St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ARTIFICIAL TEARS 83-15 % OP OINT [122104]

Facility

$2.45

Service Code	NDC 00065051801
Hospital Charge Code	00065051801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.23
Rate for Payer: Aetna Government	$1.23
Rate for Payer: Brighton Health Commercial	$1.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.67
Rate for Payer: Group Health Inc Commercial	$1.23
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23
Rate for Payer: Hamaspik Choice Inc Medicare	$1.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.59

ARTIFICIAL TEARS 83-15 % OP OINT [122104]

Facility

$1.85

Service Code	NDC 00904648838
Hospital Charge Code	00904648838
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.92
Rate for Payer: Aetna Government	$0.92
Rate for Payer: Brighton Health Commercial	$1.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.26
Rate for Payer: Group Health Inc Commercial	$0.92
Rate for Payer: Group Health Inc Medicare	$0.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.92
Rate for Payer: Hamaspik Choice Inc Medicare	$0.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.20

ART SPBDG IMP SYS BIOCOM4.75X19.1

Facility

$1,740.00

Service Code	HCPCS C1713
Hospital Charge Code	40201460
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,827.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$957.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,044.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$870.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,000.50
Rate for Payer: EmblemHealth Commercial	$870.00
Rate for Payer: Fidelis Medicare Advantage	$1,827.00
Rate for Payer: Group Health Inc Commercial	$870.00
Rate for Payer: Group Health Inc Medicare	$609.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$870.00
Rate for Payer: Hamaspik Choice Inc Medicare	$870.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,131.00

ART SPBDG IMP SYS BIOCOM4.75X19.1

Facility

$1,740.00

Service Code	HCPCS C1713
Hospital Charge Code	40201460
Hospital Revenue Code	278
Min. Negotiated Rate	$870.00
Max. Negotiated Rate	$870.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$870.00
Rate for Payer: Hamaspik Choice Inc Medicare	$870.00

ART SURF FIX BEARING RT 12MM

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40203388
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: Brighton Health Commercial	$2,040.00
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: EmblemHealth Commercial	$1,700.00
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

ART SURF FIX BEARING RT 12MM

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40203388
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

ART SURF FIX BEARING RT 13MM

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40203386
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

ART SURF FIX BEARING RT 13MM

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40203386
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: Brighton Health Commercial	$2,040.00
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: EmblemHealth Commercial	$1,700.00
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

ART SURF FIX BEARING RT 18MM

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40203387
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: Brighton Health Commercial	$2,040.00
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: EmblemHealth Commercial	$1,700.00
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

ART SURF FIX BEARING RT 18MM

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40203387
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

ART SURF PROLNG HI YEL 10MM

Facility

$4,192.63

Service Code	HCPCS C1713
Hospital Charge Code	64902307
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.32
Max. Negotiated Rate	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,096.32

ART SURF PROLNG HI YEL 10MM

Facility

$4,192.63

Service Code	HCPCS C1713
Hospital Charge Code	64902307
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,402.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,305.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,515.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,096.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,410.76
Rate for Payer: EmblemHealth Commercial	$2,096.32
Rate for Payer: Fidelis Medicare Advantage	$4,402.26
Rate for Payer: Group Health Inc Commercial	$2,096.32
Rate for Payer: Group Health Inc Medicare	$1,467.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,096.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,725.21

ART SURF PROLNG HI YEL 12MM

Facility

$4,192.63

Service Code	HCPCS C1713
Hospital Charge Code	64901703
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.32
Max. Negotiated Rate	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,096.32

ART SURF PROLNG HI YEL 12MM

Facility

$4,192.63

Service Code	HCPCS C1713
Hospital Charge Code	64901703
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,402.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,305.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,515.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,096.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,410.76
Rate for Payer: EmblemHealth Commercial	$2,096.32
Rate for Payer: Fidelis Medicare Advantage	$4,402.26
Rate for Payer: Group Health Inc Commercial	$2,096.32
Rate for Payer: Group Health Inc Medicare	$1,467.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,096.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,725.21

ART SURF PROLNG HI YEL 14MM

Facility

$4,192.63

Service Code	HCPCS C1713
Hospital Charge Code	64902087
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.32
Max. Negotiated Rate	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,096.32

