St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

KIT NANO SWIVELOCK

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	64907125
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$787.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$412.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$450.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$375.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$431.25
Rate for Payer: EmblemHealth Commercial	$375.00
Rate for Payer: Fidelis Medicare Advantage	$787.50
Rate for Payer: Group Health Inc Commercial	$375.00
Rate for Payer: Group Health Inc Medicare	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$487.50

KIT NANO SWIVELOCK

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	64907125
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00

KIT, NEEDLE GRAFT

Facility

$1,667.50

Hospital Charge Code	64906171
Hospital Revenue Code	270
Min. Negotiated Rate	$583.62
Max. Negotiated Rate	$1,334.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$917.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$833.75
Rate for Payer: Aetna Government	$833.75
Rate for Payer: Brighton Health Commercial	$1,250.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,334.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,133.90
Rate for Payer: Group Health Inc Commercial	$833.75
Rate for Payer: Group Health Inc Medicare	$583.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$833.75
Rate for Payer: Hamaspik Choice Inc Medicare	$833.75

KIT NOVASURE

Facility

$2,250.00

Hospital Charge Code	40206028
Hospital Revenue Code	279
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,800.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,237.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,125.00
Rate for Payer: Aetna Government	$1,125.00
Rate for Payer: Brighton Health Commercial	$1,687.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,530.00
Rate for Payer: Group Health Inc Commercial	$1,125.00
Rate for Payer: Group Health Inc Medicare	$787.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,125.00

KIT OPTIVAC 80G DBL MIX

Facility

$264.00

Hospital Charge Code	40204053
Hospital Revenue Code	279
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$211.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$145.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$132.00
Rate for Payer: Aetna Government	$132.00
Rate for Payer: Brighton Health Commercial	$198.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$211.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.52
Rate for Payer: Group Health Inc Commercial	$132.00
Rate for Payer: Group Health Inc Medicare	$92.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$132.00
Rate for Payer: Hamaspik Choice Inc Medicare	$132.00

KIT OPTIVAC 80G DOUBLE MIX

Facility

$347.50

Hospital Charge Code	64904037
Hospital Revenue Code	270
Min. Negotiated Rate	$121.62
Max. Negotiated Rate	$278.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$191.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$173.75
Rate for Payer: Aetna Government	$173.75
Rate for Payer: Brighton Health Commercial	$260.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$278.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$236.30
Rate for Payer: Group Health Inc Commercial	$173.75
Rate for Payer: Group Health Inc Medicare	$121.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.75
Rate for Payer: Hamaspik Choice Inc Medicare	$173.75

KIT,ORAL,SUCTION,Q4,INC CATH,TH P

Facility

$50.75

Hospital Charge Code	64901121
Hospital Revenue Code	279
Min. Negotiated Rate	$17.76
Max. Negotiated Rate	$40.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.38
Rate for Payer: Aetna Government	$25.38
Rate for Payer: Brighton Health Commercial	$38.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.51
Rate for Payer: Group Health Inc Commercial	$25.38
Rate for Payer: Group Health Inc Medicare	$17.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.38
Rate for Payer: Hamaspik Choice Inc Medicare	$25.38

KIT PATIENT CARE FOR JACKSON TABL

Facility

$100.00

Hospital Charge Code	64904564
Hospital Revenue Code	270
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$80.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.00
Rate for Payer: Aetna Government	$50.00
Rate for Payer: Brighton Health Commercial	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

KIT PATIENT CARE JACKSON TABLE

Facility

$80.00

Hospital Charge Code	40205963
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$64.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.00
Rate for Payer: Aetna Government	$40.00
Rate for Payer: Brighton Health Commercial	$60.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.40
Rate for Payer: Group Health Inc Commercial	$40.00
Rate for Payer: Group Health Inc Medicare	$28.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00

KIT PEG PULL 18FR SAFETY

Facility

$750.00

Hospital Charge Code	64904391
Hospital Revenue Code	270
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$600.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$412.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$375.00
Rate for Payer: Aetna Government	$375.00
Rate for Payer: Brighton Health Commercial	$562.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$510.00
Rate for Payer: Group Health Inc Commercial	$375.00
Rate for Payer: Group Health Inc Medicare	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00

