St. Barnabas Hospital

All Charges

Charge

Type

Price

ARIPIPRAZONE LA 300MG INJ

Facility IP

$13.60

Service Code	HCPCS J0401
Hospital Charge Code	41647861
Hospital Revenue Code	636
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$6.80
Rate for Payer: Cash Price	$6.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.80
Rate for Payer: Hamaspik Choice Inc Medicare	$6.80

ARIPIPRAZONE LA 300MG INJ

Facility OP

$13.60

Service Code	HCPCS J0401
Hospital Charge Code	41647861
Hospital Revenue Code	636
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$8.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.81
Rate for Payer: Aetna Government	$6.81
Rate for Payer: Cash Price	$6.81
Rate for Payer: Cash Price	$6.81
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.82
Rate for Payer: Elderplan Medicare Advantage	$6.81
Rate for Payer: EmblemHealth Commercial	$6.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.81
Rate for Payer: Fidelis Essential Plan Aliesa	$6.81
Rate for Payer: Fidelis Essential Plan QHP	$7.15
Rate for Payer: Fidelis Medicare Advantage	$6.81
Rate for Payer: Fidelis Qualified Health Plan	$7.15
Rate for Payer: Group Health Inc Commercial	$6.81
Rate for Payer: Group Health Inc Medicare	$6.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.80
Rate for Payer: Hamaspik Choice Inc Medicare	$6.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.72
Rate for Payer: Healthfirst Medicare Advantage	$5.79
Rate for Payer: Healthfirst QHP	$6.81
Rate for Payer: Senior Whole Health Medicare Advantage	$6.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.22
Rate for Payer: SOMOS Essential	$7.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.45
Rate for Payer: Wellcare Medicare	$6.47

ARM15T ROD 200MM

Facility OP

$1,077.50

Service Code	HCPCS C1713
Hospital Charge Code	64904075
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,131.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$592.62
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	$538.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$619.56
Rate for Payer: Fidelis Medicare Advantage	$1,131.38
Rate for Payer: Group Health Inc Commercial	$538.75
Rate for Payer: Group Health Inc Medicare	$377.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$538.75
Rate for Payer: Hamaspik Choice Inc Medicare	$538.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$700.38

ARM15T ROD 200MM

Facility IP

$1,077.50

Service Code	HCPCS C1713
Hospital Charge Code	64904075
Hospital Revenue Code	278
Min. Negotiated Rate	$538.75
Max. Negotiated Rate	$538.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$538.75
Rate for Payer: Hamaspik Choice Inc Medicare	$538.75

ARM15T ROD 300MM

Facility OP

$1,547.50

Service Code	HCPCS C1713
Hospital Charge Code	64904462
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,624.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$851.12
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	$773.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$889.81
Rate for Payer: Fidelis Medicare Advantage	$1,624.88
Rate for Payer: Group Health Inc Commercial	$773.75
Rate for Payer: Group Health Inc Medicare	$541.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$773.75
Rate for Payer: Hamaspik Choice Inc Medicare	$773.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,005.88

ARM15T ROD 300MM

Facility IP

$1,547.50

Service Code	HCPCS C1713
Hospital Charge Code	64904462
Hospital Revenue Code	278
Min. Negotiated Rate	$773.75
Max. Negotiated Rate	$773.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$773.75
Rate for Payer: Hamaspik Choice Inc Medicare	$773.75

ARM15T ROD, 35MM

Facility OP

$912.50

Service Code	HCPCS C1713
Hospital Charge Code	64903717
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$958.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$501.88
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	$456.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$524.69
Rate for Payer: Fidelis Medicare Advantage	$958.12
Rate for Payer: Group Health Inc Commercial	$456.25
Rate for Payer: Group Health Inc Medicare	$319.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.25
Rate for Payer: Hamaspik Choice Inc Medicare	$456.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$593.12

ARM15T ROD, 35MM

Facility IP

$912.50

Service Code	HCPCS C1713
Hospital Charge Code	64903717
Hospital Revenue Code	278
Min. Negotiated Rate	$456.25
Max. Negotiated Rate	$456.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.25
Rate for Payer: Hamaspik Choice Inc Medicare	$456.25

ARM15T ROD 40MM

Facility OP

$912.50

Service Code	HCPCS C1713
Hospital Charge Code	64903526
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$958.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$501.88
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	$456.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$524.69
Rate for Payer: Fidelis Medicare Advantage	$958.12
Rate for Payer: Group Health Inc Commercial	$456.25
Rate for Payer: Group Health Inc Medicare	$319.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.25
Rate for Payer: Hamaspik Choice Inc Medicare	$456.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$593.12

ARM15T ROD 40MM

Facility IP

$912.50

Service Code	HCPCS C1713
Hospital Charge Code	64903526
Hospital Revenue Code	278
Min. Negotiated Rate	$456.25
Max. Negotiated Rate	$456.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.25
Rate for Payer: Hamaspik Choice Inc Medicare	$456.25

ARM 15T ROD 45

Facility IP

$912.50

Service Code	HCPCS C1713
Hospital Charge Code	64903878
Hospital Revenue Code	278
Min. Negotiated Rate	$456.25
Max. Negotiated Rate	$456.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.25
Rate for Payer: Hamaspik Choice Inc Medicare	$456.25

ARM 15T ROD 45

Facility OP

$912.50

Service Code	HCPCS C1713
Hospital Charge Code	64903878
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$958.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$501.88
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	$456.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$524.69
Rate for Payer: Fidelis Medicare Advantage	$958.12
Rate for Payer: Group Health Inc Commercial	$456.25
Rate for Payer: Group Health Inc Medicare	$319.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.25
Rate for Payer: Hamaspik Choice Inc Medicare	$456.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$593.12

