St. Barnabas Hospital

All Charges

Charge

Type

Price

SET, 0 ANGLE CYL SCROT W PUMP

Facility IP

$21,975.00

Service Code	HCPCS C1813
Hospital Charge Code	64905188
Hospital Revenue Code	278
Min. Negotiated Rate	$10,987.50
Max. Negotiated Rate	$10,987.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,987.50
Rate for Payer: Hamaspik Choice Inc Medicare	$10,987.50

SET, 0 ANGLE CYL SCROT W PUMP

Facility OP

$21,975.00

Service Code	HCPCS C1813
Hospital Charge Code	64905188
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$23,073.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,086.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10,987.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,635.62
Rate for Payer: Fidelis Medicare Advantage	$23,073.75
Rate for Payer: Group Health Inc Commercial	$10,987.50
Rate for Payer: Group Health Inc Medicare	$7,691.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,987.50
Rate for Payer: Hamaspik Choice Inc Medicare	$10,987.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14,283.75

SET ADAPTER ALLIG/BANANA 4MM GE

Facility OP

$7.32

Hospital Charge Code	64902871
Hospital Revenue Code	270
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$5.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.66
Rate for Payer: Aetna Government	$3.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.98
Rate for Payer: Group Health Inc Commercial	$3.66
Rate for Payer: Group Health Inc Medicare	$2.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.66
Rate for Payer: Hamaspik Choice Inc Medicare	$3.66

SET,ADMIN,CADD,123,BAG SPI

Facility OP

$19.30

Hospital Charge Code	64901794
Hospital Revenue Code	270
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$15.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.65
Rate for Payer: Aetna Government	$9.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.12
Rate for Payer: Group Health Inc Commercial	$9.65
Rate for Payer: Group Health Inc Medicare	$6.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.65
Rate for Payer: Hamaspik Choice Inc Medicare	$9.65

SET AIR ELIMINATE FILTER

Facility OP

$10.23

Hospital Charge Code	64901787
Hospital Revenue Code	270
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$8.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.12
Rate for Payer: Aetna Government	$5.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.96
Rate for Payer: Group Health Inc Commercial	$5.12
Rate for Payer: Group Health Inc Medicare	$3.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.12
Rate for Payer: Hamaspik Choice Inc Medicare	$5.12

SET AIR ELIMINATING FILTER

Facility OP

$23.98

Hospital Charge Code	64902531
Hospital Revenue Code	270
Min. Negotiated Rate	$8.39
Max. Negotiated Rate	$19.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.99
Rate for Payer: Aetna Government	$11.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.31
Rate for Payer: Group Health Inc Commercial	$11.99
Rate for Payer: Group Health Inc Medicare	$8.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.99
Rate for Payer: Hamaspik Choice Inc Medicare	$11.99

SET ANGLE CYL W/PUMP SCROTAL

Facility OP

$19,100.00

Service Code	HCPCS C1813
Hospital Charge Code	64902704
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$20,055.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,505.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,982.50
Rate for Payer: Fidelis Medicare Advantage	$20,055.00
Rate for Payer: Group Health Inc Commercial	$9,550.00
Rate for Payer: Group Health Inc Medicare	$6,685.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9,550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12,415.00

SET ANGLE CYL W/PUMP SCROTAL

Facility IP

$19,100.00

Service Code	HCPCS C1813
Hospital Charge Code	64902704
Hospital Revenue Code	278
Min. Negotiated Rate	$9,550.00
Max. Negotiated Rate	$9,550.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9,550.00

SET ARTHROSCOPY CASS. TUBE

Facility OP

$148.50

Hospital Charge Code	64902457
Hospital Revenue Code	270
Min. Negotiated Rate	$51.98
Max. Negotiated Rate	$118.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.25
Rate for Payer: Aetna Government	$74.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$118.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$100.98
Rate for Payer: Group Health Inc Commercial	$74.25
Rate for Payer: Group Health Inc Medicare	$51.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.25
Rate for Payer: Hamaspik Choice Inc Medicare	$74.25

SET BASIN MAJOR

Facility OP

$36.02

Hospital Charge Code	64901144
Hospital Revenue Code	270
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$28.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.01
Rate for Payer: Aetna Government	$18.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.49
Rate for Payer: Group Health Inc Commercial	$18.01
Rate for Payer: Group Health Inc Medicare	$12.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.01
Rate for Payer: Hamaspik Choice Inc Medicare	$18.01

