St. Barnabas Hospital

All Charges

Charge

Type

Price

SCRW BONE CANCELL 6MM/1.9MM/4MM24

Facility OP

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64904200
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.18
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	$29.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.64
Rate for Payer: Fidelis Medicare Advantage	$61.42
Rate for Payer: Group Health Inc Commercial	$29.25
Rate for Payer: Group Health Inc Medicare	$20.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.02

SCRW BONE CANCELL 6MM/1.9MM/4MM4

Facility IP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901450
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44

SCRW BONE CANCELL 6MM/1.9MM/4MM4

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901450
Hospital Revenue Code	278
Min. Negotiated Rate	$19.91
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.28
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	$28.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.71
Rate for Payer: Fidelis Medicare Advantage	$59.72
Rate for Payer: Group Health Inc Commercial	$28.44
Rate for Payer: Group Health Inc Medicare	$19.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.97

SCRW BONE CANCELL 6MM/1.9MM/4MM5

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901682
Hospital Revenue Code	278
Min. Negotiated Rate	$19.91
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.28
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	$28.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.71
Rate for Payer: Fidelis Medicare Advantage	$59.72
Rate for Payer: Group Health Inc Commercial	$28.44
Rate for Payer: Group Health Inc Medicare	$19.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.97

SCRW BONE CANCELL 6MM/1.9MM/4MM5

Facility IP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901682
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44

SCRW BONE CANCELL 6MM/1.9MM/4MM6

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901744
Hospital Revenue Code	278
Min. Negotiated Rate	$19.91
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.28
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	$28.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.71
Rate for Payer: Fidelis Medicare Advantage	$59.72
Rate for Payer: Group Health Inc Commercial	$28.44
Rate for Payer: Group Health Inc Medicare	$19.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.97

SCRW BONE CANCELL 6MM/1.9MM/4MM6

Facility IP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901744
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44

SCRW BONE CANCELL 6MM/1.9MM/4MM7

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901749
Hospital Revenue Code	278
Min. Negotiated Rate	$19.91
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.28
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	$28.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.71
Rate for Payer: Fidelis Medicare Advantage	$59.72
Rate for Payer: Group Health Inc Commercial	$28.44
Rate for Payer: Group Health Inc Medicare	$19.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.97

SCRW BONE CANCELL 6MM/1.9MM/4MM7

Facility IP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901749
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44

SCRW INNER 5.0 SS MOSS MIAMI

Facility IP

$170.00

Service Code	HCPCS C1781
Hospital Charge Code	40209702
Hospital Revenue Code	278
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$85.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

SCRW INNER 5.0 SS MOSS MIAMI

Facility OP

$170.00

Service Code	HCPCS C1781
Hospital Charge Code	40209702
Hospital Revenue Code	278
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$178.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
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	$85.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$97.75
Rate for Payer: Fidelis Medicare Advantage	$178.50
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$110.50

SCRW LCKING 4.0X 95MM

Facility OP

$3,306.00

Hospital Charge Code	40200285
Hospital Revenue Code	278
Min. Negotiated Rate	$1,157.10
Max. Negotiated Rate	$3,471.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,818.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,653.00
Rate for Payer: Aetna Government	$1,653.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,653.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,900.95
Rate for Payer: Fidelis Medicare Advantage	$3,471.30
Rate for Payer: Group Health Inc Commercial	$1,653.00
Rate for Payer: Group Health Inc Medicare	$1,157.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,653.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,653.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,148.90

SCRW LCKING 4.0X 95MM

Facility IP

$3,306.00

Hospital Charge Code	40200285
Hospital Revenue Code	278
Min. Negotiated Rate	$1,653.00
Max. Negotiated Rate	$1,653.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,653.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,653.00

SCRW REST GAP PLATE 6.5X

Facility IP

$360.00

Service Code	HCPCS C1776
Hospital Charge Code	40205016
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$180.00

SCRW REST GAP PLATE 6.5X

Facility OP

$360.00

Service Code	HCPCS C1776
Hospital Charge Code	40205016
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$378.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$198.00
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	$180.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$207.00
Rate for Payer: Fidelis Medicare Advantage	$378.00
Rate for Payer: Group Health Inc Commercial	$180.00
Rate for Payer: Group Health Inc Medicare	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$234.00

