St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

KIT, ACHILLES SPEEDBRIDGE

Facility

$4,350.00

Service Code	HCPCS C1713
Hospital Charge Code	64905475
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,567.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,392.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,610.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,501.25
Rate for Payer: EmblemHealth Commercial	$2,175.00
Rate for Payer: Fidelis Medicare Advantage	$4,567.50
Rate for Payer: Group Health Inc Commercial	$2,175.00
Rate for Payer: Group Health Inc Medicare	$1,522.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,827.50

KIT ANKLE DISTRACTOR STRAP

Facility

$832.50

Hospital Charge Code	64904434
Hospital Revenue Code	270
Min. Negotiated Rate	$291.38
Max. Negotiated Rate	$666.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$457.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$416.25
Rate for Payer: Aetna Government	$416.25
Rate for Payer: Brighton Health Commercial	$624.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$666.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$566.10
Rate for Payer: Group Health Inc Commercial	$416.25
Rate for Payer: Group Health Inc Medicare	$291.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$416.25
Rate for Payer: Hamaspik Choice Inc Medicare	$416.25

KIT, ASSEMBLY

Facility

$1,367.50

Hospital Charge Code	64906115
Hospital Revenue Code	270
Min. Negotiated Rate	$478.62
Max. Negotiated Rate	$1,094.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$752.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$683.75
Rate for Payer: Aetna Government	$683.75
Rate for Payer: Brighton Health Commercial	$1,025.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,094.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$929.90
Rate for Payer: Group Health Inc Commercial	$683.75
Rate for Payer: Group Health Inc Medicare	$478.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$683.75
Rate for Payer: Hamaspik Choice Inc Medicare	$683.75

KIT ASSEMBLY REGULAR, TITAN

Facility

$970.00

Hospital Charge Code	40203031
Hospital Revenue Code	272
Min. Negotiated Rate	$339.50
Max. Negotiated Rate	$776.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$533.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$485.00
Rate for Payer: Aetna Government	$485.00
Rate for Payer: Brighton Health Commercial	$727.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$776.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$659.60
Rate for Payer: Group Health Inc Commercial	$485.00
Rate for Payer: Group Health Inc Medicare	$339.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$485.00
Rate for Payer: Hamaspik Choice Inc Medicare	$485.00

KIT ASSEMBLY TITAN

Facility

$1,182.50

Hospital Charge Code	64904962
Hospital Revenue Code	270
Min. Negotiated Rate	$413.88
Max. Negotiated Rate	$946.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$650.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$591.25
Rate for Payer: Aetna Government	$591.25
Rate for Payer: Brighton Health Commercial	$886.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$946.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$804.10
Rate for Payer: Group Health Inc Commercial	$591.25
Rate for Payer: Group Health Inc Medicare	$413.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$591.25
Rate for Payer: Hamaspik Choice Inc Medicare	$591.25

KIT AUTOTRANSFUSION ACCESSORY

Facility

$44.47

Hospital Charge Code	64902523
Hospital Revenue Code	270
Min. Negotiated Rate	$15.56
Max. Negotiated Rate	$35.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.24
Rate for Payer: Aetna Government	$22.24
Rate for Payer: Brighton Health Commercial	$33.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.24
Rate for Payer: Group Health Inc Commercial	$22.24
Rate for Payer: Group Health Inc Medicare	$15.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.24
Rate for Payer: Hamaspik Choice Inc Medicare	$22.24

KIT BACTISEAL CATHETER

Facility

$928.00

Hospital Charge Code	64906235
Hospital Revenue Code	279
Min. Negotiated Rate	$324.80
Max. Negotiated Rate	$742.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$510.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$464.00
Rate for Payer: Aetna Government	$464.00
Rate for Payer: Brighton Health Commercial	$696.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$742.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$631.04
Rate for Payer: Group Health Inc Commercial	$464.00
Rate for Payer: Group Health Inc Medicare	$324.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$464.00
Rate for Payer: Hamaspik Choice Inc Medicare	$464.00

