St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SUCTION LIPECTOMY, L EXTR

Facility

$9,017.48

Service Code	HCPCS 15879
Hospital Charge Code	40019930
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,763.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,148.81
Rate for Payer: Aetna Government	$4,148.81
Rate for Payer: Brighton Health Commercial	$6,763.11
Rate for Payer: Cash Price	$4,148.81
Rate for Payer: Cash Price	$4,148.81
Rate for Payer: Cash Price	$4,148.81
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,148.81
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: Elderplan Medicare Advantage	$4,148.81
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,526.49
Rate for Payer: Fidelis Essential Plan QHP	$3,692.44
Rate for Payer: Fidelis Medicare Advantage	$4,148.81
Rate for Payer: Fidelis Qualified Health Plan	$3,692.44
Rate for Payer: Group Health Inc Commercial	$4,148.81
Rate for Payer: Group Health Inc Medicare	$4,148.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,508.74
Rate for Payer: Hamaspik Choice Inc Medicare	$4,148.81
Rate for Payer: Healthfirst Medicare Advantage	$3,526.49
Rate for Payer: Healthfirst QHP	$4,148.81
Rate for Payer: Senior Whole Health Medicare Advantage	$4,148.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,148.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,319.05
Rate for Payer: Wellcare Medicare	$3,941.37

SUCTION MACHINE, PER DAY

Facility

$45.36

Hospital Charge Code	40200840
Hospital Revenue Code	270
Min. Negotiated Rate	$15.88
Max. Negotiated Rate	$36.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.68
Rate for Payer: Aetna Government	$22.68
Rate for Payer: Brighton Health Commercial	$34.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.84
Rate for Payer: Group Health Inc Commercial	$22.68
Rate for Payer: Group Health Inc Medicare	$15.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.68
Rate for Payer: Hamaspik Choice Inc Medicare	$22.68

suction tips

Facility

$1.77

Hospital Charge Code	40000345
Hospital Revenue Code	272
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.89
Rate for Payer: Aetna Government	$0.89
Rate for Payer: Brighton Health Commercial	$1.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.20
Rate for Payer: Group Health Inc Commercial	$0.89
Rate for Payer: Group Health Inc Medicare	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.89
Rate for Payer: Hamaspik Choice Inc Medicare	$0.89

SUCTION TUBING

Facility

$7.80

Hospital Charge Code	40000350
Hospital Revenue Code	272
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$6.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.90
Rate for Payer: Aetna Government	$3.90
Rate for Payer: Brighton Health Commercial	$5.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.30
Rate for Payer: Group Health Inc Commercial	$3.90
Rate for Payer: Group Health Inc Medicare	$2.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.90
Rate for Payer: Hamaspik Choice Inc Medicare	$3.90

SUGAMMADEX 200MG/2ML INJ

Facility

$236.18

Service Code	HCPCS J3490
Hospital Charge Code	41656626
Hospital Revenue Code	636
Min. Negotiated Rate	$118.09
Max. Negotiated Rate	$118.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.09
Rate for Payer: Hamaspik Choice Inc Medicare	$118.09

SUGAMMADEX 200MG/2ML INJ

Facility

$236.18

Service Code	HCPCS J3490
Hospital Charge Code	41646626
Hospital Revenue Code	636
Min. Negotiated Rate	$82.66
Max. Negotiated Rate	$153.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$129.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$118.09
Rate for Payer: Aetna Government	$118.09
Rate for Payer: Brighton Health Commercial	$141.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$118.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$135.80
Rate for Payer: Group Health Inc Commercial	$118.09
Rate for Payer: Group Health Inc Medicare	$82.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.09
Rate for Payer: Hamaspik Choice Inc Medicare	$118.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$153.52

SUGAMMADEX 200MG/2ML INJ

Facility

$236.18

Service Code	HCPCS J3490
Hospital Charge Code	41656626
Hospital Revenue Code	636
Min. Negotiated Rate	$82.66
Max. Negotiated Rate	$153.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$129.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$118.09
Rate for Payer: Aetna Government	$118.09
Rate for Payer: Brighton Health Commercial	$141.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$118.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$135.80
Rate for Payer: Group Health Inc Commercial	$118.09
Rate for Payer: Group Health Inc Medicare	$82.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.09
Rate for Payer: Hamaspik Choice Inc Medicare	$118.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$153.52

