St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SULINDAC 200 MG TAB

Facility

$0.75

Hospital Charge Code	41641084
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.51
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility

$142.00

Service Code	HCPCS J3030
Hospital Charge Code	41640916
Hospital Revenue Code	636
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$71.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.00
Rate for Payer: Hamaspik Choice Inc Medicare	$71.00

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility

$142.00

Service Code	HCPCS J3030
Hospital Charge Code	41650916
Hospital Revenue Code	636
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$92.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.96
Rate for Payer: Aetna Government	$51.96
Rate for Payer: Brighton Health Commercial	$85.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.65
Rate for Payer: Group Health Inc Commercial	$71.00
Rate for Payer: Group Health Inc Medicare	$49.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.00
Rate for Payer: Hamaspik Choice Inc Medicare	$71.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$92.30

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility

$142.00

Service Code	HCPCS J3030
Hospital Charge Code	41650916
Hospital Revenue Code	636
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$71.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.00
Rate for Payer: Hamaspik Choice Inc Medicare	$71.00

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility

$142.00

Service Code	HCPCS J3030
Hospital Charge Code	41640916
Hospital Revenue Code	636
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$92.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.96
Rate for Payer: Aetna Government	$51.96
Rate for Payer: Brighton Health Commercial	$85.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.65
Rate for Payer: Group Health Inc Commercial	$71.00
Rate for Payer: Group Health Inc Medicare	$49.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.00
Rate for Payer: Hamaspik Choice Inc Medicare	$71.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$92.30

SUMATRIPTAN SUCCINATE 100 MG PO TABS [13369]

Facility

$25.14

Service Code	NDC 69452034672
Hospital Charge Code	69452034672
Hospital Revenue Code	250
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$20.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.57
Rate for Payer: Aetna Government	$12.57
Rate for Payer: Brighton Health Commercial	$18.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.10
Rate for Payer: Group Health Inc Commercial	$12.57
Rate for Payer: Group Health Inc Medicare	$8.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.57
Rate for Payer: Hamaspik Choice Inc Medicare	$12.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.34

SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN [97343]

Facility

$26.40

Service Code	NDC 55150017301
Hospital Charge Code	55150017301
Hospital Revenue Code	250
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$21.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.20
Rate for Payer: Aetna Government	$13.20
Rate for Payer: Brighton Health Commercial	$19.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.95
Rate for Payer: Group Health Inc Commercial	$13.20
Rate for Payer: Group Health Inc Medicare	$9.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.20
Rate for Payer: Hamaspik Choice Inc Medicare	$13.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.16

SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN [97343]

Facility

$122.50

Service Code	NDC 63323027301
Hospital Charge Code	63323027301
Hospital Revenue Code	250
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$98.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.25
Rate for Payer: Aetna Government	$61.25
Rate for Payer: Brighton Health Commercial	$91.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$98.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.30
Rate for Payer: Group Health Inc Commercial	$61.25
Rate for Payer: Group Health Inc Medicare	$42.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.25
Rate for Payer: Hamaspik Choice Inc Medicare	$61.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$79.62

SUPERCROSS MICRO CATH 90* #5304

Facility

$1,030.00

Service Code	HCPCS C1887
Hospital Charge Code	66523440
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$1,081.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$566.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$618.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$515.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$592.25
Rate for Payer: EmblemHealth Commercial	$515.00
Rate for Payer: Fidelis Medicare Advantage	$1,081.50
Rate for Payer: Group Health Inc Commercial	$515.00
Rate for Payer: Group Health Inc Medicare	$360.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.50

SUPERCROSS MICRO CATH 90* #5304

Facility

$1,030.00

Service Code	HCPCS C1887
Hospital Charge Code	66523440
Hospital Revenue Code	278
Min. Negotiated Rate	$515.00
Max. Negotiated Rate	$515.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00

SUPER CROSS MICRO-CATH 90* #9304

Facility

$1,030.00

Service Code	HCPCS C1887
Hospital Charge Code	65523440
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$1,081.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$566.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$618.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$515.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$592.25
Rate for Payer: EmblemHealth Commercial	$515.00
Rate for Payer: Fidelis Medicare Advantage	$1,081.50
Rate for Payer: Group Health Inc Commercial	$515.00
Rate for Payer: Group Health Inc Medicare	$360.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.50

SUPER CROSS MICRO-CATH 90* #9304

Facility

$1,030.00

Service Code	HCPCS C1887
Hospital Charge Code	65523440
Hospital Revenue Code	278
Min. Negotiated Rate	$515.00
Max. Negotiated Rate	$515.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00

SUPER CROSS MIRCO-CATH 120* #5306

Facility

$1,030.00

Service Code	HCPCS C1887
Hospital Charge Code	66523441
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$1,081.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$566.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$618.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$515.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$592.25
Rate for Payer: EmblemHealth Commercial	$515.00
Rate for Payer: Fidelis Medicare Advantage	$1,081.50
Rate for Payer: Group Health Inc Commercial	$515.00
Rate for Payer: Group Health Inc Medicare	$360.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.50

SUPER CROSS MIRCO-CATH 120* #5306

Facility

$1,030.00

Service Code	HCPCS C1887
Hospital Charge Code	66523441
Hospital Revenue Code	278
Min. Negotiated Rate	$515.00
Max. Negotiated Rate	$515.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.00
Rate for Payer: Hamaspik Choice Inc Medicare	$515.00

