St. Barnabas Hospital

All Charges

Charge

Type

Price

SODIUM CHLORIDE 10% NEB SOLN 15 ML

Facility IP

$1.43

Service Code	HCPCS J7699
Hospital Charge Code	41651993
Hospital Revenue Code	636
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72
Rate for Payer: Hamaspik Choice Inc Medicare	$0.72

SODIUM CHLORIDE 2% OPHTHALMIC SOLN

Facility OP

$24.00

Hospital Charge Code	41643499
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$19.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.00
Rate for Payer: Aetna Government	$12.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.32
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

SODIUM CHLORIDE 2% OPHTHALMIC SOLN

Facility OP

$24.00

Hospital Charge Code	41653499
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$19.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.00
Rate for Payer: Aetna Government	$12.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.32
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

SODIUM CHLORIDE 3% INFUSION 500 ML

Facility OP

$1.58

Service Code	HCPCS J7799
Hospital Charge Code	41651443
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.91
Rate for Payer: Group Health Inc Commercial	$0.79
Rate for Payer: Group Health Inc Medicare	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.79
Rate for Payer: Hamaspik Choice Inc Medicare	$0.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.03

SODIUM CHLORIDE 3% INFUSION 500 ML

Facility IP

$1.58

Service Code	HCPCS J7799
Hospital Charge Code	41651443
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.79
Rate for Payer: Hamaspik Choice Inc Medicare	$0.79

SODIUM CHLORIDE 3% INFUSION 500 ML

Facility IP

$1.58

Service Code	HCPCS J7799
Hospital Charge Code	41641443
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.79
Rate for Payer: Hamaspik Choice Inc Medicare	$0.79

SODIUM CHLORIDE 3% INFUSION 500 ML

Facility OP

$1.58

Service Code	HCPCS J7799
Hospital Charge Code	41641443
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.91
Rate for Payer: Group Health Inc Commercial	$0.79
Rate for Payer: Group Health Inc Medicare	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.79
Rate for Payer: Hamaspik Choice Inc Medicare	$0.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.03

SODIUM CHLORIDE 3% NEB SOLN 15 ML

Facility OP

$0.94

Service Code	HCPCS A4216
Hospital Charge Code	41650760
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.64
Rate for Payer: Group Health Inc Commercial	$0.47
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47

SODIUM CHLORIDE 3% NEB SOLN 15 ML

Facility OP

$0.94

Service Code	HCPCS A4216
Hospital Charge Code	41640760
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.64
Rate for Payer: Group Health Inc Commercial	$0.47
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47

SODIUM CHLORIDE 4 MEQ/ML INJ

Facility OP

$5.52

Hospital Charge Code	41650351
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$4.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.76
Rate for Payer: Aetna Government	$2.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.75
Rate for Payer: Group Health Inc Commercial	$2.76
Rate for Payer: Group Health Inc Medicare	$1.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.76
Rate for Payer: Hamaspik Choice Inc Medicare	$2.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.59

SODIUM CHLORIDE 4 MEQ/ML INJ

Facility OP

$5.52

Hospital Charge Code	41640351
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$4.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.76
Rate for Payer: Aetna Government	$2.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.75
Rate for Payer: Group Health Inc Commercial	$2.76
Rate for Payer: Group Health Inc Medicare	$1.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.76
Rate for Payer: Hamaspik Choice Inc Medicare	$2.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.59

SODIUM CHLORIDE 5% OPHTHALMIC SOLN

Facility OP

$7.70

Hospital Charge Code	41653498
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.85
Rate for Payer: Aetna Government	$3.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.24
Rate for Payer: Group Health Inc Commercial	$3.85
Rate for Payer: Group Health Inc Medicare	$2.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.85
Rate for Payer: Hamaspik Choice Inc Medicare	$3.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.00

SODIUM CHLORIDE 5% OPHTHALMIC SOLN

Facility OP

$7.70

Hospital Charge Code	41643498
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.85
Rate for Payer: Aetna Government	$3.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.24
Rate for Payer: Group Health Inc Commercial	$3.85
Rate for Payer: Group Health Inc Medicare	$2.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.85
Rate for Payer: Hamaspik Choice Inc Medicare	$3.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.00

SODIUM CHLORIDE 9%

Facility OP

$2.10

Hospital Charge Code	41657025
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.43
Rate for Payer: Group Health Inc Commercial	$1.05
Rate for Payer: Group Health Inc Medicare	$0.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.05
Rate for Payer: Hamaspik Choice Inc Medicare	$1.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.36

