St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

POT CL IN D5W LACT RINGERS 20 MEQ/L IV SOLN [11062]

Facility

$0.01

Service Code	NDC 00338081104
Hospital Charge Code	00338081104
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
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: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$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

POT CL IN D5W LACT RINGERS 20 MEQ/L IV SOLN [11062]

Facility

$0.01

Service Code	NDC 00990711109
Hospital Charge Code	00990711109
Hospital Revenue Code	278
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

POUCH DRAINABLE

Facility

$2.00

Hospital Charge Code	40200617
Hospital Revenue Code	270
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

POUCH, DRAINABLE, CUT-TO-FIT,CERA

Facility

$27.33

Hospital Charge Code	64903922
Hospital Revenue Code	270
Min. Negotiated Rate	$9.57
Max. Negotiated Rate	$21.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.66
Rate for Payer: Aetna Government	$13.66
Rate for Payer: Brighton Health Commercial	$20.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.58
Rate for Payer: Group Health Inc Commercial	$13.66
Rate for Payer: Group Health Inc Medicare	$9.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.66
Rate for Payer: Hamaspik Choice Inc Medicare	$13.66

POUCH ENDO CATCH GOLD 10MM

Facility

$467.65

Hospital Charge Code	64904662
Hospital Revenue Code	270
Min. Negotiated Rate	$163.68
Max. Negotiated Rate	$374.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$257.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$233.82
Rate for Payer: Aetna Government	$233.82
Rate for Payer: Brighton Health Commercial	$350.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$374.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$318.00
Rate for Payer: Group Health Inc Commercial	$233.82
Rate for Payer: Group Health Inc Medicare	$163.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$233.82
Rate for Payer: Hamaspik Choice Inc Medicare	$233.82

POUCH ENDO CATCH GOLD 10MM

Facility

$1,012.78

Hospital Charge Code	40205114
Hospital Revenue Code	270
Min. Negotiated Rate	$354.47
Max. Negotiated Rate	$810.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$557.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$506.39
Rate for Payer: Aetna Government	$506.39
Rate for Payer: Brighton Health Commercial	$759.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$810.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$688.69
Rate for Payer: Group Health Inc Commercial	$506.39
Rate for Payer: Group Health Inc Medicare	$354.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.39
Rate for Payer: Hamaspik Choice Inc Medicare	$506.39

POUCH ENDO CATCH GOLD 10MM DSP

Facility

$1,265.98

Hospital Charge Code	64904021
Hospital Revenue Code	270
Min. Negotiated Rate	$443.09
Max. Negotiated Rate	$1,012.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$696.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$632.99
Rate for Payer: Aetna Government	$632.99
Rate for Payer: Brighton Health Commercial	$949.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,012.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$860.87
Rate for Payer: Group Health Inc Commercial	$632.99
Rate for Payer: Group Health Inc Medicare	$443.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$632.99
Rate for Payer: Hamaspik Choice Inc Medicare	$632.99

POUCHES TISSUE SURGICAL LAPSAC4X6

Facility

$105.00

Hospital Charge Code	40202008
Hospital Revenue Code	270
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$84.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.50
Rate for Payer: Aetna Government	$52.50
Rate for Payer: Brighton Health Commercial	$78.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.40
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

POUCHES TISSUE SURGICAL LAPSAC8X5

Facility

$105.00

Hospital Charge Code	40202009
Hospital Revenue Code	270
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$84.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.50
Rate for Payer: Aetna Government	$52.50
Rate for Payer: Brighton Health Commercial	$78.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.40
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

POUCH FECAL INCONTINENCE

Facility

$8.95

Hospital Charge Code	64901818
Hospital Revenue Code	270
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$7.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.48
Rate for Payer: Aetna Government	$4.48
Rate for Payer: Brighton Health Commercial	$6.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.09
Rate for Payer: Group Health Inc Commercial	$4.48
Rate for Payer: Group Health Inc Medicare	$3.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.48
Rate for Payer: Hamaspik Choice Inc Medicare	$4.48

POUCH NI HIGH OP 2PC DRNBL 2.75

Facility

$3.56

Hospital Charge Code	64902144
Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$2.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.78
Rate for Payer: Aetna Government	$1.78
Rate for Payer: Brighton Health Commercial	$2.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.42
Rate for Payer: Group Health Inc Commercial	$1.78
Rate for Payer: Group Health Inc Medicare	$1.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.78
Rate for Payer: Hamaspik Choice Inc Medicare	$1.78

POUCH NI HI OP 2PC DRNBL 2.25

Facility

$3.56

Hospital Charge Code	64902143
Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$2.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.78
Rate for Payer: Aetna Government	$1.78
Rate for Payer: Brighton Health Commercial	$2.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.42
Rate for Payer: Group Health Inc Commercial	$1.78
Rate for Payer: Group Health Inc Medicare	$1.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.78
Rate for Payer: Hamaspik Choice Inc Medicare	$1.78