KIT PEG PULL 20FR SAFETY

Facility

$380.00

Hospital Charge Code	40200890
Hospital Revenue Code	270
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$304.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$190.00
Rate for Payer: Aetna Government	$190.00
Rate for Payer: Brighton Health Commercial	$285.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$304.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.40
Rate for Payer: Group Health Inc Commercial	$190.00
Rate for Payer: Group Health Inc Medicare	$133.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.00
Rate for Payer: Hamaspik Choice Inc Medicare	$190.00

KIT PEG PUSH 20FR PREFIL LIDO SYR

Facility

$475.00

Hospital Charge Code	64903213
Hospital Revenue Code	270
Min. Negotiated Rate	$166.25
Max. Negotiated Rate	$380.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$261.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$237.50
Rate for Payer: Aetna Government	$237.50
Rate for Payer: Brighton Health Commercial	$356.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$380.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$323.00
Rate for Payer: Group Health Inc Commercial	$237.50
Rate for Payer: Group Health Inc Medicare	$166.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.50
Rate for Payer: Hamaspik Choice Inc Medicare	$237.50

KITPEG PUSH 20FR PRE-FIL LIDO SYR

Facility

$380.00

Hospital Charge Code	40209769
Hospital Revenue Code	270
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$304.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$190.00
Rate for Payer: Aetna Government	$190.00
Rate for Payer: Brighton Health Commercial	$285.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$304.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.40
Rate for Payer: Group Health Inc Commercial	$190.00
Rate for Payer: Group Health Inc Medicare	$133.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.00
Rate for Payer: Hamaspik Choice Inc Medicare	$190.00

KIT PEG PUSH 20FR STANDARD

Facility

$342.03

Hospital Charge Code	64903098
Hospital Revenue Code	270
Min. Negotiated Rate	$119.71
Max. Negotiated Rate	$273.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$188.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$171.02
Rate for Payer: Aetna Government	$171.02
Rate for Payer: Brighton Health Commercial	$256.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$273.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$232.58
Rate for Payer: Group Health Inc Commercial	$171.02
Rate for Payer: Group Health Inc Medicare	$119.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.02
Rate for Payer: Hamaspik Choice Inc Medicare	$171.02

KIT PEG PUSH 24FR PREFIL LIDO SYR

Facility

$493.75

Hospital Charge Code	64903215
Hospital Revenue Code	270
Min. Negotiated Rate	$172.81
Max. Negotiated Rate	$395.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$271.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.88
Rate for Payer: Aetna Government	$246.88
Rate for Payer: Brighton Health Commercial	$370.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$395.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$335.75
Rate for Payer: Group Health Inc Commercial	$246.88
Rate for Payer: Group Health Inc Medicare	$172.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$246.88
Rate for Payer: Hamaspik Choice Inc Medicare	$246.88

KIT PEG SAFETY

Facility

$395.00

Hospital Charge Code	40200891
Hospital Revenue Code	270
Min. Negotiated Rate	$138.25
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$197.50
Rate for Payer: Aetna Government	$197.50
Rate for Payer: Brighton Health Commercial	$296.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$316.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$268.60
Rate for Payer: Group Health Inc Commercial	$197.50
Rate for Payer: Group Health Inc Medicare	$138.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.50
Rate for Payer: Hamaspik Choice Inc Medicare	$197.50

KIT PERM CATH DUAL LUME 36CM

Facility

$2,663.88

Hospital Charge Code	64902797
Hospital Revenue Code	279
Min. Negotiated Rate	$932.36
Max. Negotiated Rate	$2,131.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,465.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,331.94
Rate for Payer: Aetna Government	$1,331.94
Rate for Payer: Brighton Health Commercial	$1,997.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,131.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,811.44
Rate for Payer: Group Health Inc Commercial	$1,331.94
Rate for Payer: Group Health Inc Medicare	$932.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,331.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1,331.94