SODIUM CHLORIDE BTL 0.9 250ML

Facility OP

$3.17

Hospital Charge Code	64902217
Hospital Revenue Code	270
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$2.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.58
Rate for Payer: Aetna Government	$1.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.16
Rate for Payer: Group Health Inc Commercial	$1.58
Rate for Payer: Group Health Inc Medicare	$1.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.58
Rate for Payer: Hamaspik Choice Inc Medicare	$1.58

SODIUM CHLORIDE, IRRIG, 0.9 ,USP

Facility OP

$22.98

Hospital Charge Code	64902526
Hospital Revenue Code	270
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$18.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.49
Rate for Payer: Aetna Government	$11.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.63
Rate for Payer: Group Health Inc Commercial	$11.49
Rate for Payer: Group Health Inc Medicare	$8.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.49
Rate for Payer: Hamaspik Choice Inc Medicare	$11.49

SODIUM CITRATE-CITRIC ACID LIQUID

Facility OP

$1.02

Hospital Charge Code	41643472
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.69
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

SODIUM CITRATE-CITRIC ACID LIQUID

Facility OP

$1.02

Hospital Charge Code	41653472
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.69
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

SODIUM, FECAL

Facility OP

$12.15

Service Code	HCPCS 84302
Hospital Charge Code	40609899
Hospital Revenue Code	301
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$7.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.86
Rate for Payer: Aetna Government	$4.86
Rate for Payer: Cash Price	$4.86
Rate for Payer: Cash Price	$4.86
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.54
Rate for Payer: Elderplan Medicare Advantage	$4.86
Rate for Payer: EmblemHealth Commercial	$4.86
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.37
Rate for Payer: Fidelis Essential Plan Aliesa	$4.13
Rate for Payer: Fidelis Essential Plan QHP	$4.33
Rate for Payer: Fidelis Medicare Advantage	$4.86
Rate for Payer: Fidelis Qualified Health Plan	$4.33
Rate for Payer: Group Health Inc Commercial	$4.86
Rate for Payer: Group Health Inc Medicare	$4.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.08
Rate for Payer: Hamaspik Choice Inc Medicare	$4.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.86
Rate for Payer: Healthfirst Medicare Advantage	$4.86
Rate for Payer: Healthfirst QHP	$4.86
Rate for Payer: Senior Whole Health Medicare Advantage	$4.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.89
Rate for Payer: Wellcare Medicare	$4.37

SODIUM HYALURONATE 1.4% INTRAOCULAR INJ

Facility OP

$78.00

Hospital Charge Code	41645037
Hospital Revenue Code	250
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$62.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.00
Rate for Payer: Aetna Government	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.04
Rate for Payer: Group Health Inc Commercial	$39.00
Rate for Payer: Group Health Inc Medicare	$27.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.00
Rate for Payer: Hamaspik Choice Inc Medicare	$39.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.70

SODIUM HYALURONATE 1.4% INTRAOCULAR INJ

Facility OP

$78.00

Hospital Charge Code	41655037
Hospital Revenue Code	250
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$62.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.00
Rate for Payer: Aetna Government	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.04
Rate for Payer: Group Health Inc Commercial	$39.00
Rate for Payer: Group Health Inc Medicare	$27.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.00
Rate for Payer: Hamaspik Choice Inc Medicare	$39.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.70

SODIUM HYALURONATE + CHONDROITIN INTRAOC

Facility OP

$345.00

Hospital Charge Code	41642066
Hospital Revenue Code	250
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$276.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$172.50
Rate for Payer: Aetna Government	$172.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$276.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.60
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.25

SODIUM HYALURONATE + CHONDROITIN INTRAOC

Facility OP

$345.00

Hospital Charge Code	41652066
Hospital Revenue Code	250
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$276.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$172.50
Rate for Payer: Aetna Government	$172.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$276.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.60
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.25

SODIUM HYALURONATE INTRA-ARTICULAR 8 MG/

Facility OP

$530.00

Hospital Charge Code	41644748
Hospital Revenue Code	250
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$424.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$291.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.00
Rate for Payer: Aetna Government	$265.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$424.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.40
Rate for Payer: Group Health Inc Commercial	$265.00
Rate for Payer: Group Health Inc Medicare	$185.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.00
Rate for Payer: Hamaspik Choice Inc Medicare	$265.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$344.50

SODIUM HYALURONATE INTRA-ARTICULAR 8 MG/

Facility OP

$530.00

Hospital Charge Code	41654748
Hospital Revenue Code	250
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$424.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$291.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.00
Rate for Payer: Aetna Government	$265.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$424.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.40
Rate for Payer: Group Health Inc Commercial	$265.00
Rate for Payer: Group Health Inc Medicare	$185.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.00
Rate for Payer: Hamaspik Choice Inc Medicare	$265.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$344.50

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