ART SURF PROLNG HI YEL 14MM

Facility

$4,192.63

Service Code	HCPCS C1713
Hospital Charge Code	64902087
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,402.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,305.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,515.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,096.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,410.76
Rate for Payer: EmblemHealth Commercial	$2,096.32
Rate for Payer: Fidelis Medicare Advantage	$4,402.26
Rate for Payer: Group Health Inc Commercial	$2,096.32
Rate for Payer: Group Health Inc Medicare	$1,467.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,096.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,725.21

ART SURF PROLONG HI YEL 12MM

Facility

$3,539.40

Hospital Charge Code	40205056
Hospital Revenue Code	270
Min. Negotiated Rate	$1,238.79
Max. Negotiated Rate	$2,831.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,946.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,769.70
Rate for Payer: Aetna Government	$1,769.70
Rate for Payer: Brighton Health Commercial	$2,654.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,831.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,406.79
Rate for Payer: Group Health Inc Commercial	$1,769.70
Rate for Payer: Group Health Inc Medicare	$1,238.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,769.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1,769.70

ARTTH LO-PRO SCR 3.5X45MM COTRX

Facility

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	40201568
Hospital Revenue Code	278
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.12
Rate for Payer: EmblemHealth Commercial	$17.50
Rate for Payer: Fidelis Medicare Advantage	$36.75
Rate for Payer: Group Health Inc Commercial	$17.50
Rate for Payer: Group Health Inc Medicare	$12.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$17.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.75

ARTTH LO-PRO SCR 3.5X45MM COTRX

Facility

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	40201568
Hospital Revenue Code	278
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$17.50

ARTX KNOTLESS RPE SYND REPAIR IMP

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	40207457
Hospital Revenue Code	278
Min. Negotiated Rate	$440.00
Max. Negotiated Rate	$440.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$440.00
Rate for Payer: Hamaspik Choice Inc Medicare	$440.00

ARTX KNOTLESS RPE SYND REPAIR IMP

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	40207457
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$924.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$484.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$528.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$506.00
Rate for Payer: EmblemHealth Commercial	$440.00
Rate for Payer: Fidelis Medicare Advantage	$924.00
Rate for Payer: Group Health Inc Commercial	$440.00
Rate for Payer: Group Health Inc Medicare	$308.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$440.00
Rate for Payer: Hamaspik Choice Inc Medicare	$440.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$572.00

ARTX LO-PRO SCRW SS 2.7X16MM CRTX

Facility

$45.00

Service Code	HCPCS C1713
Hospital Charge Code	40207455
Hospital Revenue Code	278
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$27.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.88
Rate for Payer: EmblemHealth Commercial	$22.50
Rate for Payer: Fidelis Medicare Advantage	$47.25
Rate for Payer: Group Health Inc Commercial	$22.50
Rate for Payer: Group Health Inc Medicare	$15.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.50
Rate for Payer: Hamaspik Choice Inc Medicare	$22.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.25

ARTX LO-PRO SCRW SS 2.7X16MM CRTX

Facility

$45.00

Service Code	HCPCS C1713
Hospital Charge Code	40207455
Hospital Revenue Code	278
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.50
Rate for Payer: Hamaspik Choice Inc Medicare	$22.50

ARTX LO-PRO SCRW SS 2.7X18MM CRTX

Facility

$45.00

Service Code	HCPCS C1713
Hospital Charge Code	40207456
Hospital Revenue Code	278
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$27.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.88
Rate for Payer: EmblemHealth Commercial	$22.50
Rate for Payer: Fidelis Medicare Advantage	$47.25
Rate for Payer: Group Health Inc Commercial	$22.50
Rate for Payer: Group Health Inc Medicare	$15.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.50
Rate for Payer: Hamaspik Choice Inc Medicare	$22.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.25

ARTX LO-PRO SCRW SS 2.7X18MM CRTX

Facility

$45.00

Service Code	HCPCS C1713
Hospital Charge Code	40207456
Hospital Revenue Code	278
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.50
Rate for Payer: Hamaspik Choice Inc Medicare	$22.50

Know your out-of-pocket cost for care.

All Charges