St. Barnabas Hospital

All Charges

Charge

Type

Price

ARCH BAR REMOVAL- NOT BY 1ST O.S.

Facility OP

$851.00

Service Code	HCPCS D7997
Hospital Charge Code	42303359
Hospital Revenue Code	361
Min. Negotiated Rate	$84.72
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$468.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$84.72
Rate for Payer: Aetna Government	$84.72
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: Group Health Inc Commercial	$425.50
Rate for Payer: Group Health Inc Medicare	$297.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$425.50
Rate for Payer: Hamaspik Choice Inc Medicare	$425.50

ARCHON PLATE, 36MM 2-LEVEL

Facility IP

$3,595.00

Service Code	HCPCS C1713
Hospital Charge Code	64905576
Hospital Revenue Code	278
Min. Negotiated Rate	$1,797.50
Max. Negotiated Rate	$1,797.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,797.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,797.50

ARCHON PLATE, 36MM 2-LEVEL

Facility OP

$3,595.00

Service Code	HCPCS C1713
Hospital Charge Code	64905576
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,774.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,977.25
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	$1,797.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,067.12
Rate for Payer: Fidelis Medicare Advantage	$3,774.75
Rate for Payer: Group Health Inc Commercial	$1,797.50
Rate for Payer: Group Health Inc Medicare	$1,258.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,797.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,797.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,336.75

ARCHON PLATE, 50MM 2-LEVEL

Facility OP

$3,595.00

Service Code	HCPCS C1713
Hospital Charge Code	64905581
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,774.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,977.25
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	$1,797.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,067.12
Rate for Payer: Fidelis Medicare Advantage	$3,774.75
Rate for Payer: Group Health Inc Commercial	$1,797.50
Rate for Payer: Group Health Inc Medicare	$1,258.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,797.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,797.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,336.75

ARCHON PLATE, 50MM 2-LEVEL

Facility IP

$3,595.00

Service Code	HCPCS C1713
Hospital Charge Code	64905581
Hospital Revenue Code	278
Min. Negotiated Rate	$1,797.50
Max. Negotiated Rate	$1,797.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,797.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,797.50

ARCHON SCREW,4.0 X 13MM ST

Facility OP

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905422
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,063.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$556.88
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	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: Fidelis Medicare Advantage	$1,063.12
Rate for Payer: Group Health Inc Commercial	$506.25
Rate for Payer: Group Health Inc Medicare	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$658.12

ARCHON SCREW,4.0 X 13MM ST

Facility IP

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905422
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25

ARCHON SCREW, 4.0X15MM SELFTAP

Facility OP

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905578
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,063.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$556.88
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	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: Fidelis Medicare Advantage	$1,063.12
Rate for Payer: Group Health Inc Commercial	$506.25
Rate for Payer: Group Health Inc Medicare	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$658.12

ARCHON SCREW, 4.0X15MM SELFTAP

Facility IP

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905578
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25

ARCHON SCREW,4.0 X 15MM ST

Facility OP

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905420
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,063.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$556.88
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	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: Fidelis Medicare Advantage	$1,063.12
Rate for Payer: Group Health Inc Commercial	$506.25
Rate for Payer: Group Health Inc Medicare	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$658.12

ARCHON SCREW,4.0 X 15MM ST

Facility IP

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905420
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25

ARCHON SCREW, 4.0X17MM SELF-T

Facility OP

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905582
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,063.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$556.88
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	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: Fidelis Medicare Advantage	$1,063.12
Rate for Payer: Group Health Inc Commercial	$506.25
Rate for Payer: Group Health Inc Medicare	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$658.12

ARCHON SCREW, 4.0X17MM SELF-T

Facility IP

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905582
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25

ARCHON SCREW, 4.0X19MM SELFT

Facility OP

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905280
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,063.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$556.88
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	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: Fidelis Medicare Advantage	$1,063.12
Rate for Payer: Group Health Inc Commercial	$506.25
Rate for Payer: Group Health Inc Medicare	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$658.12

ARCHON SCREW, 4.0X19MM SELFT

Facility IP

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905280
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25

ARCHON SCREW, 4.5X19MM SELFT

Facility OP

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905279
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,063.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$556.88
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	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: Fidelis Medicare Advantage	$1,063.12
Rate for Payer: Group Health Inc Commercial	$506.25
Rate for Payer: Group Health Inc Medicare	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$658.12

ARCHON SCREW, 4.5X19MM SELFT

Facility IP

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905279
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25

ARGATROBAN 250MG/250ML NS - 5MG

Facility OP

$49.00

Hospital Charge Code	41658048
Hospital Revenue Code	250
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$39.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.50
Rate for Payer: Aetna Government	$24.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.32
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.85

ARGATROBAN 250MG/250ML NS -5MG

Facility OP

$49.00

Hospital Charge Code	41648048
Hospital Revenue Code	250
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$39.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.50
Rate for Payer: Aetna Government	$24.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.32
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.85

ARGATROBAN 250MG/2.5ML INJ - 5MG

Facility OP

$22.77

Hospital Charge Code	41648046
Hospital Revenue Code	250
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$18.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.38
Rate for Payer: Aetna Government	$11.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.48
Rate for Payer: Group Health Inc Commercial	$11.38
Rate for Payer: Group Health Inc Medicare	$7.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.38
Rate for Payer: Hamaspik Choice Inc Medicare	$11.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.80

ARGATROBAN 250MG/D5W250ML INF 5MG

Facility OP

$22.77

Hospital Charge Code	41658049
Hospital Revenue Code	250
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$18.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.38
Rate for Payer: Aetna Government	$11.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.48
Rate for Payer: Group Health Inc Commercial	$11.38
Rate for Payer: Group Health Inc Medicare	$7.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.38
Rate for Payer: Hamaspik Choice Inc Medicare	$11.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.80

ARGATROBAN 250MG/D5W250ML INF 5MG

Facility OP

$22.77

Hospital Charge Code	41648049
Hospital Revenue Code	250
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$18.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.38
Rate for Payer: Aetna Government	$11.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.48
Rate for Payer: Group Health Inc Commercial	$11.38
Rate for Payer: Group Health Inc Medicare	$7.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.38
Rate for Payer: Hamaspik Choice Inc Medicare	$11.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.80

ARGATROGAN 250MG/2.5ML INJ - 5MG

Facility OP

$22.77

Hospital Charge Code	41658046
Hospital Revenue Code	250
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$18.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.38
Rate for Payer: Aetna Government	$11.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.48
Rate for Payer: Group Health Inc Commercial	$11.38
Rate for Payer: Group Health Inc Medicare	$7.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.38
Rate for Payer: Hamaspik Choice Inc Medicare	$11.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.80

ARHTHROSCOPY KNEE MEDIAL OR LATRL

Facility OP

$8,291.05

Service Code	HCPCS 29881
Hospital Charge Code	40024228
Hospital Revenue Code	360
Min. Negotiated Rate	$615.60
Max. Negotiated Rate	$4,145.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
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	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$615.60
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$684.00
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

ARIPIPRAZOLE 10 MG TAB

Facility OP

$34.00

Hospital Charge Code	41652991
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$27.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.00
Rate for Payer: Aetna Government	$17.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.12
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.10

Price Transparency.

All Charges