St. Barnabas Hospital

All Charges

Charge

Type

Price

ATOVAQUONE 750MG/5ML SUSP UDC

Facility OP

$47.45

Hospital Charge Code	41653260
Hospital Revenue Code	250
Min. Negotiated Rate	$16.61
Max. Negotiated Rate	$37.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.72
Rate for Payer: Aetna Government	$23.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.27
Rate for Payer: Group Health Inc Commercial	$23.72
Rate for Payer: Group Health Inc Medicare	$16.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.72
Rate for Payer: Hamaspik Choice Inc Medicare	$23.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.84

ATOVAQUONE 750MG/5ML SUSP UDC

Facility OP

$47.45

Hospital Charge Code	41643260
Hospital Revenue Code	250
Min. Negotiated Rate	$16.61
Max. Negotiated Rate	$37.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.72
Rate for Payer: Aetna Government	$23.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.27
Rate for Payer: Group Health Inc Commercial	$23.72
Rate for Payer: Group Health Inc Medicare	$16.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.72
Rate for Payer: Hamaspik Choice Inc Medicare	$23.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.84

ATOVAQUONE/PROGUANIL 250-100MG

Facility OP

$1.18

Hospital Charge Code	41646493
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.59
Rate for Payer: Aetna Government	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.80
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

ATOVAQUONE/PROGUANIL 250-100MG

Facility OP

$1.18

Hospital Charge Code	41656493
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.59
Rate for Payer: Aetna Government	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.80
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

ATOVAQUONE PROGUANIL 62/5-25MG

Facility OP

$3.34

Hospital Charge Code	41656494
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$2.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.67
Rate for Payer: Aetna Government	$1.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.27
Rate for Payer: Group Health Inc Commercial	$1.67
Rate for Payer: Group Health Inc Medicare	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.67
Rate for Payer: Hamaspik Choice Inc Medicare	$1.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.17

ATOVAQUONE/PROGUANIL 62.5-25MG

Facility OP

$3.34

Hospital Charge Code	41646494
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$2.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.67
Rate for Payer: Aetna Government	$1.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.27
Rate for Payer: Group Health Inc Commercial	$1.67
Rate for Payer: Group Health Inc Medicare	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.67
Rate for Payer: Hamaspik Choice Inc Medicare	$1.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.17

ATRACURIUM 100MG/250ML

Facility OP

$28.60

Hospital Charge Code	41650221
Hospital Revenue Code	636
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$18.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.30
Rate for Payer: Aetna Government	$14.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.44
Rate for Payer: Group Health Inc Commercial	$14.30
Rate for Payer: Group Health Inc Medicare	$10.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.30
Rate for Payer: Hamaspik Choice Inc Medicare	$14.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.59

ATRACURIUM 100MG/250ML

Facility OP

$28.60

Hospital Charge Code	41640221
Hospital Revenue Code	636
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$18.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.30
Rate for Payer: Aetna Government	$14.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.44
Rate for Payer: Group Health Inc Commercial	$14.30
Rate for Payer: Group Health Inc Medicare	$10.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.30
Rate for Payer: Hamaspik Choice Inc Medicare	$14.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.59

ATRACURIUM 100MG/250ML

Facility IP

$28.60

Hospital Charge Code	41640221
Hospital Revenue Code	636
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$14.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.30
Rate for Payer: Hamaspik Choice Inc Medicare	$14.30

ATRACURIUM 100MG/250ML

Facility IP

$28.60

Hospital Charge Code	41650221
Hospital Revenue Code	636
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$14.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.30
Rate for Payer: Hamaspik Choice Inc Medicare	$14.30

ATRIAL LEAD 4592 53 CM

Facility IP

$1,300.00

Service Code	HCPCS C1713
Hospital Charge Code	40200398
Hospital Revenue Code	278
Min. Negotiated Rate	$650.00
Max. Negotiated Rate	$650.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$650.00
Rate for Payer: Hamaspik Choice Inc Medicare	$650.00

ATRIAL LEAD 4592 53 CM

Facility OP

$1,300.00

Service Code	HCPCS C1713
Hospital Charge Code	40200398
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,365.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$715.00
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	$650.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$747.50
Rate for Payer: Fidelis Medicare Advantage	$1,365.00
Rate for Payer: Group Health Inc Commercial	$650.00
Rate for Payer: Group Health Inc Medicare	$455.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$650.00
Rate for Payer: Hamaspik Choice Inc Medicare	$650.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$845.00

ATRIUM C-QUR MESH 25.4 X 35.5CM

Facility IP

$3,410.00

Service Code	HCPCS C1781
Hospital Charge Code	40206279
Hospital Revenue Code	278
Min. Negotiated Rate	$1,705.00
Max. Negotiated Rate	$1,705.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,705.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,705.00