KIT BAND ID TAY SPA FRM FSTFX

Facility

$1,064.53

Hospital Charge Code	64904633
Hospital Revenue Code	270
Min. Negotiated Rate	$372.59
Max. Negotiated Rate	$851.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$585.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$532.26
Rate for Payer: Aetna Government	$532.26
Rate for Payer: Brighton Health Commercial	$798.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$851.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$723.88
Rate for Payer: Group Health Inc Commercial	$532.26
Rate for Payer: Group Health Inc Medicare	$372.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.26
Rate for Payer: Hamaspik Choice Inc Medicare	$532.26

KIT,BLOOD SAMPLING,PRO-VENT PL

Facility

$1.25

Hospital Charge Code	64901326
Hospital Revenue Code	270
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$1.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.85
Rate for Payer: Group Health Inc Commercial	$0.63
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63

KIT, BMAC GRAFT

Facility

$6,500.00

Hospital Charge Code	64906170
Hospital Revenue Code	270
Min. Negotiated Rate	$2,275.00
Max. Negotiated Rate	$5,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,575.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,250.00
Rate for Payer: Aetna Government	$3,250.00
Rate for Payer: Brighton Health Commercial	$4,875.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,420.00
Rate for Payer: Group Health Inc Commercial	$3,250.00
Rate for Payer: Group Health Inc Medicare	$2,275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,250.00

KIT BONE CEMENT CALC PHOS

Facility

$7,777.13

Hospital Charge Code	64904490
Hospital Revenue Code	270
Min. Negotiated Rate	$2,722.00
Max. Negotiated Rate	$6,221.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,277.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,888.56
Rate for Payer: Aetna Government	$3,888.56
Rate for Payer: Brighton Health Commercial	$5,832.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,221.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,288.45
Rate for Payer: Group Health Inc Commercial	$3,888.56
Rate for Payer: Group Health Inc Medicare	$2,722.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,888.56
Rate for Payer: Hamaspik Choice Inc Medicare	$3,888.56

KIT BONE CEMENT VAC SYST CART

Facility

$385.00

Hospital Charge Code	64904446
Hospital Revenue Code	270
Min. Negotiated Rate	$134.75
Max. Negotiated Rate	$308.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$211.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$192.50
Rate for Payer: Aetna Government	$192.50
Rate for Payer: Brighton Health Commercial	$288.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$308.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$261.80
Rate for Payer: Group Health Inc Commercial	$192.50
Rate for Payer: Group Health Inc Medicare	$134.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.50
Rate for Payer: Hamaspik Choice Inc Medicare	$192.50

KIT CANNULA UNIVERSAL

Facility

$66.15

Hospital Charge Code	64903018
Hospital Revenue Code	270
Min. Negotiated Rate	$23.15
Max. Negotiated Rate	$52.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$33.08
Rate for Payer: Aetna Government	$33.08
Rate for Payer: Brighton Health Commercial	$49.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.98
Rate for Payer: Group Health Inc Commercial	$33.08
Rate for Payer: Group Health Inc Medicare	$23.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.08
Rate for Payer: Hamaspik Choice Inc Medicare	$33.08

KIT CATARACT PATIENT CARE 2

Facility

$10.00

Hospital Charge Code	64904780
Hospital Revenue Code	270
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00

KIT,CATHETER,16 G X 20 CE

Facility

$58.82

Hospital Charge Code	64901659
Hospital Revenue Code	279
Min. Negotiated Rate	$20.59
Max. Negotiated Rate	$47.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.41
Rate for Payer: Aetna Government	$29.41
Rate for Payer: Brighton Health Commercial	$44.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.00
Rate for Payer: Group Health Inc Commercial	$29.41
Rate for Payer: Group Health Inc Medicare	$20.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.41
Rate for Payer: Hamaspik Choice Inc Medicare	$29.41

KIT CATHETER ON-OFF W/BIOPATCH

Facility

$460.00

Service Code	HCPCS C1750
Hospital Charge Code	40208005
Hospital Revenue Code	278
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$483.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$253.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.25
Rate for Payer: Aetna Government	$16.25
Rate for Payer: Brighton Health Commercial	$276.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$230.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$264.50
Rate for Payer: EmblemHealth Commercial	$230.00
Rate for Payer: Fidelis Medicare Advantage	$483.00
Rate for Payer: Group Health Inc Commercial	$230.00
Rate for Payer: Group Health Inc Medicare	$161.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$299.00

