St. Barnabas Hospital

All Charges

Charge

Type

Price

SMALL BOWEL ENDOSCOPY/BIOPSY

Facility OP

$4,716.98

Service Code	HCPCS 44377
Hospital Charge Code	40019837
Hospital Revenue Code	360
Min. Negotiated Rate	$320.09
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,200.46
Rate for Payer: Aetna Government	$2,200.46
Rate for Payer: Cash Price	$2,200.46
Rate for Payer: Cash Price	$2,200.46
Rate for Payer: Cash Price	$2,200.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,200.46
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: Elderplan Medicare Advantage	$2,200.46
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$320.09
Rate for Payer: Fidelis Essential Plan Aliesa	$1,870.39
Rate for Payer: Fidelis Essential Plan QHP	$1,958.41
Rate for Payer: Fidelis Medicare Advantage	$2,200.46
Rate for Payer: Fidelis Qualified Health Plan	$1,958.41
Rate for Payer: Group Health Inc Commercial	$2,200.46
Rate for Payer: Group Health Inc Medicare	$2,200.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,358.49
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$355.66
Rate for Payer: Healthfirst Medicare Advantage	$1,870.39
Rate for Payer: Healthfirst QHP	$2,200.46
Rate for Payer: Senior Whole Health Medicare Advantage	$2,200.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,200.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,760.37
Rate for Payer: Wellcare Medicare	$2,090.44

SMALL JOINT

Facility OP

$792.83

Service Code	HCPCS 20600
Hospital Charge Code	30301304
Hospital Revenue Code	510
Min. Negotiated Rate	$38.34
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$342.51
Rate for Payer: Aetna Government	$342.51
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$342.51
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: Elderplan Medicare Advantage	$342.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38.34
Rate for Payer: Fidelis Essential Plan Aliesa	$291.13
Rate for Payer: Fidelis Essential Plan QHP	$304.83
Rate for Payer: Fidelis Medicare Advantage	$342.51
Rate for Payer: Fidelis Qualified Health Plan	$304.83
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	$396.42
Rate for Payer: Hamaspik Choice Inc Medicare	$342.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42.60
Rate for Payer: Healthfirst Medicare Advantage	$291.13
Rate for Payer: Healthfirst QHP	$342.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$342.51
Rate for Payer: Senior Whole Health Medicare Advantage	$342.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$342.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$274.01
Rate for Payer: Wellcare Medicare	$325.38

SMALL JOINT 2.5MM FULL RAD

Facility OP

$500.00

Hospital Charge Code	64905882
Hospital Revenue Code	270
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$250.00
Rate for Payer: Aetna Government	$250.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

SMALL MEDEBRA WOMEN WHTE

Facility OP

$63.13

Hospital Charge Code	64905833
Hospital Revenue Code	270
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$50.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.56
Rate for Payer: Aetna Government	$31.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.93
Rate for Payer: Group Health Inc Commercial	$31.56
Rate for Payer: Group Health Inc Medicare	$22.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.56
Rate for Payer: Hamaspik Choice Inc Medicare	$31.56

SMALL STAPLE

Facility IP

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	40200802
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00

SMALL STAPLE

Facility OP

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	40200802
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$945.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
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	$450.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$517.50
Rate for Payer: Fidelis Medicare Advantage	$945.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$585.00

SMALL STAPLE 13 X 10 MM

Facility IP

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	40200803
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00

SMALL STAPLE 13 X 10 MM

Facility OP

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	40200803
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$945.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
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	$450.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$517.50
Rate for Payer: Fidelis Medicare Advantage	$945.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$585.00

SMALL STAPLE 2

Facility OP

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	40205163
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,181.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$618.75
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	$562.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$646.88
Rate for Payer: Fidelis Medicare Advantage	$1,181.25
Rate for Payer: Group Health Inc Commercial	$562.50
Rate for Payer: Group Health Inc Medicare	$393.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$562.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$731.25

