St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

POLIOVIRUS IMMUNE STATUS

Facility

$32.58

Service Code	HCPCS 86658
Hospital Charge Code	40729358
Hospital Revenue Code	300
Rate for Payer: Cash Price	$13.03

POLIOVIRUS IMMUNE STATUS

Facility

$32.58

Service Code	HCPCS 86658
Hospital Charge Code	40729358
Hospital Revenue Code	300
Min. Negotiated Rate	$9.12
Max. Negotiated Rate	$24.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.03
Rate for Payer: Aetna Government	$13.03
Rate for Payer: Affinity Essential Plan 1&2	$9.12
Rate for Payer: Affinity Essential Plan 3&4	$9.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.12
Rate for Payer: Brighton Health Commercial	$24.44
Rate for Payer: Cash Price	$13.03
Rate for Payer: Cash Price	$13.03
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.52
Rate for Payer: Elderplan Medicare Advantage	$13.03
Rate for Payer: EmblemHealth Commercial	$13.03
Rate for Payer: Fidelis Essential Plan Aliesa	$11.08
Rate for Payer: Fidelis Essential Plan QHP	$11.60
Rate for Payer: Fidelis Medicare Advantage	$13.03
Rate for Payer: Fidelis Qualified Health Plan	$11.60
Rate for Payer: Group Health Inc Commercial	$13.03
Rate for Payer: Group Health Inc Medicare	$13.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.29
Rate for Payer: Hamaspik Choice Inc Medicare	$13.03
Rate for Payer: Healthfirst Medicare Advantage	$13.03
Rate for Payer: Healthfirst QHP	$13.03
Rate for Payer: Humana Medicare	$13.29
Rate for Payer: Senior Whole Health Medicare Advantage	$13.03
Rate for Payer: United Healthcare Commercial	$16.51
Rate for Payer: United Healthcare Medicare Advantage	$13.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.42
Rate for Payer: Wellcare Medicare	$11.73

POLIOVIRUS VACCINE INACTIVATED IJ INJ [108127]

Facility

$102.03

Service Code	NDC 49281086010
Hospital Charge Code	49281086010
Hospital Revenue Code	250
Min. Negotiated Rate	$35.71
Max. Negotiated Rate	$81.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.02
Rate for Payer: Aetna Government	$51.02
Rate for Payer: Brighton Health Commercial	$76.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.38
Rate for Payer: Group Health Inc Commercial	$51.02
Rate for Payer: Group Health Inc Medicare	$35.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.02
Rate for Payer: Hamaspik Choice Inc Medicare	$51.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.32

POLIOVIRUS VACCINE INJ

Facility

$52.76

Hospital Charge Code	41653113
Hospital Revenue Code	636
Min. Negotiated Rate	$18.47
Max. Negotiated Rate	$34.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.38
Rate for Payer: Aetna Government	$26.38
Rate for Payer: Brighton Health Commercial	$31.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.34
Rate for Payer: Group Health Inc Commercial	$26.38
Rate for Payer: Group Health Inc Medicare	$18.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.38
Rate for Payer: Hamaspik Choice Inc Medicare	$26.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.29

POLIOVIRUS VACCINE INJ

Facility

$52.76

Hospital Charge Code	41643113
Hospital Revenue Code	636
Min. Negotiated Rate	$18.47
Max. Negotiated Rate	$34.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.38
Rate for Payer: Aetna Government	$26.38
Rate for Payer: Brighton Health Commercial	$31.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.34
Rate for Payer: Group Health Inc Commercial	$26.38
Rate for Payer: Group Health Inc Medicare	$18.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.38
Rate for Payer: Hamaspik Choice Inc Medicare	$26.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.29

POLIOVIRUS VACCINE INJ

Facility

$52.76

Hospital Charge Code	41643113
Hospital Revenue Code	636
Min. Negotiated Rate	$26.38
Max. Negotiated Rate	$26.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.38
Rate for Payer: Hamaspik Choice Inc Medicare	$26.38

POLIOVIRUS VACCINE INJ

Facility

$52.76

Hospital Charge Code	41653113
Hospital Revenue Code	636
Min. Negotiated Rate	$26.38
Max. Negotiated Rate	$26.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.38
Rate for Payer: Hamaspik Choice Inc Medicare	$26.38

POLIOVIRUS VACCINE (VFC) 5ML MDV

Facility

$0.01

Service Code	HCPCS 90713
Hospital Charge Code	41659562
Hospital Revenue Code	636
Max. Negotiated Rate	$37.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.49
Rate for Payer: Aetna Government	$37.49
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

POLIOVIRUS VACCINE (VFC) 5ML MDV

Facility

$0.01

Service Code	HCPCS 90713
Hospital Charge Code	41649562
Hospital Revenue Code	636
Max. Negotiated Rate	$37.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.49
Rate for Payer: Aetna Government	$37.49
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

