Affinity Essential Plan 3&4	$46,366.27
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,607.23
Rate for Payer: Amida Care Medicaid	$20,607.23
Rate for Payer: EmblemHealth Essential Plan 1&2	$46,366.27
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,607.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,607.23
Rate for Payer: Fidelis Qualified Health Plan	$24,728.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,607.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,607.23
Rate for Payer: Healthfirst Commercial	$15,128.00
Rate for Payer: Healthfirst Essential Plan	$46,366.27
Rate for Payer: Healthfirst QHP	$8,971.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,607.23
Rate for Payer: SOMOS Essential	$46,366.27
Rate for Payer: United Healthcare Essential Plan 1&2	$46,366.27
Rate for Payer: United Healthcare Essential Plan 3&4	$46,366.27
Rate for Payer: United Healthcare Medicaid	$20,607.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,607.23

Spinal disorders & injuries

Facility

$54,604.24

Service Code	APR-DRG 0402
Min. Negotiated Rate	$11,718.00
Max. Negotiated Rate	$54,604.24
Rate for Payer: Affinity Essential Plan 1&2	$54,604.24
Rate for Payer: Affinity Essential Plan 3&4	$54,604.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,268.55
Rate for Payer: Amida Care Medicaid	$24,268.55
Rate for Payer: EmblemHealth Essential Plan 1&2	$54,604.24
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,268.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,268.55
Rate for Payer: Fidelis Qualified Health Plan	$29,122.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,268.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,268.55
Rate for Payer: Healthfirst Commercial	$18,208.00
Rate for Payer: Healthfirst Essential Plan	$54,604.24
Rate for Payer: Healthfirst QHP	$11,718.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,268.55
Rate for Payer: SOMOS Essential	$54,604.24
Rate for Payer: United Healthcare Essential Plan 1&2	$54,604.24
Rate for Payer: United Healthcare Essential Plan 3&4	$54,604.24
Rate for Payer: United Healthcare Medicaid	$24,268.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,268.55

Know your out-of-pocket cost for care.

All Charges