SMALL STAPLE 2

Facility IP

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	40205163
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$562.50

SMALL STAPLE 7 X 5MM

Facility OP

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	40200804
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$945.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
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	$450.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$517.50
Rate for Payer: Fidelis Medicare Advantage	$945.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$585.00

SMALL STAPLE 7 X 5MM

Facility IP

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	40200804
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00

SMALL STAPLE 9 X 7 MM

Facility OP

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	40200808
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$577.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
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	$275.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$316.25
Rate for Payer: Fidelis Medicare Advantage	$577.50
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$357.50

SMALL STAPLE 9 X 7 MM

Facility IP

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	40200808
Hospital Revenue Code	278
Min. Negotiated Rate	$275.00
Max. Negotiated Rate	$275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00

SMALL VAKU-PAK DRESSING WITH PUMP

Facility OP

$3,920.00

Service Code	HCPCS E2402
Hospital Charge Code	40208002
Hospital Revenue Code	270
Min. Negotiated Rate	$1,372.00
Max. Negotiated Rate	$9,052.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,156.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9,052.47
Rate for Payer: Aetna Government	$9,052.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,136.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,665.60
Rate for Payer: Group Health Inc Commercial	$1,960.00
Rate for Payer: Group Health Inc Medicare	$1,372.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,960.00

SMALL VAKU-PAK DRESSING W/O PUMP

Facility OP

$3,269.00

Hospital Charge Code	40208004
Hospital Revenue Code	270
Min. Negotiated Rate	$1,144.15
Max. Negotiated Rate	$2,615.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,797.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,634.50
Rate for Payer: Aetna Government	$1,634.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,615.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,222.92
Rate for Payer: Group Health Inc Commercial	$1,634.50
Rate for Payer: Group Health Inc Medicare	$1,144.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,634.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,634.50

SMARTLOCK HMMF HMMF SCR/2.0X6MM

Facility OP

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40203410
Hospital Revenue Code	278
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$264.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.60
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	$126.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.90
Rate for Payer: Fidelis Medicare Advantage	$264.60
Rate for Payer: Group Health Inc Commercial	$126.00
Rate for Payer: Group Health Inc Medicare	$88.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.80

SMARTLOCK HMMF HMMF SCR/2.0X6MM

Facility IP

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40203410
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00

SMARTLOCK HMMF HMMF SCR/2.0X8MM

Facility OP

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40203409
Hospital Revenue Code	278
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$264.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.60
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	$126.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.90
Rate for Payer: Fidelis Medicare Advantage	$264.60
Rate for Payer: Group Health Inc Commercial	$126.00
Rate for Payer: Group Health Inc Medicare	$88.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.80

SMARTLOCK HMMF HMMF SCR/2.0X8MM

Facility IP

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40203409
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00

SMARTLOCK HMMF PLATE

Facility IP

$1,170.00

Service Code	HCPCS C1713
Hospital Charge Code	40005857
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

SMARTLOCK HMMF PLATE

Facility OP

$1,170.00

Service Code	HCPCS C1713
Hospital Charge Code	40005857
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,228.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$643.50
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	$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

SMARTLOCK HMMF PLATE SCR/2.0X8MM

Facility OP

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40203406
Hospital Revenue Code	278
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$264.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.60
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	$126.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.90
Rate for Payer: Fidelis Medicare Advantage	$264.60
Rate for Payer: Group Health Inc Commercial	$126.00
Rate for Payer: Group Health Inc Medicare	$88.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.80

SMARTLOCK HMMF PLATE SCR/2.0X8MM

Facility IP

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40203406
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00

SMARTLOCK HMMF PLATE SM

Facility IP

$825.00

Service Code	HCPCS C1713
Hospital Charge Code	64903291
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$412.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$412.50
Rate for Payer: Hamaspik Choice Inc Medicare	$412.50

Price Transparency.

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