St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SALINE 0.65 % NA SOLN [18225]

Facility

$0.05

Service Code	NDC 00225038280
Hospital Charge Code	00225038280
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

SALINE INFUSION PUMP

Facility

$10,790.00

Hospital Charge Code	40005132
Hospital Revenue Code	272
Min. Negotiated Rate	$3,776.50
Max. Negotiated Rate	$8,632.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,934.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,395.00
Rate for Payer: Aetna Government	$5,395.00
Rate for Payer: Brighton Health Commercial	$8,092.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,632.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,337.20
Rate for Payer: Group Health Inc Commercial	$5,395.00
Rate for Payer: Group Health Inc Medicare	$3,776.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,395.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,395.00

SALINE MAM/BREAST IMPLT 350CC

Facility

$1,750.00

Service Code	HCPCS C1789
Hospital Charge Code	40209948
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,837.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$962.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,050.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$875.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,006.25
Rate for Payer: EmblemHealth Commercial	$875.00
Rate for Payer: Fidelis Medicare Advantage	$1,837.50
Rate for Payer: Group Health Inc Commercial	$875.00
Rate for Payer: Group Health Inc Medicare	$612.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,137.50

SALINE MAM/BREAST IMPLT 350CC

Facility

$1,750.00

Service Code	HCPCS C1789
Hospital Charge Code	40209948
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00

SALINE MAMMARY BREST IMPNT 200 CC

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	40201119
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,207.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: EmblemHealth Commercial	$575.00
Rate for Payer: Fidelis Medicare Advantage	$1,207.50
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.50

SALINE MAMMARY BREST IMPNT 200 CC

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	40201119
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

SALINE MAMMARY BREST IMPNT 300 CC

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	40201121
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

SALINE MAMMARY BREST IMPNT 300 CC

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	40201121
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,207.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: EmblemHealth Commercial	$575.00
Rate for Payer: Fidelis Medicare Advantage	$1,207.50
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.50

SALINE MAMMARY BREST IMPNT 350 CC

Facility

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	40201122
Hospital Revenue Code	278
Min. Negotiated Rate	$1,150.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00

SALINE MAMMARY BREST IMPNT 350 CC

Facility

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	40201122
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,415.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,265.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,380.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,322.50
Rate for Payer: EmblemHealth Commercial	$1,150.00
Rate for Payer: Fidelis Medicare Advantage	$2,415.00
Rate for Payer: Group Health Inc Commercial	$1,150.00
Rate for Payer: Group Health Inc Medicare	$805.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,495.00

SALINE MAMMARY BREST IMPNT 450 CC

Facility

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	40201123
Hospital Revenue Code	278
Min. Negotiated Rate	$1,150.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00

SALINE MAMMARY BREST IMPNT 450 CC

Facility

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	40201123
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,415.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,265.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,380.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,322.50
Rate for Payer: EmblemHealth Commercial	$1,150.00
Rate for Payer: Fidelis Medicare Advantage	$2,415.00
Rate for Payer: Group Health Inc Commercial	$1,150.00
Rate for Payer: Group Health Inc Medicare	$805.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,495.00

SALINE MAMMARY BREST IMPNT 550 CC

Facility

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	40201124
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,415.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,265.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,380.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,322.50
Rate for Payer: EmblemHealth Commercial	$1,150.00
Rate for Payer: Fidelis Medicare Advantage	$2,415.00
Rate for Payer: Group Health Inc Commercial	$1,150.00
Rate for Payer: Group Health Inc Medicare	$805.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,495.00

SALINE MAMMARY BREST IMPNT 550 CC

Facility

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	40201124
Hospital Revenue Code	278
Min. Negotiated Rate	$1,150.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00

SALINE MAMMARY BREST IMPNT 650 CC

Facility

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	40201125
Hospital Revenue Code	278
Min. Negotiated Rate	$1,150.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00

SALINE MAMMARY BREST IMPNT 650 CC

Facility

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	40201125
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,415.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,265.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,380.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,322.50
Rate for Payer: EmblemHealth Commercial	$1,150.00
Rate for Payer: Fidelis Medicare Advantage	$2,415.00
Rate for Payer: Group Health Inc Commercial	$1,150.00
Rate for Payer: Group Health Inc Medicare	$805.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,495.00

