St. Barnabas Hospital

All Charges

Charge

Type

Price

045% SODIUM CHLORIDE- 1000CC

Facility OP

$9.92

Hospital Charge Code	40504020
Hospital Revenue Code	260
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$7.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.96
Rate for Payer: Aetna Government	$4.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.75
Rate for Payer: Group Health Inc Commercial	$4.96
Rate for Payer: Group Health Inc Medicare	$3.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.96
Rate for Payer: Hamaspik Choice Inc Medicare	$4.96

045% SODIUM CHLORIDE -500CC

Facility OP

$8.15

Hospital Charge Code	40504021
Hospital Revenue Code	260
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$6.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.54
Rate for Payer: Group Health Inc Commercial	$4.08
Rate for Payer: Group Health Inc Medicare	$2.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.08
Rate for Payer: Hamaspik Choice Inc Medicare	$4.08

10% ALCOL-5% DEXTRS WAT 1000CC

Facility OP

$20.20

Hospital Charge Code	40509780
Hospital Revenue Code	260
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$16.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.10
Rate for Payer: Aetna Government	$10.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.74
Rate for Payer: Group Health Inc Commercial	$10.10
Rate for Payer: Group Health Inc Medicare	$7.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.10
Rate for Payer: Hamaspik Choice Inc Medicare	$10.10

10% DEX IN .9 NS 1000CC

Facility OP

$10.64

Hospital Charge Code	40509786
Hospital Revenue Code	260
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$8.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.32
Rate for Payer: Aetna Government	$5.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.24
Rate for Payer: Group Health Inc Commercial	$5.32
Rate for Payer: Group Health Inc Medicare	$3.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.32
Rate for Payer: Hamaspik Choice Inc Medicare	$5.32

10% DEX IN .9 NS 500CC

Facility OP

$8.86

Hospital Charge Code	40509785
Hospital Revenue Code	260
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$7.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.43
Rate for Payer: Aetna Government	$4.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.02
Rate for Payer: Group Health Inc Commercial	$4.43
Rate for Payer: Group Health Inc Medicare	$3.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.43
Rate for Payer: Hamaspik Choice Inc Medicare	$4.43

10% DEXTROSE 1000 CC

Facility OP

$4.97

Hospital Charge Code	40501200
Hospital Revenue Code	260
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$3.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.48
Rate for Payer: Aetna Government	$2.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.38
Rate for Payer: Group Health Inc Commercial	$2.48
Rate for Payer: Group Health Inc Medicare	$1.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.48
Rate for Payer: Hamaspik Choice Inc Medicare	$2.48

10H CURV PLT UP MALL CNDSD

Facility OP

$366.00

Service Code	HCPCS C1713
Hospital Charge Code	40209800
Hospital Revenue Code	278
Min. Negotiated Rate	$128.10
Max. Negotiated Rate	$384.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$201.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$183.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.45
Rate for Payer: Fidelis Medicare Advantage	$384.30
Rate for Payer: Group Health Inc Commercial	$183.00
Rate for Payer: Group Health Inc Medicare	$128.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$183.00
Rate for Payer: Hamaspik Choice Inc Medicare	$183.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$237.90

10H CURV PLT UP MALL CNDSD

Facility IP

$366.00

Service Code	HCPCS C1713
Hospital Charge Code	40209800
Hospital Revenue Code	278
Min. Negotiated Rate	$183.00
Max. Negotiated Rate	$183.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$183.00
Rate for Payer: Hamaspik Choice Inc Medicare	$183.00

10H CURV PLT UPPERFACE

Facility IP

$2,036.00

Service Code	HCPCS C1781
Hospital Charge Code	40209802
Hospital Revenue Code	278
Min. Negotiated Rate	$1,018.00
Max. Negotiated Rate	$1,018.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,018.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.00

10H CURV PLT UPPERFACE

Facility OP

$2,036.00

Service Code	HCPCS C1781
Hospital Charge Code	40209802
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,137.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,119.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,018.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,170.70
Rate for Payer: Fidelis Medicare Advantage	$2,137.80
Rate for Payer: Group Health Inc Commercial	$1,018.00
Rate for Payer: Group Health Inc Medicare	$712.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,018.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,323.40

10% INVRT SURG IN WATER-1000CC

Facility OP

$14.53

Hospital Charge Code	40501500
Hospital Revenue Code	260
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$11.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.26
Rate for Payer: Aetna Government	$7.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.88
Rate for Payer: Group Health Inc Commercial	$7.26
Rate for Payer: Group Health Inc Medicare	$5.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.26
Rate for Payer: Hamaspik Choice Inc Medicare	$7.26

