St. Barnabas Hospital

All Charges

Charge

Type

Price

SAFESHEATH II PLI KIT 7FR 23CM

Facility OP

$657.00

Hospital Charge Code	40005901
Hospital Revenue Code	272
Min. Negotiated Rate	$229.95
Max. Negotiated Rate	$525.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$361.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$328.50
Rate for Payer: Aetna Government	$328.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$525.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$446.76
Rate for Payer: Group Health Inc Commercial	$328.50
Rate for Payer: Group Health Inc Medicare	$229.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.50
Rate for Payer: Hamaspik Choice Inc Medicare	$328.50

SAFE SHEATH WORLEY STD 19M

Facility OP

$836.00

Service Code	HCPCS C1776
Hospital Charge Code	66570514
Hospital Revenue Code	278
Min. Negotiated Rate	$292.60
Max. Negotiated Rate	$877.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$459.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$418.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$480.70
Rate for Payer: Fidelis Medicare Advantage	$877.80
Rate for Payer: Group Health Inc Commercial	$418.00
Rate for Payer: Group Health Inc Medicare	$292.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$418.00
Rate for Payer: Hamaspik Choice Inc Medicare	$418.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$543.40

SAFE SHEATH WORLEY STD 19M

Facility IP

$836.00

Service Code	HCPCS C1776
Hospital Charge Code	66570514
Hospital Revenue Code	278
Min. Negotiated Rate	$418.00
Max. Negotiated Rate	$418.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$418.00
Rate for Payer: Hamaspik Choice Inc Medicare	$418.00

SAFETY SCREW

Facility OP

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	40200061
Hospital Revenue Code	278
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.20
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	$52.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.80
Rate for Payer: Fidelis Medicare Advantage	$109.20
Rate for Payer: Group Health Inc Commercial	$52.00
Rate for Payer: Group Health Inc Medicare	$36.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$67.60

SAFETY SCREW

Facility IP

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	40200061
Hospital Revenue Code	278
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$52.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00

SAFETY SCREW 1.9X4MM

Facility IP

$140.00

Service Code	HCPCS C1713
Hospital Charge Code	40200168
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.00
Rate for Payer: Hamaspik Choice Inc Medicare	$70.00

SAFETY SCREW 1.9X4MM

Facility OP

$140.00

Service Code	HCPCS C1713
Hospital Charge Code	40200168
Hospital Revenue Code	278
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$147.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.00
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	$70.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.50
Rate for Payer: Fidelis Medicare Advantage	$147.00
Rate for Payer: Group Health Inc Commercial	$70.00
Rate for Payer: Group Health Inc Medicare	$49.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.00
Rate for Payer: Hamaspik Choice Inc Medicare	$70.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$91.00

SALICYLATE QUANTITATION

Facility OP

$107.50

Service Code	HCPCS 80329
Hospital Charge Code	40602225
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$86.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.10
Rate for Payer: Group Health Inc Commercial	$53.75
Rate for Payer: Group Health Inc Medicare	$37.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.75
Rate for Payer: Hamaspik Choice Inc Medicare	$53.75

SALICYLIC ACID 30% 60ML

Facility OP

$54.00

Hospital Charge Code	41658012
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$43.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.00
Rate for Payer: Aetna Government	$27.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.72
Rate for Payer: Group Health Inc Commercial	$27.00
Rate for Payer: Group Health Inc Medicare	$18.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.00
Rate for Payer: Hamaspik Choice Inc Medicare	$27.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.10

SALICYLIC ACID 30% 60ML

Facility OP

$54.00

Hospital Charge Code	41648012
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$43.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.00
Rate for Payer: Aetna Government	$27.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.72
Rate for Payer: Group Health Inc Commercial	$27.00
Rate for Payer: Group Health Inc Medicare	$18.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.00
Rate for Payer: Hamaspik Choice Inc Medicare	$27.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.10

SALICYLIC ACID-SULFUR SHAMPOO

Facility OP

$2.88

Hospital Charge Code	41643290
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.44
Rate for Payer: Aetna Government	$1.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.96
Rate for Payer: Group Health Inc Commercial	$1.44
Rate for Payer: Group Health Inc Medicare	$1.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.87

