St. Barnabas Hospital

All Charges

Charge

Type

Price

BIOM LEFT BLTIBIAL TR RAY

Facility OP

$4,428.00

Service Code	HCPCS C1776
Hospital Charge Code	40009741
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,649.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,435.40
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	$2,214.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,546.10
Rate for Payer: Fidelis Medicare Advantage	$4,649.40
Rate for Payer: Group Health Inc Commercial	$2,214.00
Rate for Payer: Group Health Inc Medicare	$1,549.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,214.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,214.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,878.20

BIOM LEFT BLTIBIAL TR RAY

Facility IP

$4,428.00

Service Code	HCPCS C1776
Hospital Charge Code	40009741
Hospital Revenue Code	278
Min. Negotiated Rate	$2,214.00
Max. Negotiated Rate	$2,214.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,214.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,214.00

BIOMONITOR 2AF LOOP RECORD 398493

Facility OP

$8,400.00

Service Code	HCPCS C1898
Hospital Charge Code	66573257
Hospital Revenue Code	275
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$8,820.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,620.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,830.00
Rate for Payer: Fidelis Medicare Advantage	$8,820.00
Rate for Payer: Group Health Inc Commercial	$4,200.00
Rate for Payer: Group Health Inc Medicare	$2,940.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,460.00

BIOM OXFORD BLAL KNEE S

Facility IP

$6,648.00

Service Code	HCPCS C1776
Hospital Charge Code	40009742
Hospital Revenue Code	278
Min. Negotiated Rate	$3,324.00
Max. Negotiated Rate	$3,324.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,324.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,324.00

BIOM OXFORD BLAL KNEE S

Facility OP

$6,648.00

Service Code	HCPCS C1776
Hospital Charge Code	40009742
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,980.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,656.40
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	$3,324.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,822.60
Rate for Payer: Fidelis Medicare Advantage	$6,980.40
Rate for Payer: Group Health Inc Commercial	$3,324.00
Rate for Payer: Group Health Inc Medicare	$2,326.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,324.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,324.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,321.20

BIOM OXFORD BLAL KNEE S LEFT

Facility OP

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40009743
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,320.00
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	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,380.00
Rate for Payer: Fidelis Medicare Advantage	$2,520.00
Rate for Payer: Group Health Inc Commercial	$1,200.00
Rate for Payer: Group Health Inc Medicare	$840.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,560.00

BIOM OXFORD BLAL KNEE S LEFT

Facility IP

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40009743
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00

BIO PART KNEE RT TIB TRAY

Facility IP

$4,428.00

Service Code	HCPCS C1776
Hospital Charge Code	40009268
Hospital Revenue Code	278
Min. Negotiated Rate	$2,214.00
Max. Negotiated Rate	$2,214.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,214.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,214.00

BIO PART KNEE RT TIB TRAY

Facility OP

$4,428.00

Service Code	HCPCS C1776
Hospital Charge Code	40009268
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,649.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,435.40
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	$2,214.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,546.10
Rate for Payer: Fidelis Medicare Advantage	$4,649.40
Rate for Payer: Group Health Inc Commercial	$2,214.00
Rate for Payer: Group Health Inc Medicare	$1,549.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,214.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,214.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,878.20

BIOPIN 18X10

Facility OP

$122.50

Hospital Charge Code	64903539
Hospital Revenue Code	270
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$98.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.25
Rate for Payer: Aetna Government	$61.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$98.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.30
Rate for Payer: Group Health Inc Commercial	$61.25
Rate for Payer: Group Health Inc Medicare	$42.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.25
Rate for Payer: Hamaspik Choice Inc Medicare	$61.25

BIOPIN 18X15

Facility OP

$120.00

Hospital Charge Code	64903541
Hospital Revenue Code	270
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$96.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$60.00
Rate for Payer: Aetna Government	$60.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.60
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

BIOPIN 18X20

Facility OP

$122.50

Hospital Charge Code	64903543
Hospital Revenue Code	270
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$98.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.25
Rate for Payer: Aetna Government	$61.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$98.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.30
Rate for Payer: Group Health Inc Commercial	$61.25
Rate for Payer: Group Health Inc Medicare	$42.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.25
Rate for Payer: Hamaspik Choice Inc Medicare	$61.25

