St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SONOGRAM - LIMITED

Facility

$339.45

Service Code	HCPCS 76815 TC
Hospital Charge Code	40250900
Hospital Revenue Code	402
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

SONOGRAM - LIMITED

Facility

$339.45

Service Code	HCPCS 76815 TC
Hospital Charge Code	40250900
Hospital Revenue Code	402
Rate for Payer: Cash Price	$127.14

SORBITOL 70 % SOLN [93927]

Facility

$0.13

Service Code	NDC 46287050030
Hospital Charge Code	46287050030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

SORBITOL 70% SOLUTION

Facility

$1.23

Hospital Charge Code	41642361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.62
Rate for Payer: Aetna Government	$0.62
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.84
Rate for Payer: Group Health Inc Commercial	$0.62
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.80

SORBITOL 70% SOLUTION

Facility

$1.23

Hospital Charge Code	41652361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.62
Rate for Payer: Aetna Government	$0.62
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.84
Rate for Payer: Group Health Inc Commercial	$0.62
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.80

SOTALOL 80 MG TAB

Facility

$0.22

Hospital Charge Code	41651531
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

SOTALOL 80 MG TAB

Facility

$0.22

Hospital Charge Code	41641531
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

SOTALOL HCL 80 MG PO TABS [11421]

Facility

$2.35

Service Code	NDC 69584084110
Hospital Charge Code	69584084110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$1.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.17
Rate for Payer: Aetna Government	$1.17
Rate for Payer: Brighton Health Commercial	$1.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.60
Rate for Payer: Group Health Inc Commercial	$1.17
Rate for Payer: Group Health Inc Medicare	$0.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.17
Rate for Payer: Hamaspik Choice Inc Medicare	$1.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.53

SOTA MED CATH FISH SPLIT 32

Facility

$800.00

Hospital Charge Code	40203377
Hospital Revenue Code	272
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$640.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$440.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$400.00
Rate for Payer: Aetna Government	$400.00
Rate for Payer: Brighton Health Commercial	$600.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$640.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$544.00
Rate for Payer: Group Health Inc Commercial	$400.00
Rate for Payer: Group Health Inc Medicare	$280.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00

SOTA MED CATH FISH SPLIT 32

Facility

$800.00

Hospital Charge Code	40009361
Hospital Revenue Code	272
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$640.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$440.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$400.00
Rate for Payer: Aetna Government	$400.00
Rate for Payer: Brighton Health Commercial	$600.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$640.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$544.00
Rate for Payer: Group Health Inc Commercial	$400.00
Rate for Payer: Group Health Inc Medicare	$280.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00

SOTRADECOL 1% 2ML INJ

Facility

$50.00

Hospital Charge Code	41658005
Hospital Revenue Code	250
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$40.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$37.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.50

SOTRADECOL 1% 2ML INJ

Facility

$50.00

Hospital Charge Code	41648005
Hospital Revenue Code	250
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$40.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$37.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.50

SOTROVIMAB 500MG/8ML(COVID-19MAB)

Facility

$0.01

Service Code	HCPCS Q0247
Hospital Charge Code	41650288
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

SOTROVIMAB 500MG/8ML(COVID-19MAB)

Facility

$0.01

Service Code	HCPCS Q0247
Hospital Charge Code	41650288
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
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	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
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	$0.00
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

SOTROVIMAB 500MG/8ML(COVID-19MAB)

Facility

$0.01

Service Code	HCPCS Q0247
Hospital Charge Code	41640288
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

SOTROVIMAB 500MG/8ML(COVID-19MAB)

Facility

$0.01

Service Code	HCPCS Q0247
Hospital Charge Code	41640288
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
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	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
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	$0.00
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

SOTROVIMAB INFUSION

Facility

$1,357.80

Service Code	HCPCS M0247
Hospital Charge Code	30302526
Hospital Revenue Code	771
Rate for Payer: Cash Price	$546.78