SALICYLIC ACID-SULFUR SHAMPOO

Facility OP

$2.88

Hospital Charge Code	41653290
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.44
Rate for Payer: Aetna Government	$1.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.96
Rate for Payer: Group Health Inc Commercial	$1.44
Rate for Payer: Group Health Inc Medicare	$1.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.87

SALICYLIC ACID TOPICAL 6% GEL

Facility OP

$64.36

Hospital Charge Code	41643564
Hospital Revenue Code	250
Min. Negotiated Rate	$22.53
Max. Negotiated Rate	$51.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.18
Rate for Payer: Aetna Government	$32.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.76
Rate for Payer: Group Health Inc Commercial	$32.18
Rate for Payer: Group Health Inc Medicare	$22.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.18
Rate for Payer: Hamaspik Choice Inc Medicare	$32.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.83

SALICYLIC ACID TOPICAL 6% GEL

Facility OP

$64.36

Hospital Charge Code	41653564
Hospital Revenue Code	250
Min. Negotiated Rate	$22.53
Max. Negotiated Rate	$51.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.18
Rate for Payer: Aetna Government	$32.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.76
Rate for Payer: Group Health Inc Commercial	$32.18
Rate for Payer: Group Health Inc Medicare	$22.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.18
Rate for Payer: Hamaspik Choice Inc Medicare	$32.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.83

SALINE INFUSION PUMP

Facility OP

$10,790.00

Hospital Charge Code	40005132
Hospital Revenue Code	272
Min. Negotiated Rate	$3,776.50
Max. Negotiated Rate	$8,632.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,934.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,395.00
Rate for Payer: Aetna Government	$5,395.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,632.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,337.20
Rate for Payer: Group Health Inc Commercial	$5,395.00
Rate for Payer: Group Health Inc Medicare	$3,776.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,395.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,395.00

SALINE MAM/BREAST IMPLT 350CC

Facility IP

$1,750.00

Service Code	HCPCS C1789
Hospital Charge Code	40209948
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00

SALINE MAM/BREAST IMPLT 350CC

Facility OP

$1,750.00

Service Code	HCPCS C1789
Hospital Charge Code	40209948
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,837.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$962.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$875.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,006.25
Rate for Payer: Fidelis Medicare Advantage	$1,837.50
Rate for Payer: Group Health Inc Commercial	$875.00
Rate for Payer: Group Health Inc Medicare	$612.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,137.50

SALINE MAMMARY BREST IMPNT 200 CC

Facility OP

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	40201119
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,207.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: Fidelis Medicare Advantage	$1,207.50
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.50

SALINE MAMMARY BREST IMPNT 200 CC

Facility IP

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	40201119
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

SALINE MAMMARY BREST IMPNT 300 CC

Facility OP

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	40201121
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,207.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: Fidelis Medicare Advantage	$1,207.50
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.50

SALINE MAMMARY BREST IMPNT 300 CC

Facility IP

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	40201121
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

SALINE MAMMARY BREST IMPNT 350 CC

Facility IP

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	40201122
Hospital Revenue Code	278
Min. Negotiated Rate	$1,150.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00

SALINE MAMMARY BREST IMPNT 350 CC

Facility OP

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	40201122
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,415.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,265.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,322.50
Rate for Payer: Fidelis Medicare Advantage	$2,415.00
Rate for Payer: Group Health Inc Commercial	$1,150.00
Rate for Payer: Group Health Inc Medicare	$805.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,495.00

SALINE MAMMARY BREST IMPNT 450 CC

Facility OP

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	40201123
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,415.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,265.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,322.50
Rate for Payer: Fidelis Medicare Advantage	$2,415.00
Rate for Payer: Group Health Inc Commercial	$1,150.00
Rate for Payer: Group Health Inc Medicare	$805.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,495.00

SALINE MAMMARY BREST IMPNT 450 CC

Facility IP

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	40201123
Hospital Revenue Code	278
Min. Negotiated Rate	$1,150.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00

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