KIT CATHETER ON-OFF W/BIOPATCH

Facility

$460.00

Service Code	HCPCS C1750
Hospital Charge Code	40208005
Hospital Revenue Code	278
Min. Negotiated Rate	$230.00
Max. Negotiated Rate	$230.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00

KIT,CATHETER,RADIAL ARTERY,20

Facility

$20.03

Hospital Charge Code	64901067
Hospital Revenue Code	279
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$16.02
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	$15.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.62
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

KIT, CATH, MAHURKAR 12FR 20

Facility

$210.96

Hospital Charge Code	64901022
Hospital Revenue Code	279
Min. Negotiated Rate	$73.84
Max. Negotiated Rate	$168.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.48
Rate for Payer: Aetna Government	$105.48
Rate for Payer: Brighton Health Commercial	$158.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$143.45
Rate for Payer: Group Health Inc Commercial	$105.48
Rate for Payer: Group Health Inc Medicare	$73.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.48
Rate for Payer: Hamaspik Choice Inc Medicare	$105.48

KIT,CLOSED SUCTION,14F,4.6,21.3

Facility

$40.00

Hospital Charge Code	64901191
Hospital Revenue Code	270
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$32.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.00
Rate for Payer: Aetna Government	$20.00
Rate for Payer: Brighton Health Commercial	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.20
Rate for Payer: Group Health Inc Commercial	$20.00
Rate for Payer: Group Health Inc Medicare	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20.00

KIT,CLOSED SUCTION 14FR,4.6 12

Facility

$40.00

Hospital Charge Code	64901199
Hospital Revenue Code	270
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$32.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.00
Rate for Payer: Aetna Government	$20.00
Rate for Payer: Brighton Health Commercial	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.20
Rate for Payer: Group Health Inc Commercial	$20.00
Rate for Payer: Group Health Inc Medicare	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20.00

KIT CRANIAL ACCESS

Facility

$895.00

Hospital Charge Code	64903885
Hospital Revenue Code	270
Min. Negotiated Rate	$313.25
Max. Negotiated Rate	$716.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$492.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$447.50
Rate for Payer: Aetna Government	$447.50
Rate for Payer: Brighton Health Commercial	$671.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$716.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$608.60
Rate for Payer: Group Health Inc Commercial	$447.50
Rate for Payer: Group Health Inc Medicare	$313.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$447.50
Rate for Payer: Hamaspik Choice Inc Medicare	$447.50

KIT CVC PED DBL LUMEN 4F 13CM

Facility

$453.93

Hospital Charge Code	64903223
Hospital Revenue Code	270
Min. Negotiated Rate	$158.88
Max. Negotiated Rate	$363.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$249.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$226.96
Rate for Payer: Aetna Government	$226.96
Rate for Payer: Brighton Health Commercial	$340.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$363.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$308.67
Rate for Payer: Group Health Inc Commercial	$226.96
Rate for Payer: Group Health Inc Medicare	$158.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.96
Rate for Payer: Hamaspik Choice Inc Medicare	$226.96

KIT DENVER II TEST

Facility

$200.00

Hospital Charge Code	64903236
Hospital Revenue Code	270
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$160.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$100.00
Rate for Payer: Aetna Government	$100.00
Rate for Payer: Brighton Health Commercial	$150.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.00
Rate for Payer: Group Health Inc Commercial	$100.00
Rate for Payer: Group Health Inc Medicare	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00

KIT FIBERTAK

Facility

$487.50

Hospital Charge Code	64907348
Hospital Revenue Code	270
Min. Negotiated Rate	$170.62
Max. Negotiated Rate	$390.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$268.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$243.75
Rate for Payer: Aetna Government	$243.75
Rate for Payer: Brighton Health Commercial	$365.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$390.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$331.50
Rate for Payer: Group Health Inc Commercial	$243.75
Rate for Payer: Group Health Inc Medicare	$170.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75

Know your out-of-pocket cost for care.

All Charges