St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]

Facility

$0.19

Service Code	NDC 00409729983
Hospital Charge Code	00409729983
Hospital Revenue Code	278
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10

SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]

Facility

$0.44

Service Code	NDC 69784023020
Hospital Charge Code	69784023020
Hospital Revenue Code	278
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.25
Rate for Payer: EmblemHealth Commercial	$0.22
Rate for Payer: Fidelis Medicare Advantage	$0.46
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]

Facility

$0.19

Service Code	NDC 00409729983
Hospital Charge Code	00409729983
Hospital Revenue Code	278
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Fidelis Medicare Advantage	$0.20
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]

Facility

$0.19

Service Code	NDC 00409729973
Hospital Charge Code	00409729973
Hospital Revenue Code	278
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Fidelis Medicare Advantage	$0.20
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]

Facility

$0.30

Service Code	NDC 69784023120
Hospital Charge Code	69784023120
Hospital Revenue Code	278
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: EmblemHealth Commercial	$0.15
Rate for Payer: Fidelis Medicare Advantage	$0.31
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]

Facility

$0.19

Service Code	NDC 00409729973
Hospital Charge Code	00409729973
Hospital Revenue Code	278
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10

SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]

Facility

$0.08

Service Code	NDC 00409329906
Hospital Charge Code	00409329906
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Fidelis Medicare Advantage	$0.08
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

SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]

Facility

$0.44

Service Code	NDC 69784023020
Hospital Charge Code	69784023020
Hospital Revenue Code	278
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22

SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]

Facility

$0.30

Service Code	NDC 69784023120
Hospital Charge Code	69784023120
Hospital Revenue Code	278
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15

SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]

Facility

$0.08

Service Code	NDC 00409329906
Hospital Charge Code	00409329906
Hospital Revenue Code	278
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04

SODIUM BICARBONATE 4.2% INJ 5 ML

Facility

$4.02

Hospital Charge Code	41654268
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$3.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.01
Rate for Payer: Aetna Government	$2.01
Rate for Payer: Brighton Health Commercial	$3.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.73
Rate for Payer: Group Health Inc Commercial	$2.01
Rate for Payer: Group Health Inc Medicare	$1.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.01
Rate for Payer: Hamaspik Choice Inc Medicare	$2.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.61

SODIUM BICARBONATE 4.2% INJ 5 ML

Facility

$4.02

Hospital Charge Code	41644268
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$3.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.01
Rate for Payer: Aetna Government	$2.01
Rate for Payer: Brighton Health Commercial	$3.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.73
Rate for Payer: Group Health Inc Commercial	$2.01
Rate for Payer: Group Health Inc Medicare	$1.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.01
Rate for Payer: Hamaspik Choice Inc Medicare	$2.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.61

SODIUM BICARBONATE 4.2 % IV SOLN [7306]

Facility

$2.19

Service Code	NDC 00409553414
Hospital Charge Code	00409553414
Hospital Revenue Code	278
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1.10

SODIUM BICARBONATE 4.2 % IV SOLN [7306]

Facility

$1.86

Service Code	NDC 00409555502
Hospital Charge Code	00409555502
Hospital Revenue Code	278
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$0.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.93
Rate for Payer: Hamaspik Choice Inc Medicare	$0.93

SODIUM BICARBONATE 4.2 % IV SOLN [7306]

Facility

$2.19

Service Code	NDC 00409553414
Hospital Charge Code	00409553414
Hospital Revenue Code	278
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$2.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.10
Rate for Payer: Aetna Government	$1.10
Rate for Payer: Brighton Health Commercial	$1.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.26
Rate for Payer: EmblemHealth Commercial	$1.10
Rate for Payer: Fidelis Medicare Advantage	$2.30
Rate for Payer: Group Health Inc Commercial	$1.10
Rate for Payer: Group Health Inc Medicare	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.43

SODIUM BICARBONATE 4.2 % IV SOLN [7306]

Facility

$1.86

Service Code	NDC 00409555502
Hospital Charge Code	00409555502
Hospital Revenue Code	278
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.93
Rate for Payer: Aetna Government	$0.93
Rate for Payer: Brighton Health Commercial	$1.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.07
Rate for Payer: EmblemHealth Commercial	$0.93
Rate for Payer: Fidelis Medicare Advantage	$1.95
Rate for Payer: Group Health Inc Commercial	$0.93
Rate for Payer: Group Health Inc Medicare	$0.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.93
Rate for Payer: Hamaspik Choice Inc Medicare	$0.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.21

SODIUM BICARBONATE 4.2% SYRINGE 10 ML

Facility

$9.28

Hospital Charge Code	41653821
Hospital Revenue Code	250
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$7.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.64
Rate for Payer: Aetna Government	$4.64
Rate for Payer: Brighton Health Commercial	$6.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.31
Rate for Payer: Group Health Inc Commercial	$4.64
Rate for Payer: Group Health Inc Medicare	$3.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.64
Rate for Payer: Hamaspik Choice Inc Medicare	$4.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.03

SODIUM BICARBONATE 4.2% SYRINGE 10 ML

Facility

$9.28

Hospital Charge Code	41643821
Hospital Revenue Code	250
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$7.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.64
Rate for Payer: Aetna Government	$4.64
Rate for Payer: Brighton Health Commercial	$6.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.31
Rate for Payer: Group Health Inc Commercial	$4.64
Rate for Payer: Group Health Inc Medicare	$3.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.64
Rate for Payer: Hamaspik Choice Inc Medicare	$4.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.03

SODIUM BICARBONATE 650 MG PO TABS [7313]

Facility

$0.02

Service Code	NDC 00536104710
Hospital Charge Code	00536104710
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	$0.01
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	$0.01

SODIUM BICARBONATE 650 MG PO TABS [7313]

Facility

$0.07

Service Code	NDC 66553000801
Hospital Charge Code	66553000801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
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	$0.04

SODIUM BICARBONATE 650 MG PO TABS [7313]

Facility

$0.20

Service Code	NDC 77333083110
Hospital Charge Code	77333083110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

SODIUM BICARBONATE 650 MG PO TABS [7313]

Facility

$0.18

Service Code	NDC 00904726161
Hospital Charge Code	00904726161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

SODIUM BICARBONATE 650 MG TAB

Facility

$1.00

Hospital Charge Code	41640894
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: 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

SODIUM BICARBONATE 650 MG TAB

Facility

$1.00

Hospital Charge Code	41650894
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: 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

SODIUM BICARBONATE 7.5% - 44.6 MEQ/50 ML

Facility

$2.00

Hospital Charge Code	41645397
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

Know your out-of-pocket cost for care.

All Charges