POLIOVIRUS VACCINE (VFC) 5ML MDV

Facility

$0.01

Service Code	HCPCS 90713
Hospital Charge Code	41649562
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

POLIOVIRUS VACCINE (VFC) 5ML MDV

Facility

$0.01

Service Code	HCPCS 90713
Hospital Charge Code	41659562
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

POLISHER CAPSULE 23G X 7/8 DSP

Facility

$27.09

Hospital Charge Code	64904400
Hospital Revenue Code	270
Min. Negotiated Rate	$9.48
Max. Negotiated Rate	$21.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.54
Rate for Payer: Aetna Government	$13.54
Rate for Payer: Brighton Health Commercial	$20.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.42
Rate for Payer: Group Health Inc Commercial	$13.54
Rate for Payer: Group Health Inc Medicare	$9.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.54
Rate for Payer: Hamaspik Choice Inc Medicare	$13.54

POLY 5537

Facility

$8,643.75

Service Code	HCPCS C1713
Hospital Charge Code	64907383
Hospital Revenue Code	278
Min. Negotiated Rate	$4,321.88
Max. Negotiated Rate	$4,321.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,321.88
Rate for Payer: Hamaspik Choice Inc Medicare	$4,321.88

POLY 5537

Facility

$8,643.75

Service Code	HCPCS C1713
Hospital Charge Code	64907383
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$9,075.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,754.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$5,186.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,321.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,970.16
Rate for Payer: EmblemHealth Commercial	$4,321.88
Rate for Payer: Fidelis Medicare Advantage	$9,075.94
Rate for Payer: Group Health Inc Commercial	$4,321.88
Rate for Payer: Group Health Inc Medicare	$3,025.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,321.88
Rate for Payer: Hamaspik Choice Inc Medicare	$4,321.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,618.44

POLYAXIAL LOCKING PLATE T10

Facility

$4,237.50

Service Code	HCPCS C1713
Hospital Charge Code	64905190
Hospital Revenue Code	278
Min. Negotiated Rate	$2,118.75
Max. Negotiated Rate	$2,118.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,118.75

POLYAXIAL LOCKING PLATE T10

Facility

$4,237.50

Service Code	HCPCS C1713
Hospital Charge Code	64905190
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,449.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,330.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,542.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,118.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,436.56
Rate for Payer: EmblemHealth Commercial	$2,118.75
Rate for Payer: Fidelis Medicare Advantage	$4,449.38
Rate for Payer: Group Health Inc Commercial	$2,118.75
Rate for Payer: Group Health Inc Medicare	$1,483.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,118.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,754.38

POLYETH VIVA 38MM 9.5

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905456
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,150.00
Rate for Payer: EmblemHealth Commercial	$1,000.00
Rate for Payer: Fidelis Medicare Advantage	$2,100.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,300.00

POLYETH VIVA 38MM 9.5

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905456
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

POLYETH VIVA RIGHT 10MM

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64905452
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

POLYETH VIVA RIGHT 10MM

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64905452
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: EmblemHealth Commercial	$2,125.00
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

POLYETH VIVA RIGHT 11MM

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64905447
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

POLYETH VIVA RIGHT 11MM

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64905447
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: EmblemHealth Commercial	$2,125.00
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

POLYETHYLENE CROSSLINK P

Facility

$2,836.88

Service Code	HCPCS C1713
Hospital Charge Code	64905109
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,978.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,560.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,702.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,418.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,631.21
Rate for Payer: EmblemHealth Commercial	$1,418.44
Rate for Payer: Fidelis Medicare Advantage	$2,978.72
Rate for Payer: Group Health Inc Commercial	$1,418.44
Rate for Payer: Group Health Inc Medicare	$992.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,418.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,418.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,843.97

POLYETHYLENE CROSSLINK P

Facility

$2,836.88

Service Code	HCPCS C1713
Hospital Charge Code	64905109
Hospital Revenue Code	278
Min. Negotiated Rate	$1,418.44
Max. Negotiated Rate	$1,418.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,418.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,418.44

POLYETHYLENE GLYCOL 3350 17 G PO PACK [25424]

Facility

$2.78

Service Code	NDC 60687043198
Hospital Charge Code	60687043198
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.39
Rate for Payer: Aetna Government	$1.39
Rate for Payer: Brighton Health Commercial	$2.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.89
Rate for Payer: Group Health Inc Commercial	$1.39
Rate for Payer: Group Health Inc Medicare	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.39
Rate for Payer: Hamaspik Choice Inc Medicare	$1.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.81

Know your out-of-pocket cost for care.

All Charges