SET BASIN SINGLE W/WRAP

Facility OP

$3.63

Hospital Charge Code	64902301
Hospital Revenue Code	270
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$2.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.82
Rate for Payer: Aetna Government	$1.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.47
Rate for Payer: Group Health Inc Commercial	$1.82
Rate for Payer: Group Health Inc Medicare	$1.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1.82

SET,BLD COLL,VCTNR,W/O HOLDER,25

Facility OP

$3.13

Hospital Charge Code	64902326
Hospital Revenue Code	270
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$2.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.13
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

SET, BLOOD COLLECT, 21G X .75

Facility OP

$1.94

Hospital Charge Code	64902130
Hospital Revenue Code	270
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.32
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97

SET, BLOOD COLLECT, 23G X .75

Facility OP

$1.94

Hospital Charge Code	64902132
Hospital Revenue Code	270
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.32
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97

SET, BLOOD COLLECT, 25G X .75

Facility OP

$1.98

Hospital Charge Code	64902133
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: 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

SET,BLOOD COLL,VACUT,21G X .75

Facility OP

$3.13

Hospital Charge Code	64902322
Hospital Revenue Code	270
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$2.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.13
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

SET,BLOOD COLL,VACUT,23G X .75

Facility OP

$3.13

Hospital Charge Code	64902324
Hospital Revenue Code	270
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$2.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.13
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

SET,BLOOD SOLUTION,Y-TYPE,STD

Facility OP

$4.82

Hospital Charge Code	64901906
Hospital Revenue Code	270
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$3.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.41
Rate for Payer: Aetna Government	$2.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.28
Rate for Payer: Group Health Inc Commercial	$2.41
Rate for Payer: Group Health Inc Medicare	$1.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.41
Rate for Payer: Hamaspik Choice Inc Medicare	$2.41

SET BLOOD Y TYPE CONV 82W/PUMP

Facility OP

$8.85

Hospital Charge Code	64905002
Hospital Revenue Code	270
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$7.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.42
Rate for Payer: Aetna Government	$4.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.02
Rate for Payer: Group Health Inc Commercial	$4.42
Rate for Payer: Group Health Inc Medicare	$3.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.42
Rate for Payer: Hamaspik Choice Inc Medicare	$4.42

SET,CABLE VIT

Facility OP

$1,170.00

Service Code	HCPCS C1776
Hospital Charge Code	64907231
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,228.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$643.50
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	$585.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$672.75
Rate for Payer: Fidelis Medicare Advantage	$1,228.50
Rate for Payer: Group Health Inc Commercial	$585.00
Rate for Payer: Group Health Inc Medicare	$409.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$585.00
Rate for Payer: Hamaspik Choice Inc Medicare	$585.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$760.50

SET,CABLE VIT

Facility IP

$1,170.00

Service Code	HCPCS C1776
Hospital Charge Code	64907231
Hospital Revenue Code	278
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$585.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$585.00
Rate for Payer: Hamaspik Choice Inc Medicare	$585.00

SET CAPD DISCONNECT

Facility OP

$213.00

Hospital Charge Code	64902085
Hospital Revenue Code	270
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$170.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$117.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$106.50
Rate for Payer: Aetna Government	$106.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$170.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.84
Rate for Payer: Group Health Inc Commercial	$106.50
Rate for Payer: Group Health Inc Medicare	$74.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.50
Rate for Payer: Hamaspik Choice Inc Medicare	$106.50

SET CAPD SOLUTION TRANSFER

Facility OP

$270.00

Hospital Charge Code	64902163
Hospital Revenue Code	270
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$216.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$148.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$135.00
Rate for Payer: Aetna Government	$135.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$216.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$183.60
Rate for Payer: Group Health Inc Commercial	$135.00
Rate for Payer: Group Health Inc Medicare	$94.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.00
Rate for Payer: Hamaspik Choice Inc Medicare	$135.00

SET,COLLECTION,LUER LOCK

Facility OP

$1.68

Hospital Charge Code	64901116
Hospital Revenue Code	270
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84

SET,CONTINU-FLO,SOLUTION,3 LUER

Facility OP

$7.41

Hospital Charge Code	64905531
Hospital Revenue Code	270
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$5.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.70
Rate for Payer: Aetna Government	$3.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.04
Rate for Payer: Group Health Inc Commercial	$3.70
Rate for Payer: Group Health Inc Medicare	$2.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.70
Rate for Payer: Hamaspik Choice Inc Medicare	$3.70

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