KIT PERSONAL

Facility

$1.83

Hospital Charge Code	64901573
Hospital Revenue Code	270
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$1.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.92
Rate for Payer: Aetna Government	$0.92
Rate for Payer: Brighton Health Commercial	$1.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.24
Rate for Payer: Group Health Inc Commercial	$0.92
Rate for Payer: Group Health Inc Medicare	$0.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.92
Rate for Payer: Hamaspik Choice Inc Medicare	$0.92

KIT PI CVC 3L 20

Facility

$137.50

Hospital Charge Code	64901812
Hospital Revenue Code	270
Min. Negotiated Rate	$48.12
Max. Negotiated Rate	$110.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.75
Rate for Payer: Aetna Government	$68.75
Rate for Payer: Brighton Health Commercial	$103.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.50
Rate for Payer: Group Health Inc Commercial	$68.75
Rate for Payer: Group Health Inc Medicare	$48.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.75
Rate for Payer: Hamaspik Choice Inc Medicare	$68.75

KIT, POST-MORTEM, 36X90

Facility

$13.95

Hospital Charge Code	64901830
Hospital Revenue Code	270
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$11.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.98
Rate for Payer: Aetna Government	$6.98
Rate for Payer: Brighton Health Commercial	$10.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.49
Rate for Payer: Group Health Inc Commercial	$6.98
Rate for Payer: Group Health Inc Medicare	$4.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.98
Rate for Payer: Hamaspik Choice Inc Medicare	$6.98

KIT PREC INSERTION FOR 2.9

Facility

$440.00

Hospital Charge Code	64906678
Hospital Revenue Code	270
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$352.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$220.00
Rate for Payer: Aetna Government	$220.00
Rate for Payer: Brighton Health Commercial	$330.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$352.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.20
Rate for Payer: Group Health Inc Commercial	$220.00
Rate for Payer: Group Health Inc Medicare	$154.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$220.00

KIT PRESSURE MONITOR PX24N

Facility

$22.03

Hospital Charge Code	64902437
Hospital Revenue Code	270
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$17.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.02
Rate for Payer: Aetna Government	$11.02
Rate for Payer: Brighton Health Commercial	$16.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.98
Rate for Payer: Group Health Inc Commercial	$11.02
Rate for Payer: Group Health Inc Medicare	$7.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.02
Rate for Payer: Hamaspik Choice Inc Medicare	$11.02

KIT PULSAVAC FAN SPRAY WOUND CLNR

Facility

$1,196.43

Hospital Charge Code	64904386
Hospital Revenue Code	270
Min. Negotiated Rate	$418.75
Max. Negotiated Rate	$957.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$658.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$598.22
Rate for Payer: Aetna Government	$598.22
Rate for Payer: Brighton Health Commercial	$897.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$957.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$813.57
Rate for Payer: Group Health Inc Commercial	$598.22
Rate for Payer: Group Health Inc Medicare	$418.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$598.22
Rate for Payer: Hamaspik Choice Inc Medicare	$598.22

KIT PUMP IMPLANT

Facility

$23,750.00

Hospital Charge Code	64904952
Hospital Revenue Code	279
Min. Negotiated Rate	$8,312.50
Max. Negotiated Rate	$19,000.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13,062.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11,875.00
Rate for Payer: Aetna Government	$11,875.00
Rate for Payer: Brighton Health Commercial	$17,812.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$16,150.00
Rate for Payer: Group Health Inc Commercial	$11,875.00
Rate for Payer: Group Health Inc Medicare	$8,312.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,875.00

KIT PX SINGLE LINE DPT 60 PX260

Facility

$22.03

Hospital Charge Code	64902233
Hospital Revenue Code	270
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$17.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.02
Rate for Payer: Aetna Government	$11.02
Rate for Payer: Brighton Health Commercial	$16.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.98
Rate for Payer: Group Health Inc Commercial	$11.02
Rate for Payer: Group Health Inc Medicare	$7.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.02
Rate for Payer: Hamaspik Choice Inc Medicare	$11.02

Know your out-of-pocket cost for care.

All Charges