ARM 15T ROD 50

Facility IP

$912.50

Service Code	HCPCS C1713
Hospital Charge Code	64903877
Hospital Revenue Code	278
Min. Negotiated Rate	$456.25
Max. Negotiated Rate	$456.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.25
Rate for Payer: Hamaspik Choice Inc Medicare	$456.25

ARM 15T ROD 50

Facility OP

$912.50

Service Code	HCPCS C1713
Hospital Charge Code	64903877
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$958.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$501.88
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	$456.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$524.69
Rate for Payer: Fidelis Medicare Advantage	$958.12
Rate for Payer: Group Health Inc Commercial	$456.25
Rate for Payer: Group Health Inc Medicare	$319.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.25
Rate for Payer: Hamaspik Choice Inc Medicare	$456.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$593.12

ARMBOARD 3 X 9

Facility OP

$1.05

Hospital Charge Code	64901934
Hospital Revenue Code	270
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.71
Rate for Payer: Group Health Inc Commercial	$0.53
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53
Rate for Payer: Hamaspik Choice Inc Medicare	$0.53

ARMBOARD,IV,DISP INFANT

Facility OP

$24.44

Hospital Charge Code	64902449
Hospital Revenue Code	270
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$19.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.22
Rate for Payer: Aetna Government	$12.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.62
Rate for Payer: Group Health Inc Commercial	$12.22
Rate for Payer: Group Health Inc Medicare	$8.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.22
Rate for Payer: Hamaspik Choice Inc Medicare	$12.22

ARMBOARD,IV,DISP INFANT,1X4

Facility OP

$285.63

Hospital Charge Code	64906213
Hospital Revenue Code	270
Min. Negotiated Rate	$99.97
Max. Negotiated Rate	$228.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$142.82
Rate for Payer: Aetna Government	$142.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$228.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$194.23
Rate for Payer: Group Health Inc Commercial	$142.82
Rate for Payer: Group Health Inc Medicare	$99.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.82
Rate for Payer: Hamaspik Choice Inc Medicare	$142.82

ARMBOARD PEDIATRIC

Facility OP

$6.79

Hospital Charge Code	64902451
Hospital Revenue Code	270
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$5.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.40
Rate for Payer: Aetna Government	$3.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.62
Rate for Payer: Group Health Inc Commercial	$3.40
Rate for Payer: Group Health Inc Medicare	$2.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.40
Rate for Payer: Hamaspik Choice Inc Medicare	$3.40

ARMBOARD PEDS 2 X 9

Facility OP

$1.11

Hospital Charge Code	64902260
Hospital Revenue Code	270
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.56
Rate for Payer: Aetna Government	$0.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.75
Rate for Payer: Group Health Inc Commercial	$0.56
Rate for Payer: Group Health Inc Medicare	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56
Rate for Payer: Hamaspik Choice Inc Medicare	$0.56

ARM FLUORO VENT TUBE E 1.14 MM

Facility OP

$83.00

Service Code	HCPCS L8699
Hospital Charge Code	40004613
Hospital Revenue Code	278
Min. Negotiated Rate	$29.05
Max. Negotiated Rate	$87.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.50
Rate for Payer: Aetna Government	$41.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.72
Rate for Payer: Fidelis Medicare Advantage	$87.15
Rate for Payer: Group Health Inc Commercial	$41.50
Rate for Payer: Group Health Inc Medicare	$29.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.50
Rate for Payer: Hamaspik Choice Inc Medicare	$41.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.95

ARM FLUORO VENT TUBE E 1.14 MM

Facility IP

$83.00

Service Code	HCPCS L8699
Hospital Charge Code	40004613
Hospital Revenue Code	278
Min. Negotiated Rate	$41.50
Max. Negotiated Rate	$41.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.50
Rate for Payer: Hamaspik Choice Inc Medicare	$41.50

ARM KNIFE

Facility OP

$41.82

Hospital Charge Code	40200535
Hospital Revenue Code	270
Min. Negotiated Rate	$14.64
Max. Negotiated Rate	$33.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.91
Rate for Payer: Aetna Government	$20.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.44
Rate for Payer: Group Health Inc Commercial	$20.91
Rate for Payer: Group Health Inc Medicare	$14.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.91
Rate for Payer: Hamaspik Choice Inc Medicare	$20.91

ARM SLING

Facility OP

$28.35

Hospital Charge Code	40200540
Hospital Revenue Code	270
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$22.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.18
Rate for Payer: Aetna Government	$14.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.28
Rate for Payer: Group Health Inc Commercial	$14.18
Rate for Payer: Group Health Inc Medicare	$9.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.18
Rate for Payer: Hamaspik Choice Inc Medicare	$14.18

ARROW CATHETERIZATION TRAY

Facility OP

$59.89

Hospital Charge Code	40207595
Hospital Revenue Code	270
Min. Negotiated Rate	$20.96
Max. Negotiated Rate	$47.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.94
Rate for Payer: Aetna Government	$29.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.73
Rate for Payer: Group Health Inc Commercial	$29.94
Rate for Payer: Group Health Inc Medicare	$20.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.94
Rate for Payer: Hamaspik Choice Inc Medicare	$29.94

ARROW CENTRAL VENOUS CATH KIT W/B

Facility OP

$26.50

Hospital Charge Code	40205565
Hospital Revenue Code	270
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$21.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.25
Rate for Payer: Aetna Government	$13.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.02
Rate for Payer: Group Health Inc Commercial	$13.25
Rate for Payer: Group Health Inc Medicare	$9.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.25
Rate for Payer: Hamaspik Choice Inc Medicare	$13.25

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