SUGAMMADEX 200MG/2ML INJ

Facility

$236.18

Service Code	HCPCS J3490
Hospital Charge Code	41646626
Hospital Revenue Code	636
Min. Negotiated Rate	$118.09
Max. Negotiated Rate	$118.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.09
Rate for Payer: Hamaspik Choice Inc Medicare	$118.09

SUGAMMADEX 500MG/5ML INJ

Facility

$432.59

Service Code	HCPCS J3490
Hospital Charge Code	41646627
Hospital Revenue Code	636
Min. Negotiated Rate	$216.30
Max. Negotiated Rate	$216.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.30
Rate for Payer: Hamaspik Choice Inc Medicare	$216.30

SUGAMMADEX 500MG/5ML INJ

Facility

$432.59

Service Code	HCPCS J3490
Hospital Charge Code	41656627
Hospital Revenue Code	636
Min. Negotiated Rate	$216.30
Max. Negotiated Rate	$216.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.30
Rate for Payer: Hamaspik Choice Inc Medicare	$216.30

SUGAMMADEX 500MG/5ML INJ

Facility

$432.59

Service Code	HCPCS J3490
Hospital Charge Code	41656627
Hospital Revenue Code	636
Min. Negotiated Rate	$151.41
Max. Negotiated Rate	$281.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$237.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$216.30
Rate for Payer: Aetna Government	$216.30
Rate for Payer: Brighton Health Commercial	$259.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$216.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$248.74
Rate for Payer: Group Health Inc Commercial	$216.30
Rate for Payer: Group Health Inc Medicare	$151.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.30
Rate for Payer: Hamaspik Choice Inc Medicare	$216.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$281.18

SUGAMMADEX 500MG/5ML INJ

Facility

$432.59

Service Code	HCPCS J3490
Hospital Charge Code	41646627
Hospital Revenue Code	636
Min. Negotiated Rate	$151.41
Max. Negotiated Rate	$281.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$237.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$216.30
Rate for Payer: Aetna Government	$216.30
Rate for Payer: Brighton Health Commercial	$259.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$216.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$248.74
Rate for Payer: Group Health Inc Commercial	$216.30
Rate for Payer: Group Health Inc Medicare	$151.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.30
Rate for Payer: Hamaspik Choice Inc Medicare	$216.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$281.18

SUGAMMADEX SODIUM 200 MG/2ML IV SOLN [131263]

Facility

$77.80

Service Code	NDC 00006542312
Hospital Charge Code	00006542312
Hospital Revenue Code	278
Min. Negotiated Rate	$38.90
Max. Negotiated Rate	$38.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.90
Rate for Payer: Hamaspik Choice Inc Medicare	$38.90

SUGAMMADEX SODIUM 200 MG/2ML IV SOLN [131263]

Facility

$77.80

Service Code	NDC 00006542312
Hospital Charge Code	00006542312
Hospital Revenue Code	278
Min. Negotiated Rate	$27.23
Max. Negotiated Rate	$81.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.90
Rate for Payer: Aetna Government	$38.90
Rate for Payer: Brighton Health Commercial	$46.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.73
Rate for Payer: EmblemHealth Commercial	$38.90
Rate for Payer: Fidelis Medicare Advantage	$81.69
Rate for Payer: Group Health Inc Commercial	$38.90
Rate for Payer: Group Health Inc Medicare	$27.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.90
Rate for Payer: Hamaspik Choice Inc Medicare	$38.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.57

SUGAMMADEX SODIUM 500 MG/5ML IV SOLN [131267]

Facility

$57.00

Service Code	NDC 00006542515
Hospital Charge Code	00006542515
Hospital Revenue Code	278
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$59.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.50
Rate for Payer: Aetna Government	$28.50
Rate for Payer: Brighton Health Commercial	$34.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.78
Rate for Payer: EmblemHealth Commercial	$28.50
Rate for Payer: Fidelis Medicare Advantage	$59.85
Rate for Payer: Group Health Inc Commercial	$28.50
Rate for Payer: Group Health Inc Medicare	$19.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.50
Rate for Payer: Hamaspik Choice Inc Medicare	$28.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37.05

SUGAMMADEX SODIUM 500 MG/5ML IV SOLN [131267]

