St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

POUCH STERI TYVEK SLFSEL 5-1/4X10

Facility

$0.65

Hospital Charge Code	64903029
Hospital Revenue Code	270
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33

POUCH STERI TYVEK SLFSEL 7-1/2X13

Facility

$0.86

Hospital Charge Code	64903225
Hospital Revenue Code	270
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.43
Rate for Payer: Aetna Government	$0.43
Rate for Payer: Brighton Health Commercial	$0.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: Group Health Inc Commercial	$0.43
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.43
Rate for Payer: Hamaspik Choice Inc Medicare	$0.43

POUCH STOMA DRAIN 57MM 2-1/4

Facility

$3.09

Hospital Charge Code	64901337
Hospital Revenue Code	270
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$2.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.54
Rate for Payer: Aetna Government	$1.54
Rate for Payer: Brighton Health Commercial	$2.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.10
Rate for Payer: Group Health Inc Commercial	$1.54
Rate for Payer: Group Health Inc Medicare	$1.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1.54

POUCH STOMA DRAIN 57MM 2-1/4

Facility

$1.21

Hospital Charge Code	40201979
Hospital Revenue Code	270
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.61
Rate for Payer: Aetna Government	$0.61
Rate for Payer: Brighton Health Commercial	$0.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.82
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61

POUCH STOMA DRAINABLE 2-3/4

Facility

$1.21

Hospital Charge Code	40201980
Hospital Revenue Code	270
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.61
Rate for Payer: Aetna Government	$0.61
Rate for Payer: Brighton Health Commercial	$0.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.82
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61

POUCH STOMA DRAINABLE 2-3/4

Facility

$2.62

Hospital Charge Code	64901340
Hospital Revenue Code	270
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$2.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.31
Rate for Payer: Aetna Government	$1.31
Rate for Payer: Brighton Health Commercial	$1.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.78
Rate for Payer: Group Health Inc Commercial	$1.31
Rate for Payer: Group Health Inc Medicare	$0.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.31
Rate for Payer: Hamaspik Choice Inc Medicare	$1.31

POUCH UROSTOMY

Facility

$1.98

Hospital Charge Code	40201981
Hospital Revenue Code	270
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.99
Rate for Payer: Aetna Government	$0.99
Rate for Payer: Brighton Health Commercial	$1.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.35
Rate for Payer: Group Health Inc Commercial	$0.99
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.99
Rate for Payer: Hamaspik Choice Inc Medicare	$0.99

POUCH UROSTOMY 57MM 2-1/4 FLG

Facility

$3.65

Hospital Charge Code	64901186
Hospital Revenue Code	270
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$2.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.82
Rate for Payer: Aetna Government	$1.82
Rate for Payer: Brighton Health Commercial	$2.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.48
Rate for Payer: Group Health Inc Commercial	$1.82
Rate for Payer: Group Health Inc Medicare	$1.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1.82

POVIDONE-IODINE 10 % EX OINT [6455]

Facility

$0.06

Service Code	NDC 00536127180
Hospital Charge Code	00536127180
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

POVIDONE IODINE 10% OINT 1 GRAM

Facility

$0.29

Hospital Charge Code	41643614
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

POVIDONE IODINE 10% OINT 1 GRAM

Facility

$0.29

Hospital Charge Code	41653614
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

POVIDONE-IODINE 5 % OP SOLN [19791]

Facility

$0.68

Service Code	NDC 00065041130
Hospital Charge Code	00065041130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.34
Rate for Payer: Aetna Government	$0.34
Rate for Payer: Brighton Health Commercial	$0.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.46
Rate for Payer: Group Health Inc Commercial	$0.34
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.44

POWDER, ADAPT STOMAHESIVE

Facility

$4.13

Hospital Charge Code	40201974
Hospital Revenue Code	270
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$3.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.06
Rate for Payer: Aetna Government	$2.06
Rate for Payer: Brighton Health Commercial	$3.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.81
Rate for Payer: Group Health Inc Commercial	$2.06
Rate for Payer: Group Health Inc Medicare	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.06
Rate for Payer: Hamaspik Choice Inc Medicare	$2.06

POWDER WOUND CARE MULTIDEX 12GM

Facility

$13.08

Hospital Charge Code	64901044
Hospital Revenue Code	270
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$10.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.54
Rate for Payer: Aetna Government	$6.54
Rate for Payer: Brighton Health Commercial	$9.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.89
Rate for Payer: Group Health Inc Commercial	$6.54
Rate for Payer: Group Health Inc Medicare	$4.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.54
Rate for Payer: Hamaspik Choice Inc Medicare	$6.54