10X10 H 3D PLATE UPFC MALLEABLE

Facility OP

$2,130.00

Service Code	HCPCS C1713
Hospital Charge Code	40200577
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,236.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,171.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,065.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,224.75
Rate for Payer: Fidelis Medicare Advantage	$2,236.50
Rate for Payer: Group Health Inc Commercial	$1,065.00
Rate for Payer: Group Health Inc Medicare	$745.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,065.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,065.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,384.50

10X10 H 3D PLATE UPFC MALLEABLE

Facility IP

$2,130.00

Service Code	HCPCS C1713
Hospital Charge Code	40200577
Hospital Revenue Code	278
Min. Negotiated Rate	$1,065.00
Max. Negotiated Rate	$1,065.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,065.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,065.00

10X10H 3D PLT UPPERFACE

Facility OP

$450.00

Service Code	HCPCS C1781
Hospital Charge Code	40209803
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$472.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.75
Rate for Payer: Fidelis Medicare Advantage	$472.50
Rate for Payer: Group Health Inc Commercial	$225.00
Rate for Payer: Group Health Inc Medicare	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.50

10X10H 3D PLT UPPERFACE

Facility IP

$450.00

Service Code	HCPCS C1781
Hospital Charge Code	40209803
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00

10X10H 3D PLT UPPER FC MALLBL

Facility IP

$2,132.00

Service Code	HCPCS C1713
Hospital Charge Code	40209807
Hospital Revenue Code	278
Min. Negotiated Rate	$1,066.00
Max. Negotiated Rate	$1,066.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,066.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,066.00

10X10H 3D PLT UPPER FC MALLBL

Facility OP

$2,132.00

Service Code	HCPCS C1713
Hospital Charge Code	40209807
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,238.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,172.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,066.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,225.90
Rate for Payer: Fidelis Medicare Advantage	$2,238.60
Rate for Payer: Group Health Inc Commercial	$1,066.00
Rate for Payer: Group Health Inc Medicare	$746.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,066.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,066.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,385.80

10X35CM RIGIFLEX ACHALAS

Facility OP

$1,656.00

Hospital Charge Code	40203563
Hospital Revenue Code	272
Min. Negotiated Rate	$579.60
Max. Negotiated Rate	$1,324.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$910.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$828.00
Rate for Payer: Aetna Government	$828.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,324.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,126.08
Rate for Payer: Group Health Inc Commercial	$828.00
Rate for Payer: Group Health Inc Medicare	$579.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$828.00
Rate for Payer: Hamaspik Choice Inc Medicare	$828.00

11MMX360MMX130

Facility IP

$2,650.00

Service Code	HCPCS C1713
Hospital Charge Code	40209808
Hospital Revenue Code	278
Min. Negotiated Rate	$1,325.00
Max. Negotiated Rate	$1,325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,325.00

11MMX360MMX130

Facility OP

$2,650.00

Service Code	HCPCS C1713
Hospital Charge Code	40209808
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,782.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,457.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,325.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,523.75
Rate for Payer: Fidelis Medicare Advantage	$2,782.50
Rate for Payer: Group Health Inc Commercial	$1,325.00
Rate for Payer: Group Health Inc Medicare	$927.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,325.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,722.50

1-1 NURSING SHIFT - CNA

Facility OP

$467.78

Hospital Charge Code	30011001
Hospital Revenue Code	239
Min. Negotiated Rate	$163.72
Max. Negotiated Rate	$374.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$257.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$233.89
Rate for Payer: Aetna Government	$233.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$374.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$318.09
Rate for Payer: Group Health Inc Commercial	$233.89
Rate for Payer: Group Health Inc Medicare	$163.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$233.89
Rate for Payer: Hamaspik Choice Inc Medicare	$233.89

1-1 NURSING SHIFT - RN

Facility OP

$467.78

Hospital Charge Code	30011002
Hospital Revenue Code	239
Min. Negotiated Rate	$163.72
Max. Negotiated Rate	$374.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$257.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$233.89
Rate for Payer: Aetna Government	$233.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$374.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$318.09
Rate for Payer: Group Health Inc Commercial	$233.89
Rate for Payer: Group Health Inc Medicare	$163.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$233.89
Rate for Payer: Hamaspik Choice Inc Medicare	$233.89

11X180MMX125DEG TROCHANTERIC NKIT

Facility IP

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40200573
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

11X180MMX125DEG TROCHANTERIC NKIT

Facility OP

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40200573
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,575.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$862.50
Rate for Payer: Fidelis Medicare Advantage	$1,575.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$975.00

11X300MM X 125 RIGHT

Facility OP

$2,650.00

Service Code	HCPCS C1713
Hospital Charge Code	40200575
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,782.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,457.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,325.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,523.75
Rate for Payer: Fidelis Medicare Advantage	$2,782.50
Rate for Payer: Group Health Inc Commercial	$1,325.00
Rate for Payer: Group Health Inc Medicare	$927.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,325.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,722.50

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