St. Barnabas Hospital

All Charges

Charge

Type

Price

BEARING PSN KNEE LFT 20MM

Facility OP

$1,700.00

Hospital Charge Code	64906271
Hospital Revenue Code	270
Min. Negotiated Rate	$595.00
Max. Negotiated Rate	$1,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$935.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$850.00
Rate for Payer: Aetna Government	$850.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,360.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,156.00
Rate for Payer: Group Health Inc Commercial	$850.00
Rate for Payer: Group Health Inc Medicare	$595.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00

BEARING PSN L TB E-F FM 6-9

Facility IP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	64906657
Hospital Revenue Code	278
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

BEARING PSN L TB E-F FM 6-9

Facility OP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	64906657
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
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	$1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,955.00
Rate for Payer: Fidelis Medicare Advantage	$3,570.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,210.00

BEARING PSN RGT 11MM C-D 00511

Facility OP

$3,400.00

Hospital Charge Code	64906734
Hospital Revenue Code	279
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$2,720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,700.00
Rate for Payer: Aetna Government	$1,700.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,312.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

BEARING PSN RGT SZ 12MM C-D

Facility OP

$3,400.00

Hospital Charge Code	64906713
Hospital Revenue Code	279
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$2,720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,700.00
Rate for Payer: Aetna Government	$1,700.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,312.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

BEARING PSN R TB C-D FM 6-9

Facility IP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	64906659
Hospital Revenue Code	278
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

BEARING PSN R TB C-D FM 6-9

Facility OP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	64906659
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
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	$1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,955.00
Rate for Payer: Fidelis Medicare Advantage	$3,570.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,210.00

BEARING SHOULDER VIV-E 36MM

Facility IP

$4,620.00

Service Code	HCPCS C1776
Hospital Charge Code	64906971
Hospital Revenue Code	278
Min. Negotiated Rate	$2,310.00
Max. Negotiated Rate	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,310.00

BEARING SHOULDER VIV-E 36MM

Facility OP

$4,620.00

Service Code	HCPCS C1776
Hospital Charge Code	64906971
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,851.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,541.00
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	$2,310.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,656.50
Rate for Payer: Fidelis Medicare Advantage	$4,851.00
Rate for Payer: Group Health Inc Commercial	$2,310.00
Rate for Payer: Group Health Inc Medicare	$1,617.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,310.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,003.00

BEARING TIB

Facility OP

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907256
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,500.00
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	$5,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,750.00
Rate for Payer: Fidelis Medicare Advantage	$10,500.00
Rate for Payer: Group Health Inc Commercial	$5,000.00
Rate for Payer: Group Health Inc Medicare	$3,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,500.00

BEARING TIB

Facility IP

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907256
Hospital Revenue Code	278
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,000.00

BEARING VIVACIT E 3MM REV

Facility OP

$4,620.00

Service Code	HCPCS C1776
Hospital Charge Code	64907003
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,851.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,541.00
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	$2,310.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,656.50
Rate for Payer: Fidelis Medicare Advantage	$4,851.00
Rate for Payer: Group Health Inc Commercial	$2,310.00
Rate for Payer: Group Health Inc Medicare	$1,617.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,310.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,003.00

BEARING VIVACIT E 3MM REV

Facility IP

$4,620.00

Service Code	HCPCS C1776
Hospital Charge Code	64907003
Hospital Revenue Code	278
Min. Negotiated Rate	$2,310.00
Max. Negotiated Rate	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,310.00

BEBTELOVIMAB (COVID-19 MAB) INJ

Facility OP

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640333
Hospital Revenue Code	636
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: 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

BEBTELOVIMAB (COVID-19 MAB) INJ

Facility OP

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650333
Hospital Revenue Code	636
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: 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

BEBTELOVIMAB (COVID-19 MAB) INJ

Facility IP

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640333
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

BEBTELOVIMAB (COVID-19 MAB) INJ

Facility IP

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650333
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

BECLOMETHASONE INHALER 40 MCG/INHALATION

Facility OP

$193.00

Hospital Charge Code	41654328
Hospital Revenue Code	250
Min. Negotiated Rate	$67.55
Max. Negotiated Rate	$154.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.50
Rate for Payer: Aetna Government	$96.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$154.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.24
Rate for Payer: Group Health Inc Commercial	$96.50
Rate for Payer: Group Health Inc Medicare	$67.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.50
Rate for Payer: Hamaspik Choice Inc Medicare	$96.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$125.45

BECLOMETHASONE INHALER 40 MCG/INHALATION

Facility OP

$193.00

Hospital Charge Code	41644328
Hospital Revenue Code	250
Min. Negotiated Rate	$67.55
Max. Negotiated Rate	$154.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.50
Rate for Payer: Aetna Government	$96.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$154.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.24
Rate for Payer: Group Health Inc Commercial	$96.50
Rate for Payer: Group Health Inc Medicare	$67.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.50
Rate for Payer: Hamaspik Choice Inc Medicare	$96.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$125.45

BED EFICA

Facility OP

$349.85

Hospital Charge Code	64902954
Hospital Revenue Code	270
Min. Negotiated Rate	$122.45
Max. Negotiated Rate	$279.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$174.92
Rate for Payer: Aetna Government	$174.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$279.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$237.90
Rate for Payer: Group Health Inc Commercial	$174.92
Rate for Payer: Group Health Inc Medicare	$122.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.92
Rate for Payer: Hamaspik Choice Inc Medicare	$174.92

BED ELEXIS

Facility OP

$345.00

Hospital Charge Code	64902966
Hospital Revenue Code	270
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$276.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$172.50
Rate for Payer: Aetna Government	$172.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$276.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.60
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50

BED FLEXICAIR W/SCALE

Facility OP

$186.20

Hospital Charge Code	64902952
Hospital Revenue Code	270
Min. Negotiated Rate	$65.17
Max. Negotiated Rate	$148.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$102.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$93.10
Rate for Payer: Aetna Government	$93.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.62
Rate for Payer: Group Health Inc Commercial	$93.10
Rate for Payer: Group Health Inc Medicare	$65.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.10
Rate for Payer: Hamaspik Choice Inc Medicare	$93.10

BEDPAN 2QT STACKABLE TEAL H113-13

Facility OP

$1.49

Hospital Charge Code	40209461
Hospital Revenue Code	270
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.01
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75

BEDPAN FRACTURE GOLD

Facility OP

$1.70

Hospital Charge Code	64901856
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.85
Rate for Payer: Aetna Government	$0.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.16
Rate for Payer: Group Health Inc Commercial	$0.85
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.85
Rate for Payer: Hamaspik Choice Inc Medicare	$0.85

BED PULMONEX

Facility OP

$162.50

Hospital Charge Code	64902956
Hospital Revenue Code	270
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$130.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$81.25
Rate for Payer: Aetna Government	$81.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$130.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$110.50
Rate for Payer: Group Health Inc Commercial	$81.25
Rate for Payer: Group Health Inc Medicare	$56.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.25
Rate for Payer: Hamaspik Choice Inc Medicare	$81.25

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