St. Barnabas Hospital

All Charges

Charge

Type

Price

SULFATE-3-GLUC.PARAG. AB IGM

Facility OP

$28.83

Service Code	HCPCS 83516
Hospital Charge Code	40609887
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$18.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.53
Rate for Payer: Aetna Government	$11.53
Rate for Payer: Cash Price	$11.53
Rate for Payer: Cash Price	$11.53
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.52
Rate for Payer: Elderplan Medicare Advantage	$11.53
Rate for Payer: EmblemHealth Commercial	$11.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.38
Rate for Payer: Fidelis Essential Plan Aliesa	$9.80
Rate for Payer: Fidelis Essential Plan QHP	$10.26
Rate for Payer: Fidelis Medicare Advantage	$11.53
Rate for Payer: Fidelis Qualified Health Plan	$10.26
Rate for Payer: Group Health Inc Commercial	$11.53
Rate for Payer: Group Health Inc Medicare	$11.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.42
Rate for Payer: Hamaspik Choice Inc Medicare	$11.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.53
Rate for Payer: Healthfirst Medicare Advantage	$11.53
Rate for Payer: Healthfirst QHP	$11.53
Rate for Payer: Senior Whole Health Medicare Advantage	$11.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.22
Rate for Payer: Wellcare Medicare	$10.38

SULFISOXAZOLE 100 MG/ML SUSPENSION PEDIA

Facility OP

$1.00

Hospital Charge Code	41641359
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: 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

SULFISOXAZOLE 100 MG/ML SUSPENSION PEDIA

Facility OP

$1.00

Hospital Charge Code	41651359
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: 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

SULFONYLUREA SCREEN, QT

Facility OP

$146.78

Service Code	HCPCS 80377
Hospital Charge Code	40609025
Hospital Revenue Code	300
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$117.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$117.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.81
Rate for Payer: Group Health Inc Commercial	$73.39
Rate for Payer: Group Health Inc Medicare	$51.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.39
Rate for Payer: Hamaspik Choice Inc Medicare	$73.39

SULINDAC 150 MG TAB

Facility OP

$1.00

Hospital Charge Code	41641082
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: 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

SULINDAC 150 MG TAB

Facility OP

$1.00

Hospital Charge Code	41651082
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: 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

SULINDAC 200 MG TAB

Facility OP

$0.75

Hospital Charge Code	41641084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.51
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

SULINDAC 200 MG TAB

Facility OP

$0.75

Hospital Charge Code	41651084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.51
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility IP

$142.00

Service Code	HCPCS J3030
Hospital Charge Code	41640916
Hospital Revenue Code	636
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$71.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.00
Rate for Payer: Hamaspik Choice Inc Medicare	$71.00

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility IP

$142.00

Service Code	HCPCS J3030
Hospital Charge Code	41650916
Hospital Revenue Code	636
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$71.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.00
Rate for Payer: Hamaspik Choice Inc Medicare	$71.00

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility OP

$142.00

Service Code	HCPCS J3030
Hospital Charge Code	41650916
Hospital Revenue Code	636
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$92.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.96
Rate for Payer: Aetna Government	$51.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.65
Rate for Payer: Group Health Inc Commercial	$71.00
Rate for Payer: Group Health Inc Medicare	$49.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.00
Rate for Payer: Hamaspik Choice Inc Medicare	$71.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$92.30

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility OP

$142.00

Service Code	HCPCS J3030
Hospital Charge Code	41640916
Hospital Revenue Code	636
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$92.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.96
Rate for Payer: Aetna Government	$51.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.65
Rate for Payer: Group Health Inc Commercial	$71.00
Rate for Payer: Group Health Inc Medicare	$49.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.00
Rate for Payer: Hamaspik Choice Inc Medicare	$71.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$92.30

SUPERCROSS MICRO CATH 90* #5304

Facility OP

$1,030.00

Service Code	HCPCS C1887
Hospital Charge Code	66523440
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$1,081.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$566.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$515.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$592.25
Rate for Payer: Fidelis Medicare Advantage	$1,081.50
Rate for Payer: Group Health Inc Commercial	$515.00
Rate for Payer: Group Health Inc Medicare	$360.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.50

SUPERCROSS MICRO CATH 90* #5304

Facility IP

$1,030.00

Service Code	HCPCS C1887
Hospital Charge Code	66523440
Hospital Revenue Code	278
Min. Negotiated Rate	$515.00
Max. Negotiated Rate	$515.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00

SUPER CROSS MICRO-CATH 90* #9304

Facility IP

$1,030.00

Service Code	HCPCS C1887
Hospital Charge Code	65523440
Hospital Revenue Code	278
Min. Negotiated Rate	$515.00
Max. Negotiated Rate	$515.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00