SUPERIOR HYPOGASTRIC PLEXUS

Facility

$2,459.50

Service Code	HCPCS 64517
Hospital Charge Code	30305037
Hospital Revenue Code	510
Min. Negotiated Rate	$233.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,054.06
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	$1,054.06
Rate for Payer: Fidelis Essential Plan Aliesa	$895.95
Rate for Payer: Fidelis Essential Plan QHP	$938.11
Rate for Payer: Fidelis Medicare Advantage	$1,054.06
Rate for Payer: Fidelis Qualified Health Plan	$938.11
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	$1,229.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,054.06
Rate for Payer: Healthfirst Medicare Advantage	$895.95
Rate for Payer: Healthfirst QHP	$1,054.06
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,054.06
Rate for Payer: Senior Whole Health Medicare Advantage	$1,054.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,054.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$843.25
Rate for Payer: Wellcare Medicare	$1,001.36

SUPERIOR HYPOGASTRIC PLEXUS

Facility

$2,459.50

Service Code	HCPCS 64517
Hospital Charge Code	30305037
Hospital Revenue Code	510
Rate for Payer: Cash Price	$1,054.06

SUPERTURBOVAC90 W/INTEGRATEDCABLE

Facility

$386.00

Hospital Charge Code	40200958
Hospital Revenue Code	270
Min. Negotiated Rate	$135.10
Max. Negotiated Rate	$308.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$212.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$193.00
Rate for Payer: Aetna Government	$193.00
Rate for Payer: Brighton Health Commercial	$289.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$308.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$262.48
Rate for Payer: Group Health Inc Commercial	$193.00
Rate for Payer: Group Health Inc Medicare	$135.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$193.00
Rate for Payer: Hamaspik Choice Inc Medicare	$193.00

SUPERV HAND & LOAD

Facility

$258.40

Service Code	HCPCS 77790
Hospital Charge Code	66542964
Hospital Revenue Code	342
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$206.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.63
Rate for Payer: Aetna Government	$19.63
Rate for Payer: Brighton Health Commercial	$193.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$175.71
Rate for Payer: Group Health Inc Commercial	$129.20
Rate for Payer: Group Health Inc Medicare	$90.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.20
Rate for Payer: Hamaspik Choice Inc Medicare	$129.20

Support Collar

Facility

$167.27

Hospital Charge Code	40205980
Hospital Revenue Code	270
Min. Negotiated Rate	$58.54
Max. Negotiated Rate	$133.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$92.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$83.64
Rate for Payer: Aetna Government	$83.64
Rate for Payer: Brighton Health Commercial	$125.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.74
Rate for Payer: Group Health Inc Commercial	$83.64
Rate for Payer: Group Health Inc Medicare	$58.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.64
Rate for Payer: Hamaspik Choice Inc Medicare	$83.64

SUPPORTER, ATHL, W/LS, XL, 41.5

Facility

$49.95

Hospital Charge Code	64901260
Hospital Revenue Code	270
Min. Negotiated Rate	$17.48
Max. Negotiated Rate	$39.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.98
Rate for Payer: Aetna Government	$24.98
Rate for Payer: Brighton Health Commercial	$37.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.97
Rate for Payer: Group Health Inc Commercial	$24.98
Rate for Payer: Group Health Inc Medicare	$17.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.98
Rate for Payer: Hamaspik Choice Inc Medicare	$24.98

SUPPORT KNEE NEOP 12-13-1/2 SM

Facility

$62.23

Hospital Charge Code	64902844
Hospital Revenue Code	270
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$49.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.12
Rate for Payer: Aetna Government	$31.12
Rate for Payer: Brighton Health Commercial	$46.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.32
Rate for Payer: Group Health Inc Commercial	$31.12
Rate for Payer: Group Health Inc Medicare	$21.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.12
Rate for Payer: Hamaspik Choice Inc Medicare	$31.12

SUPPORT KNEE NEOP 13-1/2-15 MED

Facility

$62.23

Hospital Charge Code	64902840
Hospital Revenue Code	270
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$49.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.12
Rate for Payer: Aetna Government	$31.12
Rate for Payer: Brighton Health Commercial	$46.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.32
Rate for Payer: Group Health Inc Commercial	$31.12
Rate for Payer: Group Health Inc Medicare	$21.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.12
Rate for Payer: Hamaspik Choice Inc Medicare	$31.12

SUPPORT KNEE NEOP 15-16 LARGE

Facility

$62.23

Hospital Charge Code	64902842
Hospital Revenue Code	270
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$49.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.12
Rate for Payer: Aetna Government	$31.12
Rate for Payer: Brighton Health Commercial	$46.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.32
Rate for Payer: Group Health Inc Commercial	$31.12
Rate for Payer: Group Health Inc Medicare	$21.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.12
Rate for Payer: Hamaspik Choice Inc Medicare	$31.12

SUPPORT KNEE NEOPR UNIV OPEN PAT

Facility

$47.70

Hospital Charge Code	64902838
Hospital Revenue Code	270
Min. Negotiated Rate	$16.70
Max. Negotiated Rate	$38.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.85
Rate for Payer: Aetna Government	$23.85
Rate for Payer: Brighton Health Commercial	$35.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.44
Rate for Payer: Group Health Inc Commercial	$23.85
Rate for Payer: Group Health Inc Medicare	$16.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.85
Rate for Payer: Hamaspik Choice Inc Medicare	$23.85

SUPRAPUBIC CYSTOSTOMY

Facility

$5,365.58

Service Code	HCPCS 51040
Hospital Charge Code	40123040
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,355.42

Know your out-of-pocket cost for care.

All Charges