SC THER INFUSION, RESET PUMP

Facility OP

$183.15

Service Code	HCPCS 96371
Hospital Charge Code	40509900
Hospital Revenue Code	269
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$146.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$81.46
Rate for Payer: Aetna Government	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$81.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.54
Rate for Payer: Elderplan Medicare Advantage	$81.46
Rate for Payer: EmblemHealth Commercial	$81.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62.10
Rate for Payer: Fidelis Essential Plan Aliesa	$69.24
Rate for Payer: Fidelis Essential Plan QHP	$72.50
Rate for Payer: Fidelis Medicare Advantage	$81.46
Rate for Payer: Fidelis Qualified Health Plan	$72.50
Rate for Payer: Group Health Inc Commercial	$81.46
Rate for Payer: Group Health Inc Medicare	$81.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.58
Rate for Payer: Hamaspik Choice Inc Medicare	$81.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$69.00
Rate for Payer: Healthfirst Medicare Advantage	$69.24
Rate for Payer: Healthfirst QHP	$81.46
Rate for Payer: Senior Whole Health Medicare Advantage	$81.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$65.17
Rate for Payer: Wellcare Medicare	$77.39

SCTHER INFUSION, RESET PUMP

Facility OP

$183.15

Service Code	HCPCS 96371
Hospital Charge Code	30306649
Hospital Revenue Code	510
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$81.46
Rate for Payer: Aetna Government	$81.46
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$81.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Elderplan Medicare Advantage	$81.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62.10
Rate for Payer: Fidelis Essential Plan Aliesa	$69.24
Rate for Payer: Fidelis Essential Plan QHP	$72.50
Rate for Payer: Fidelis Medicare Advantage	$81.46
Rate for Payer: Fidelis Qualified Health Plan	$72.50
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.58
Rate for Payer: Hamaspik Choice Inc Medicare	$81.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$69.00
Rate for Payer: Healthfirst Medicare Advantage	$69.24
Rate for Payer: Healthfirst QHP	$81.46
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$81.46
Rate for Payer: Senior Whole Health Medicare Advantage	$81.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$65.17
Rate for Payer: Wellcare Medicare	$77.39

SEALANT DRASEAL 5ML AUTOSUTURE

Facility OP

$110.00

Hospital Charge Code	64906437
Hospital Revenue Code	270
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$88.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.00
Rate for Payer: Aetna Government	$55.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$88.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.80
Rate for Payer: Group Health Inc Commercial	$55.00
Rate for Payer: Group Health Inc Medicare	$38.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.00
Rate for Payer: Hamaspik Choice Inc Medicare	$55.00

SEALANT HUMAN CROSSEAL 5ML

Facility OP

$1,150.00

Hospital Charge Code	64904454
Hospital Revenue Code	270
Min. Negotiated Rate	$402.50
Max. Negotiated Rate	$920.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$575.00
Rate for Payer: Aetna Government	$575.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$920.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$782.00
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

SEALANT-PER TOOTH

Facility OP

$87.50

Service Code	HCPCS D1351
Hospital Charge Code	42300285
Hospital Revenue Code	361
Min. Negotiated Rate	$13.97
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.97
Rate for Payer: Aetna Government	$13.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$43.75
Rate for Payer: Group Health Inc Medicare	$30.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.75
Rate for Payer: Hamaspik Choice Inc Medicare	$43.75

SEAL CLOSURE DEVICE

Facility OP

$550.00

Hospital Charge Code	66521496
Hospital Revenue Code	270
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.00
Rate for Payer: Aetna Government	$275.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$374.00
Rate for Payer: Group Health Inc Commercial	$275.00
Rate for Payer: Group Health Inc Medicare	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00

SEALED CONTAINER W/LID MID SIZE

Facility OP

$1,114.25

Hospital Charge Code	64905546
Hospital Revenue Code	270
Min. Negotiated Rate	$389.99
Max. Negotiated Rate	$891.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$612.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$557.12
Rate for Payer: Aetna Government	$557.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$891.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$757.69
Rate for Payer: Group Health Inc Commercial	$557.12
Rate for Payer: Group Health Inc Medicare	$389.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$557.12
Rate for Payer: Hamaspik Choice Inc Medicare	$557.12

SEALER LIGASURE LF

Facility OP

$1,262.55

Hospital Charge Code	64907088
Hospital Revenue Code	270
Min. Negotiated Rate	$441.89
Max. Negotiated Rate	$1,010.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$631.28
Rate for Payer: Aetna Government	$631.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,010.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$858.53
Rate for Payer: Group Health Inc Commercial	$631.28
Rate for Payer: Group Health Inc Medicare	$441.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$631.28
Rate for Payer: Hamaspik Choice Inc Medicare	$631.28

SEALING CAP WITH VENT

Facility OP

$31.20

Hospital Charge Code	40209538
Hospital Revenue Code	270
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$24.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.60
Rate for Payer: Aetna Government	$15.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.22
Rate for Payer: Group Health Inc Commercial	$15.60
Rate for Payer: Group Health Inc Medicare	$10.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.60
Rate for Payer: Hamaspik Choice Inc Medicare	$15.60

SEAL PULL TIGHT YELLOW

Facility OP

$0.45

Hospital Charge Code	64902122
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

Price Transparency.

All Charges