SUPER CROSS MICRO-CATH 90* #9304

Facility OP

$1,030.00

Service Code	HCPCS C1887
Hospital Charge Code	65523440
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$1,081.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$566.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$515.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$592.25
Rate for Payer: Fidelis Medicare Advantage	$1,081.50
Rate for Payer: Group Health Inc Commercial	$515.00
Rate for Payer: Group Health Inc Medicare	$360.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.50

SUPER CROSS MIRCO-CATH 120* #5306

Facility OP

$1,030.00

Service Code	HCPCS C1887
Hospital Charge Code	66523441
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$1,081.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$566.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$515.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$592.25
Rate for Payer: Fidelis Medicare Advantage	$1,081.50
Rate for Payer: Group Health Inc Commercial	$515.00
Rate for Payer: Group Health Inc Medicare	$360.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.50

SUPER CROSS MIRCO-CATH 120* #5306

Facility IP

$1,030.00

Service Code	HCPCS C1887
Hospital Charge Code	66523441
Hospital Revenue Code	278
Min. Negotiated Rate	$515.00
Max. Negotiated Rate	$515.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00

SUPERIOR HYPOGASTRIC PLEXUS

Facility OP

$2,459.50

Service Code	HCPCS 64517
Hospital Charge Code	30305037
Hospital Revenue Code	510
Min. Negotiated Rate	$133.76
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,054.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,054.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$133.76
Rate for Payer: Fidelis Essential Plan Aliesa	$895.95
Rate for Payer: Fidelis Essential Plan QHP	$938.11
Rate for Payer: Fidelis Medicare Advantage	$1,054.06
Rate for Payer: Fidelis Qualified Health Plan	$938.11
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,229.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,054.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$148.62
Rate for Payer: Healthfirst Medicare Advantage	$895.95
Rate for Payer: Healthfirst QHP	$1,054.06
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,054.06
Rate for Payer: Senior Whole Health Medicare Advantage	$1,054.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,054.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$843.25
Rate for Payer: Wellcare Medicare	$1,001.36

SUPERTURBOVAC90 W/INTEGRATEDCABLE

Facility OP

$386.00

Hospital Charge Code	40200958
Hospital Revenue Code	270
Min. Negotiated Rate	$135.10
Max. Negotiated Rate	$308.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$212.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$193.00
Rate for Payer: Aetna Government	$193.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$308.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$262.48
Rate for Payer: Group Health Inc Commercial	$193.00
Rate for Payer: Group Health Inc Medicare	$135.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$193.00
Rate for Payer: Hamaspik Choice Inc Medicare	$193.00

SUPERV HAND & LOAD

Facility OP

$258.40

Service Code	HCPCS 77790
Hospital Charge Code	66542964
Hospital Revenue Code	342
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$206.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.63
Rate for Payer: Aetna Government	$19.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$175.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19.89
Rate for Payer: Group Health Inc Commercial	$129.20
Rate for Payer: Group Health Inc Medicare	$90.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.20
Rate for Payer: Hamaspik Choice Inc Medicare	$129.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22.10

Support Collar

Facility OP

$167.27

Hospital Charge Code	40205980
Hospital Revenue Code	270
Min. Negotiated Rate	$58.54
Max. Negotiated Rate	$133.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$92.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$83.64
Rate for Payer: Aetna Government	$83.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.74
Rate for Payer: Group Health Inc Commercial	$83.64
Rate for Payer: Group Health Inc Medicare	$58.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.64
Rate for Payer: Hamaspik Choice Inc Medicare	$83.64

SUPPORTER, ATHL, W/LS, XL, 41.5

Facility OP

$49.95

Hospital Charge Code	64901260
Hospital Revenue Code	270
Min. Negotiated Rate	$17.48
Max. Negotiated Rate	$39.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.98
Rate for Payer: Aetna Government	$24.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.97
Rate for Payer: Group Health Inc Commercial	$24.98
Rate for Payer: Group Health Inc Medicare	$17.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.98
Rate for Payer: Hamaspik Choice Inc Medicare	$24.98

SUPPORT KNEE NEOP 12-13-1/2 SM

Facility OP

$62.23

Hospital Charge Code	64902844
Hospital Revenue Code	270
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$49.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.12
Rate for Payer: Aetna Government	$31.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.32
Rate for Payer: Group Health Inc Commercial	$31.12
Rate for Payer: Group Health Inc Medicare	$21.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.12
Rate for Payer: Hamaspik Choice Inc Medicare	$31.12

SUPPORT KNEE NEOP 13-1/2-15 MED

Facility OP

$62.23

Hospital Charge Code	64902840
Hospital Revenue Code	270
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$49.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.12
Rate for Payer: Aetna Government	$31.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.32
Rate for Payer: Group Health Inc Commercial	$31.12
Rate for Payer: Group Health Inc Medicare	$21.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.12
Rate for Payer: Hamaspik Choice Inc Medicare	$31.12

Price Transparency.

All Charges