SOTROVIMAB INFUSION

Facility

$1,357.80

Service Code	HCPCS M0247
Hospital Charge Code	30302526
Hospital Revenue Code	771
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$1,086.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$746.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$546.78
Rate for Payer: Aetna Government	$546.78
Rate for Payer: Brighton Health Commercial	$1,018.35
Rate for Payer: Cash Price	$546.78
Rate for Payer: Cash Price	$546.78
Rate for Payer: Cash Price	$546.78
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$546.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,086.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$923.30
Rate for Payer: Elderplan Medicare Advantage	$546.78
Rate for Payer: Fidelis Essential Plan Aliesa	$464.76
Rate for Payer: Fidelis Essential Plan QHP	$486.63
Rate for Payer: Fidelis Medicare Advantage	$546.78
Rate for Payer: Fidelis Qualified Health Plan	$486.63
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	$678.90
Rate for Payer: Hamaspik Choice Inc Medicare	$546.78
Rate for Payer: Healthfirst Medicare Advantage	$464.76
Rate for Payer: Healthfirst QHP	$546.78
Rate for Payer: Senior Whole Health Medicare Advantage	$546.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$546.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$437.42
Rate for Payer: Wellcare Medicare	$519.44

SOUNDS UTERINE DISPOSABLE SIMS

Facility

$4.70

Hospital Charge Code	64903367
Hospital Revenue Code	270
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$3.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.35
Rate for Payer: Aetna Government	$2.35
Rate for Payer: Brighton Health Commercial	$3.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.20
Rate for Payer: Group Health Inc Commercial	$2.35
Rate for Payer: Group Health Inc Medicare	$1.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.35
Rate for Payer: Hamaspik Choice Inc Medicare	$2.35

SP ABCESS CATH. CHANGE

Facility

$711.45

Service Code	HCPCS 43762 TC
Hospital Charge Code	41547458
Hospital Revenue Code	361
Min. Negotiated Rate	$249.01
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$391.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$355.72
Rate for Payer: Aetna Government	$355.72
Rate for Payer: Brighton Health Commercial	$533.59
Rate for Payer: Cash Price	$285.81
Rate for Payer: Cash Price	$285.81
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: Group Health Inc Commercial	$355.72
Rate for Payer: Group Health Inc Medicare	$249.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.72
Rate for Payer: Hamaspik Choice Inc Medicare	$355.72

SP ABCESS CATH. CHANGE

Facility

$711.45

Service Code	HCPCS 43762 TC
Hospital Charge Code	41547458
Hospital Revenue Code	361
Rate for Payer: Cash Price	$285.81

SP ABCESS CATH. CHECK

Facility

$127.89

Service Code	HCPCS 20501 TC
Hospital Charge Code	41547457
Hospital Revenue Code	361
Min. Negotiated Rate	$44.76
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.94
Rate for Payer: Aetna Government	$63.94
Rate for Payer: Brighton Health Commercial	$95.92
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: Group Health Inc Commercial	$63.94
Rate for Payer: Group Health Inc Medicare	$44.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.94
Rate for Payer: Hamaspik Choice Inc Medicare	$63.94

SP ABCESSOGRAM (VIA CATHETER)

Facility

$4,542.00

Service Code	HCPCS 49424 TC
Hospital Charge Code	41547628
Hospital Revenue Code	361
Min. Negotiated Rate	$1,589.70
Max. Negotiated Rate	$3,406.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,498.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,271.00
Rate for Payer: Aetna Government	$2,271.00
Rate for Payer: Brighton Health Commercial	$3,406.50
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: Group Health Inc Commercial	$2,271.00
Rate for Payer: Group Health Inc Medicare	$1,589.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,271.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,271.00

SP ABD PARACENTESIS W/IMAGING

Facility

$2,380.35

Service Code	HCPCS 49083 TC
Hospital Charge Code	41542788
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,048.28

SP ABD PARACENTESIS W/IMAGING

Facility

$2,380.35

Service Code	HCPCS 49083 TC
Hospital Charge Code	41542788
Hospital Revenue Code	361
Min. Negotiated Rate	$833.12
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,309.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,190.18
Rate for Payer: Aetna Government	$1,190.18
Rate for Payer: Brighton Health Commercial	$1,785.26
Rate for Payer: Cash Price	$1,048.28
Rate for Payer: Cash Price	$1,048.28
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: Group Health Inc Commercial	$1,190.18
Rate for Payer: Group Health Inc Medicare	$833.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,190.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1,190.18

Know your out-of-pocket cost for care.

All Charges