BIO PLEXA PROMRI DX 65/15 414005

Facility OP

$7,100.00

Service Code	HCPCS C1777
Hospital Charge Code	66573167
Hospital Revenue Code	275
Min. Negotiated Rate	$988.18
Max. Negotiated Rate	$7,455.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,905.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,082.50
Rate for Payer: Fidelis Medicare Advantage	$7,455.00
Rate for Payer: Group Health Inc Commercial	$3,550.00
Rate for Payer: Group Health Inc Medicare	$2,485.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,615.00

BIOPOLAR PACEMAKR STYLET #550

Facility OP

$292.01

Hospital Charge Code	40200609
Hospital Revenue Code	270
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$233.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$160.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$146.00
Rate for Payer: Aetna Government	$146.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$233.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$198.57
Rate for Payer: Group Health Inc Commercial	$146.00
Rate for Payer: Group Health Inc Medicare	$102.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.00
Rate for Payer: Hamaspik Choice Inc Medicare	$146.00

BIO PRO DRILL BIT

Facility OP

$90.00

Hospital Charge Code	40205445
Hospital Revenue Code	270
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$72.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.00
Rate for Payer: Aetna Government	$45.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$72.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.20
Rate for Payer: Group Health Inc Commercial	$45.00
Rate for Payer: Group Health Inc Medicare	$31.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.00
Rate for Payer: Hamaspik Choice Inc Medicare	$45.00

BIOPRO GO-EZ 3.5 SCREW

Facility OP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	40205653
Hospital Revenue Code	278
Min. Negotiated Rate	$91.88
Max. Negotiated Rate	$275.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.38
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	$131.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.94
Rate for Payer: Fidelis Medicare Advantage	$275.62
Rate for Payer: Group Health Inc Commercial	$131.25
Rate for Payer: Group Health Inc Medicare	$91.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$170.62

BIOPRO GO-EZ 3.5 SCREW

Facility IP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	40205653
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25

BIOPRO GO-EZ SCREW 2.0 X10-12MM

Facility OP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	40206239
Hospital Revenue Code	278
Min. Negotiated Rate	$91.88
Max. Negotiated Rate	$275.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.38
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	$131.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.94
Rate for Payer: Fidelis Medicare Advantage	$275.62
Rate for Payer: Group Health Inc Commercial	$131.25
Rate for Payer: Group Health Inc Medicare	$91.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$170.62

BIOPRO GO-EZ SCREW 2.0 X10-12MM

Facility IP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	40206239
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25

BIOPRO GO-EZ SCREW 2.0X12MM

Facility IP

$210.00

Service Code	HCPCS C1713
Hospital Charge Code	40205568
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00

BIOPRO GO-EZ SCREW 2.0X12MM

Facility OP

$210.00

Service Code	HCPCS C1713
Hospital Charge Code	40205568
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$220.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.50
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	$105.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$120.75
Rate for Payer: Fidelis Medicare Advantage	$220.50
Rate for Payer: Group Health Inc Commercial	$105.00
Rate for Payer: Group Health Inc Medicare	$73.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$136.50

BIOPRO GO-EZ SCREW 2.5

Facility IP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	40205566
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25

BIOPRO GO-EZ SCREW 2.5

Facility OP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	40205566
Hospital Revenue Code	278
Min. Negotiated Rate	$91.88
Max. Negotiated Rate	$275.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.38
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	$131.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.94
Rate for Payer: Fidelis Medicare Advantage	$275.62
Rate for Payer: Group Health Inc Commercial	$131.25
Rate for Payer: Group Health Inc Medicare	$91.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$170.62

BIOPRO GO-EZ SCREW 2.5X10MM

Facility IP

$210.00

Service Code	HCPCS C1713
Hospital Charge Code	40205575
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00

BIOPRO GO-EZ SCREW 2.5X10MM

Facility OP

$210.00

Service Code	HCPCS C1713
Hospital Charge Code	40205575
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$220.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.50
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	$105.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$120.75
Rate for Payer: Fidelis Medicare Advantage	$220.50
Rate for Payer: Group Health Inc Commercial	$105.00
Rate for Payer: Group Health Inc Medicare	$73.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$136.50

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