Facility

$57.00

Service Code	NDC 00006542505
Hospital Charge Code	00006542505
Hospital Revenue Code	278
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.50
Rate for Payer: Hamaspik Choice Inc Medicare	$28.50

SUGAMMADEX SODIUM 500 MG/5ML IV SOLN [131267]

Facility

$57.00

Service Code	NDC 00006542515
Hospital Charge Code	00006542515
Hospital Revenue Code	278
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.50
Rate for Payer: Hamaspik Choice Inc Medicare	$28.50

SUGAMMADEX SODIUM 500 MG/5ML IV SOLN [131267]

Facility

$57.00

Service Code	NDC 00006542505
Hospital Charge Code	00006542505
Hospital Revenue Code	278
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$59.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.50
Rate for Payer: Aetna Government	$28.50
Rate for Payer: Brighton Health Commercial	$34.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.78
Rate for Payer: EmblemHealth Commercial	$28.50
Rate for Payer: Fidelis Medicare Advantage	$59.85
Rate for Payer: Group Health Inc Commercial	$28.50
Rate for Payer: Group Health Inc Medicare	$19.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.50
Rate for Payer: Hamaspik Choice Inc Medicare	$28.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37.05

SULFACETAMIDE 10% OPHTHALMIC SOLN

Facility

$17.36

Hospital Charge Code	41644368
Hospital Revenue Code	250
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$13.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.68
Rate for Payer: Aetna Government	$8.68
Rate for Payer: Brighton Health Commercial	$13.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.80
Rate for Payer: Group Health Inc Commercial	$8.68
Rate for Payer: Group Health Inc Medicare	$6.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.68
Rate for Payer: Hamaspik Choice Inc Medicare	$8.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.28

SULFACETAMIDE 10% OPHTHALMIC SOLN

Facility

$17.36

Hospital Charge Code	41654368
Hospital Revenue Code	250
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$13.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.68
Rate for Payer: Aetna Government	$8.68
Rate for Payer: Brighton Health Commercial	$13.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.80
Rate for Payer: Group Health Inc Commercial	$8.68
Rate for Payer: Group Health Inc Medicare	$6.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.68
Rate for Payer: Hamaspik Choice Inc Medicare	$8.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.28

SULFACETAMIDE + PREDNISOLONE SUSPENSION

Facility

$24.00

Hospital Charge Code	41650522
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$19.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.00
Rate for Payer: Aetna Government	$12.00
Rate for Payer: Brighton Health Commercial	$18.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.32
Rate for Payer: Group Health Inc Commercial	$12.00
Rate for Payer: Group Health Inc Medicare	$8.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.00
Rate for Payer: Hamaspik Choice Inc Medicare	$12.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.60

SULFACETAMIDE + PREDNISOLONE SUSPENSION

Facility

$24.00

Hospital Charge Code	41640522
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$19.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.00
Rate for Payer: Aetna Government	$12.00
Rate for Payer: Brighton Health Commercial	$18.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.32
Rate for Payer: Group Health Inc Commercial	$12.00
Rate for Payer: Group Health Inc Medicare	$8.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.00
Rate for Payer: Hamaspik Choice Inc Medicare	$12.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.60

SULFACETAMIDE SODIUM 10 % OP SOLN [7359]

Facility

$4.07

Service Code	NDC 24208067004
Hospital Charge Code	24208067004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$3.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.03
Rate for Payer: Aetna Government	$2.03
Rate for Payer: Brighton Health Commercial	$3.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.77
Rate for Payer: Group Health Inc Commercial	$2.03
Rate for Payer: Group Health Inc Medicare	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.03
Rate for Payer: Hamaspik Choice Inc Medicare	$2.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.64

SULFADIAZINE 500 MG PO TABS [7554]

Facility

$20.04

Service Code	NDC 42806075760
Hospital Charge Code	42806075760
Hospital Revenue Code	250
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$16.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.02
Rate for Payer: Aetna Government	$10.02
Rate for Payer: Brighton Health Commercial	$15.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.63
Rate for Payer: Group Health Inc Commercial	$10.02
Rate for Payer: Group Health Inc Medicare	$7.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.02
Rate for Payer: Hamaspik Choice Inc Medicare	$10.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.02

SULFADIAZINE 500 MG TAB

Facility

$5.00

Hospital Charge Code	41643470
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

Know your out-of-pocket cost for care.

All Charges