POUCH, NI, LK'N RL, DRNBL, 2P, 4

Facility

$14.78

Hospital Charge Code	64903930
Hospital Revenue Code	270
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$11.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.39
Rate for Payer: Aetna Government	$7.39
Rate for Payer: Brighton Health Commercial	$11.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.05
Rate for Payer: Group Health Inc Commercial	$7.39
Rate for Payer: Group Health Inc Medicare	$5.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.39
Rate for Payer: Hamaspik Choice Inc Medicare	$7.39

POUCH PILL CRUSHER A

Facility

$0.16

Hospital Charge Code	64901919
Hospital Revenue Code	270
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08

POUCH PILL CRUSHER B

Facility

$0.12

Hospital Charge Code	64902461
Hospital Revenue Code	270
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06

POUCH PREMIER HI OP CTF 2 3/4 NS

Facility

$116.60

Hospital Charge Code	64903920
Hospital Revenue Code	270
Min. Negotiated Rate	$40.81
Max. Negotiated Rate	$93.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$58.30
Rate for Payer: Aetna Government	$58.30
Rate for Payer: Brighton Health Commercial	$87.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$93.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$79.29
Rate for Payer: Group Health Inc Commercial	$58.30
Rate for Payer: Group Health Inc Medicare	$40.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.30
Rate for Payer: Hamaspik Choice Inc Medicare	$58.30

POUCH PREMIER HI OP CTF 4 1/3 NS

Facility

$128.28

Hospital Charge Code	64903918
Hospital Revenue Code	270
Min. Negotiated Rate	$44.90
Max. Negotiated Rate	$102.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.14
Rate for Payer: Aetna Government	$64.14
Rate for Payer: Brighton Health Commercial	$96.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$102.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.23
Rate for Payer: Group Health Inc Commercial	$64.14
Rate for Payer: Group Health Inc Medicare	$44.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.14
Rate for Payer: Hamaspik Choice Inc Medicare	$64.14

POUCH SELF SEAL STERILE 12 X 18

Facility

$0.49

Hospital Charge Code	64901237
Hospital Revenue Code	270
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25

POUCH, SFT CNVX, 2 1/8CTF BAR

Facility

$27.33

Hospital Charge Code	64903926
Hospital Revenue Code	270
Min. Negotiated Rate	$9.57
Max. Negotiated Rate	$21.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.66
Rate for Payer: Aetna Government	$13.66
Rate for Payer: Brighton Health Commercial	$20.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.58
Rate for Payer: Group Health Inc Commercial	$13.66
Rate for Payer: Group Health Inc Medicare	$9.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.66
Rate for Payer: Hamaspik Choice Inc Medicare	$13.66

POUCH, SOFT CNVX, 1 1/2 IN, 1 PC

Facility

$27.33

Hospital Charge Code	64903924
Hospital Revenue Code	270
Min. Negotiated Rate	$9.57
Max. Negotiated Rate	$21.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.66
Rate for Payer: Aetna Government	$13.66
Rate for Payer: Brighton Health Commercial	$20.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.58
Rate for Payer: Group Health Inc Commercial	$13.66
Rate for Payer: Group Health Inc Medicare	$9.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.66
Rate for Payer: Hamaspik Choice Inc Medicare	$13.66

POUCH SPECIMEN ENDO MATHC 15MM

Facility

$568.57

Hospital Charge Code	64905772
Hospital Revenue Code	270
Min. Negotiated Rate	$199.00
Max. Negotiated Rate	$454.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$312.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$284.28
Rate for Payer: Aetna Government	$284.28
Rate for Payer: Brighton Health Commercial	$426.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$454.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$386.63
Rate for Payer: Group Health Inc Commercial	$284.28
Rate for Payer: Group Health Inc Medicare	$199.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$284.28
Rate for Payer: Hamaspik Choice Inc Medicare	$284.28

POUCH,STERI,SELF-SEAL,3.5 X 9

Facility

$0.11

Hospital Charge Code	64901988
Hospital Revenue Code	270
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06

POUCH,STERI,SELF-SEAL,5.25 X 10

Facility

$0.14

Hospital Charge Code	64901277
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07

POUCH,STERI,SELF-SEAL,7.5 X 13

Facility

$0.24

Hospital Charge Code	64901492
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12

POUCH,STERI,SELF-SEAL,8 X 16

Facility

$0.35

Hospital Charge Code	64901276
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.18
Rate for Payer: Aetna Government	$0.18
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18

Know your out-of-pocket cost for care.

All Charges