St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED) [401258]

Facility

$4.09

Service Code	NDC 63323088401
Hospital Charge Code	63323088401
Hospital Revenue Code	278
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$4.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.04
Rate for Payer: Aetna Government	$2.04
Rate for Payer: Brighton Health Commercial	$2.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.35
Rate for Payer: EmblemHealth Commercial	$2.04
Rate for Payer: Fidelis Medicare Advantage	$4.29
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.66

SODIUM PHOSPHATES 3 MMOLE/ML IV SOLN (WRAPPED) [401258]

Facility

$2.89

Service Code	NDC 63323088101
Hospital Charge Code	63323088101
Hospital Revenue Code	278
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1.45

SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP [27999]

Facility

$0.52

Service Code	NDC 46287000660
Hospital Charge Code	46287000660
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

SODIUM POLYSTYRENE SULFONATE PO POWD [7356]

Facility

$0.90

Service Code	NDC 10702003615
Hospital Charge Code	10702003615
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

SODIUM POLYSTYRENE SULFONATE SUSPENSION

Facility

$12.00

Hospital Charge Code	41650520
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.00
Rate for Payer: Aetna Government	$6.00
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

SODIUM POLYSTYRENE SULFONATE SUSPENSION

Facility

$12.00

Hospital Charge Code	41640520
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.00
Rate for Payer: Aetna Government	$6.00
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

SODIUM TETRADECYL SULFATE

Facility

$3.90

Service Code	HCPCS J3490
Hospital Charge Code	41650314
Hospital Revenue Code	636
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$2.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.95
Rate for Payer: Aetna Government	$1.95
Rate for Payer: Brighton Health Commercial	$2.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.24
Rate for Payer: Group Health Inc Commercial	$1.95
Rate for Payer: Group Health Inc Medicare	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95
Rate for Payer: Hamaspik Choice Inc Medicare	$1.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.54

SODIUM TETRADECYL SULFATE

Facility

$3.90

Service Code	HCPCS J3490
Hospital Charge Code	41640314
Hospital Revenue Code	636
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$2.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.95
Rate for Payer: Aetna Government	$1.95
Rate for Payer: Brighton Health Commercial	$2.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.24
Rate for Payer: Group Health Inc Commercial	$1.95
Rate for Payer: Group Health Inc Medicare	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95
Rate for Payer: Hamaspik Choice Inc Medicare	$1.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.54

SODIUM TETRADECYL SULFATE

Facility

$3.90

Service Code	HCPCS J3490
Hospital Charge Code	41640314
Hospital Revenue Code	636
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95
Rate for Payer: Hamaspik Choice Inc Medicare	$1.95

SODIUM TETRADECYL SULFATE

Facility

$3.90

Service Code	HCPCS J3490
Hospital Charge Code	41650314
Hospital Revenue Code	636
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95
Rate for Payer: Hamaspik Choice Inc Medicare	$1.95

SODIUM TETRADECYL SULFATE 1 % IV SOLN [41787]

Facility

$46.88

Service Code	NDC 67457016202
Hospital Charge Code	67457016202
Hospital Revenue Code	278
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$49.22
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	$28.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.95
Rate for Payer: EmblemHealth Commercial	$23.44
Rate for Payer: Fidelis Medicare Advantage	$49.22
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 [41787]

Facility

$46.88

Service Code	NDC 67457016202
Hospital Charge Code	67457016202
Hospital Revenue Code	278
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$23.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.44
Rate for Payer: Hamaspik Choice Inc Medicare	$23.44

SODIUM TETRADECYL SULFATE 1 % IV SOLN [41787]

Facility

$46.88

Service Code	NDC 67457016200
Hospital Charge Code	67457016200
Hospital Revenue Code	278
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$49.22
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	$28.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.95
Rate for Payer: EmblemHealth Commercial	$23.44
Rate for Payer: Fidelis Medicare Advantage	$49.22
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 [41787]

Facility

$46.88

Service Code	NDC 67457016200
Hospital Charge Code	67457016200
Hospital Revenue Code	278
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$23.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.44
Rate for Payer: Hamaspik Choice Inc Medicare	$23.44