ATRIUM C-QUR MESH 25.4 X 35.5CM

Facility OP

$3,410.00

Service Code	HCPCS C1781
Hospital Charge Code	40206279
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$3,580.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,875.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,705.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,960.75
Rate for Payer: Fidelis Medicare Advantage	$3,580.50
Rate for Payer: Group Health Inc Commercial	$1,705.00
Rate for Payer: Group Health Inc Medicare	$1,193.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,705.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,705.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,216.50

ATRIUM C-QUR MESH 8.9X 8.9

Facility IP

$570.00

Service Code	HCPCS C1781
Hospital Charge Code	40209638
Hospital Revenue Code	278
Min. Negotiated Rate	$285.00
Max. Negotiated Rate	$285.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$285.00

ATRIUM C-QUR MESH 8.9X 8.9

Facility OP

$570.00

Service Code	HCPCS C1781
Hospital Charge Code	40209638
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$598.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$313.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$285.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$327.75
Rate for Payer: Fidelis Medicare Advantage	$598.50
Rate for Payer: Group Health Inc Commercial	$285.00
Rate for Payer: Group Health Inc Medicare	$199.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$285.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$370.50

ATRIUM C-QUR TAC MESH 7.5CMX15CM

Facility OP

$986.10

Service Code	HCPCS C1781
Hospital Charge Code	40206289
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,035.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$542.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$493.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$567.01
Rate for Payer: Fidelis Medicare Advantage	$1,035.40
Rate for Payer: Group Health Inc Commercial	$493.05
Rate for Payer: Group Health Inc Medicare	$345.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$493.05
Rate for Payer: Hamaspik Choice Inc Medicare	$493.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$640.96

ATRIUM C-QUR TAC MESH 7.5CMX15CM

Facility IP

$986.10

Service Code	HCPCS C1781
Hospital Charge Code	40206289
Hospital Revenue Code	278
Min. Negotiated Rate	$493.05
Max. Negotiated Rate	$493.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$493.05
Rate for Payer: Hamaspik Choice Inc Medicare	$493.05

ATRIUM C-QUR TACSHIELD MESH

Facility IP

$2,810.00

Service Code	HCPCS C1781
Hospital Charge Code	40206235
Hospital Revenue Code	278
Min. Negotiated Rate	$1,405.00
Max. Negotiated Rate	$1,405.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,405.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,405.00

ATRIUM C-QUR TACSHIELD MESH

Facility OP

$2,810.00

Service Code	HCPCS C1781
Hospital Charge Code	40206235
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,950.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,545.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,405.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,615.75
Rate for Payer: Fidelis Medicare Advantage	$2,950.50
Rate for Payer: Group Health Inc Commercial	$1,405.00
Rate for Payer: Group Health Inc Medicare	$983.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,405.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,405.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,826.50

ATRIUM C-QUR TACSHIELD MESH 8X12

Facility IP

$896.00

Service Code	HCPCS C1781
Hospital Charge Code	40206244
Hospital Revenue Code	278
Min. Negotiated Rate	$448.00
Max. Negotiated Rate	$448.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$448.00
Rate for Payer: Hamaspik Choice Inc Medicare	$448.00

ATRIUM C-QUR TACSHIELD MESH 8X12

Facility OP

$896.00

Service Code	HCPCS C1781
Hospital Charge Code	40206244
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$940.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$492.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$448.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$515.20
Rate for Payer: Fidelis Medicare Advantage	$940.80
Rate for Payer: Group Health Inc Commercial	$448.00
Rate for Payer: Group Health Inc Medicare	$313.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$448.00
Rate for Payer: Hamaspik Choice Inc Medicare	$448.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$582.40

ATRIUM C-QUR V-PATCH MESH

Facility IP

$735.30

Service Code	HCPCS C1781
Hospital Charge Code	40205189
Hospital Revenue Code	278
Min. Negotiated Rate	$367.65
Max. Negotiated Rate	$367.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$367.65
Rate for Payer: Hamaspik Choice Inc Medicare	$367.65

ATRIUM C-QUR V-PATCH MESH

Facility OP

$735.30

Service Code	HCPCS C1781
Hospital Charge Code	40205189
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$772.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$404.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$367.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$422.80
Rate for Payer: Fidelis Medicare Advantage	$772.06
Rate for Payer: Group Health Inc Commercial	$367.65
Rate for Payer: Group Health Inc Medicare	$257.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$367.65
Rate for Payer: Hamaspik Choice Inc Medicare	$367.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$477.94

ATRIUM C-QUR V-PATCH MESH 16.4

Facility OP

$978.25

Service Code	HCPCS C1781
Hospital Charge Code	40205900
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,027.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$538.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$489.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$562.49
Rate for Payer: Fidelis Medicare Advantage	$1,027.16
Rate for Payer: Group Health Inc Commercial	$489.12
Rate for Payer: Group Health Inc Medicare	$342.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$489.12
Rate for Payer: Hamaspik Choice Inc Medicare	$489.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$635.86

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