POWERED ECHELON FLEX 45MM

Facility

$878.93

Hospital Charge Code	64905169
Hospital Revenue Code	270
Min. Negotiated Rate	$307.63
Max. Negotiated Rate	$703.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$483.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$439.46
Rate for Payer: Aetna Government	$439.46
Rate for Payer: Brighton Health Commercial	$659.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$703.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$597.67
Rate for Payer: Group Health Inc Commercial	$439.46
Rate for Payer: Group Health Inc Medicare	$307.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$439.46
Rate for Payer: Hamaspik Choice Inc Medicare	$439.46

POWERLINK SYS W/INTUITRAK DEL SYS

Facility

$8,390.00

Hospital Charge Code	40202225
Hospital Revenue Code	279
Min. Negotiated Rate	$2,936.50
Max. Negotiated Rate	$6,712.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,614.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,195.00
Rate for Payer: Aetna Government	$4,195.00
Rate for Payer: Brighton Health Commercial	$6,292.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,712.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,705.20
Rate for Payer: Group Health Inc Commercial	$4,195.00
Rate for Payer: Group Health Inc Medicare	$2,936.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,195.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,195.00

PR 1 STAGE DSTL HYPOSPADIAS RPR W/EXTENSIVE DSJ

Professional

Both

$3,913.14

Service Code	HCPCS 54328
Min. Negotiated Rate	$2,934.86
Max. Negotiated Rate	$2,934.86
Rate for Payer: Cash Price	$1,070.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,934.86
Rate for Payer: SOMOS Essential	$2,934.86

PR 1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR

Professional

Both

$4,214.32

Service Code	HCPCS 54332
Min. Negotiated Rate	$3,160.74
Max. Negotiated Rate	$3,160.74
Rate for Payer: Cash Price	$1,153.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,160.74
Rate for Payer: SOMOS Essential	$3,160.74

PR 1ST CARE PR DAY NML NB XCPT HOSP/BIRTHING CENTER

Professional

Both

$251.30

Service Code	HCPCS 99461
Min. Negotiated Rate	$188.48
Max. Negotiated Rate	$188.48
Rate for Payer: Cash Price	$67.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$188.48
Rate for Payer: SOMOS Essential	$188.48

PR 1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS

Professional

Both

$3,937.92

Service Code	HCPCS 54326
Min. Negotiated Rate	$2,953.44
Max. Negotiated Rate	$2,953.44
Rate for Payer: Cash Price	$1,077.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,953.44
Rate for Payer: SOMOS Essential	$2,953.44

PR 1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT

Professional

Both

$3,271.66

Service Code	HCPCS 54322
Min. Negotiated Rate	$2,453.74
Max. Negotiated Rate	$2,453.74
Rate for Payer: Cash Price	$894.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,453.74
Rate for Payer: SOMOS Essential	$2,453.74

PR 1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS

Professional

Both

$4,043.73

Service Code	HCPCS 54324
Min. Negotiated Rate	$3,032.80
Max. Negotiated Rate	$3,032.80
Rate for Payer: Cash Price	$1,106.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,032.80
Rate for Payer: SOMOS Essential	$3,032.80

PR 1 STG PERINEAL HYPOSPADIAS RPR W/GRF&/FLAP

Professional

Both

$4,956.49

Service Code	HCPCS 54336
Min. Negotiated Rate	$3,717.37
Max. Negotiated Rate	$3,717.37
Rate for Payer: Cash Price	$1,355.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,717.37
Rate for Payer: SOMOS Essential	$3,717.37

PR 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB

Professional

Both

$373.94

Service Code	HCPCS 99460
Min. Negotiated Rate	$280.46
Max. Negotiated Rate	$280.46
Rate for Payer: Cash Price	$102.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$280.46
Rate for Payer: SOMOS Essential	$280.46

PR 1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT

Professional

Both

$445.55

Service Code	HCPCS 99463
Min. Negotiated Rate	$334.16
Max. Negotiated Rate	$334.16
Rate for Payer: Cash Price	$120.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$334.16
Rate for Payer: SOMOS Essential	$334.16

Know your out-of-pocket cost for care.

All Charges