SODIUM TETRADECYL SULFATE 3 % IV SOLN [41793]

Facility

$46.88

Service Code	NDC 67457016302
Hospital Charge Code	67457016302
Hospital Revenue Code	278
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$49.22
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	$28.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.95
Rate for Payer: EmblemHealth Commercial	$23.44
Rate for Payer: Fidelis Medicare Advantage	$49.22
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 [41793]

Facility

$46.88

Service Code	NDC 67457016302
Hospital Charge Code	67457016302
Hospital Revenue Code	278
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$23.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.44
Rate for Payer: Hamaspik Choice Inc Medicare	$23.44

SODIUM THIOSULFATE 10% INJ

Facility

$27.25

Hospital Charge Code	41641576
Hospital Revenue Code	250
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$21.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.62
Rate for Payer: Aetna Government	$13.62
Rate for Payer: Brighton Health Commercial	$20.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.53
Rate for Payer: Group Health Inc Commercial	$13.62
Rate for Payer: Group Health Inc Medicare	$9.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.62
Rate for Payer: Hamaspik Choice Inc Medicare	$13.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.71

SODIUM THIOSULFATE 10% INJ

Facility

$27.25

Hospital Charge Code	41651576
Hospital Revenue Code	250
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$21.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.62
Rate for Payer: Aetna Government	$13.62
Rate for Payer: Brighton Health Commercial	$20.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.53
Rate for Payer: Group Health Inc Commercial	$13.62
Rate for Payer: Group Health Inc Medicare	$9.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.62
Rate for Payer: Hamaspik Choice Inc Medicare	$13.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.71

SODIUM THIOSULFATE 250 MG/ML IV SOLN [181343]

Facility

$2.32

Service Code	NDC 60267070550
Hospital Charge Code	60267070550
Hospital Revenue Code	278
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$2.44
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	$1.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.33
Rate for Payer: EmblemHealth Commercial	$1.16
Rate for Payer: Fidelis Medicare Advantage	$2.44
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 [181343]

Facility

$2.32

Service Code	NDC 60267070550
Hospital Charge Code	60267070550
Hospital Revenue Code	278
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1.16

SODIUM THIOSULFATE 25% INJ

Facility

$30.00

Hospital Charge Code	41654756
Hospital Revenue Code	250
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$24.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.00
Rate for Payer: Aetna Government	$15.00
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.40
Rate for Payer: Group Health Inc Commercial	$15.00
Rate for Payer: Group Health Inc Medicare	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.50

SODIUM THIOSULFATE 25% INJ

Facility

$30.00

Hospital Charge Code	41644756
Hospital Revenue Code	250
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$24.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.00
Rate for Payer: Aetna Government	$15.00
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.40
Rate for Payer: Group Health Inc Commercial	$15.00
Rate for Payer: Group Health Inc Medicare	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.50

SODIUM ZIRCONIUM CYCLOSILICATE

Facility

$55.85

Hospital Charge Code	41650365
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$44.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.92
Rate for Payer: Aetna Government	$27.92
Rate for Payer: Brighton Health Commercial	$41.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.98
Rate for Payer: Group Health Inc Commercial	$27.92
Rate for Payer: Group Health Inc Medicare	$19.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.92
Rate for Payer: Hamaspik Choice Inc Medicare	$27.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.30

SODIUM ZIRCONIUM CYCLOSILICATE

Facility

$55.85

Hospital Charge Code	41640365
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$44.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.92
Rate for Payer: Aetna Government	$27.92
Rate for Payer: Brighton Health Commercial	$41.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.98
Rate for Payer: Group Health Inc Commercial	$27.92
Rate for Payer: Group Health Inc Medicare	$19.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.92
Rate for Payer: Hamaspik Choice Inc Medicare	$27.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.30

SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PACK [162642]

Facility

$32.82

Service Code	NDC 00310111001
Hospital Charge Code	00310111001
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	$24.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.32
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

Know your out-of-pocket cost for care.

All Charges