SALINE MAMMARY BRST IMPNT 250 CC

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	40201120
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

SALINE MAMMARY BRST IMPNT 250 CC

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	40201120
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,207.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: EmblemHealth Commercial	$575.00
Rate for Payer: Fidelis Medicare Advantage	$1,207.50
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.50

SALINE NASAL SPRAY 0.65 % NA SOLN [7030]

Facility

$0.09

Service Code	NDC 45802035758
Hospital Charge Code	45802035758
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

SALINE NASAL SPRAY 0.65 % NA SOLN [7030]

Facility

$0.08

Service Code	NDC 00225055050
Hospital Charge Code	00225055050
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

SALINE NASAL SPRAY 0.65 % NA SOLN [7030]

Facility

$0.03

Service Code	NDC 00904386575
Hospital Charge Code	00904386575
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
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: 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

SALINE NASAL SPRAY 0.65 % NA SOLN [7030]

Facility

$0.05

Service Code	NDC 00225038080
Hospital Charge Code	00225038080
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

SALIVARY CORTISOL X2

Facility

$234.65

Service Code	HCPCS 82533
Hospital Charge Code	40601236
Hospital Revenue Code	301
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$175.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$129.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.30
Rate for Payer: Aetna Government	$16.30
Rate for Payer: Affinity Essential Plan 1&2	$11.41
Rate for Payer: Affinity Essential Plan 3&4	$11.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.41
Rate for Payer: Brighton Health Commercial	$175.99
Rate for Payer: Cash Price	$16.30
Rate for Payer: Cash Price	$16.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.93
Rate for Payer: Elderplan Medicare Advantage	$16.30
Rate for Payer: EmblemHealth Commercial	$16.30
Rate for Payer: Fidelis Essential Plan Aliesa	$13.86
Rate for Payer: Fidelis Essential Plan QHP	$14.51
Rate for Payer: Fidelis Medicare Advantage	$16.30
Rate for Payer: Fidelis Qualified Health Plan	$14.51
Rate for Payer: Group Health Inc Commercial	$16.30
Rate for Payer: Group Health Inc Medicare	$16.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$117.32
Rate for Payer: Hamaspik Choice Inc Medicare	$16.30
Rate for Payer: Healthfirst Medicare Advantage	$16.30
Rate for Payer: Healthfirst QHP	$16.30
Rate for Payer: Humana Medicare	$16.63
Rate for Payer: Senior Whole Health Medicare Advantage	$16.30
Rate for Payer: United Healthcare Commercial	$20.66
Rate for Payer: United Healthcare Medicare Advantage	$16.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.04
Rate for Payer: Wellcare Medicare	$14.67

SALIVARY CORTISOL X2

Facility

$234.65

Service Code	HCPCS 82533
Hospital Charge Code	40601236
Hospital Revenue Code	301
Rate for Payer: Cash Price	$16.30

SALIVARY GLAND PROCEDURES

Facility

$32,722.43

Service Code	MSDRG 139
Min. Negotiated Rate	$10,184.50
Max. Negotiated Rate	$32,722.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17,512.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23,798.13
Rate for Payer: Aetna Government	$23,798.13
Rate for Payer: Brighton Health Commercial	$17,221.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$24,274.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20,510.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$16,926.06
Rate for Payer: Elderplan Medicare Advantage	$22,608.22
Rate for Payer: EmblemHealth Commercial	$10,184.50
Rate for Payer: Fidelis Medicare Advantage	$23,798.13
Rate for Payer: Group Health Inc Commercial	$23,798.13
Rate for Payer: Group Health Inc Medicare	$23,798.13
Rate for Payer: Hamaspik Choice Inc Medicare	$23,798.13
Rate for Payer: Healthfirst Medicare Advantage	$11,066.13
Rate for Payer: Humana Medicare	$32,722.43
Rate for Payer: Senior Whole Health Medicare Advantage	$23,798.13
Rate for Payer: United Healthcare Commercial	$23,619.79
Rate for Payer: United Healthcare Medicare Advantage	$23,798.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23,798.13
Rate for Payer: Wellcare Medicare	$22,608.22

Know your out-of-pocket cost for care.

All Charges