St. Barnabas Hospital

All Charges

Charge

Type

Price

SWAN GANZ BIPOLAR PACING KIT

Facility OP

$307.95

Hospital Charge Code	40205941
Hospital Revenue Code	270
Min. Negotiated Rate	$107.78
Max. Negotiated Rate	$246.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$169.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$153.98
Rate for Payer: Aetna Government	$153.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$246.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$209.41
Rate for Payer: Group Health Inc Commercial	$153.98
Rate for Payer: Group Health Inc Medicare	$107.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.98
Rate for Payer: Hamaspik Choice Inc Medicare	$153.98

SWAN GANZ SET

Facility OP

$102.77

Hospital Charge Code	40207592
Hospital Revenue Code	270
Min. Negotiated Rate	$35.97
Max. Negotiated Rate	$82.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.38
Rate for Payer: Aetna Government	$51.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.88
Rate for Payer: Group Health Inc Commercial	$51.38
Rate for Payer: Group Health Inc Medicare	$35.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.38
Rate for Payer: Hamaspik Choice Inc Medicare	$51.38

SWAN GANZ THERMO/CATH

Facility OP

$307.95

Hospital Charge Code	40205942
Hospital Revenue Code	272
Min. Negotiated Rate	$107.78
Max. Negotiated Rate	$246.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$169.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$153.98
Rate for Payer: Aetna Government	$153.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$246.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$209.41
Rate for Payer: Group Health Inc Commercial	$153.98
Rate for Payer: Group Health Inc Medicare	$107.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.98
Rate for Payer: Hamaspik Choice Inc Medicare	$153.98

SWARZ LAMKINS FUNAL STAIN 60ML

Facility OP

$42.00

Hospital Charge Code	41658013
Hospital Revenue Code	250
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$33.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.00
Rate for Payer: Aetna Government	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.56
Rate for Payer: Group Health Inc Commercial	$21.00
Rate for Payer: Group Health Inc Medicare	$14.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.30

SWARZ LAMKINS FUNGAL STAIN 60ML

Facility OP

$42.00

Hospital Charge Code	41648013
Hospital Revenue Code	250
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$33.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.00
Rate for Payer: Aetna Government	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.56
Rate for Payer: Group Health Inc Commercial	$21.00
Rate for Payer: Group Health Inc Medicare	$14.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.30

SWIVEL ARM

Facility OP

$715.40

Hospital Charge Code	40202153
Hospital Revenue Code	270
Min. Negotiated Rate	$250.39
Max. Negotiated Rate	$572.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$393.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$357.70
Rate for Payer: Aetna Government	$357.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$572.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$486.47
Rate for Payer: Group Health Inc Commercial	$357.70
Rate for Payer: Group Health Inc Medicare	$250.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$357.70
Rate for Payer: Hamaspik Choice Inc Medicare	$357.70

SYMMETRIC PATELLA 9MM S31MM

Facility IP

$1,920.00

Service Code	HCPCS C1776
Hospital Charge Code	40209847
Hospital Revenue Code	278
Min. Negotiated Rate	$960.00
Max. Negotiated Rate	$960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$960.00

SYMMETRIC PATELLA 9MM S31MM

Facility OP

$1,920.00

Service Code	HCPCS C1776
Hospital Charge Code	40209847
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,016.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,056.00
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	$960.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,104.00
Rate for Payer: Fidelis Medicare Advantage	$2,016.00
Rate for Payer: Group Health Inc Commercial	$960.00
Rate for Payer: Group Health Inc Medicare	$672.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$960.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,248.00

SYMMETRIC PATELLA 9MM S 33MM

Facility OP

$2,824.00

Service Code	HCPCS C1776
Hospital Charge Code	40209846
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,965.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,553.20
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	$1,412.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,623.80
Rate for Payer: Fidelis Medicare Advantage	$2,965.20
Rate for Payer: Group Health Inc Commercial	$1,412.00
Rate for Payer: Group Health Inc Medicare	$988.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,412.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,412.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,835.60

SYMMETRIC PATELLA 9MM S 33MM

Facility IP

$2,824.00

Service Code	HCPCS C1776
Hospital Charge Code	40209846
Hospital Revenue Code	278
Min. Negotiated Rate	$1,412.00
Max. Negotiated Rate	$1,412.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,412.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,412.00

SYMMETRIC PATELLA S27 X 8MM

Facility IP

$1,841.00

Service Code	HCPCS C1776
Hospital Charge Code	40209848
Hospital Revenue Code	278
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$920.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$920.50
Rate for Payer: Hamaspik Choice Inc Medicare	$920.50

SYMMETRIC PATELLA S27 X 8MM

Facility OP

$1,841.00

Service Code	HCPCS C1776
Hospital Charge Code	40209848
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,933.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,012.55
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	$920.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,058.58
Rate for Payer: Fidelis Medicare Advantage	$1,933.05
Rate for Payer: Group Health Inc Commercial	$920.50
Rate for Payer: Group Health Inc Medicare	$644.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$920.50
Rate for Payer: Hamaspik Choice Inc Medicare	$920.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,196.65

SYMMETRIC PATELLA S29X8MM

Facility OP

$1,841.40

Service Code	HCPCS C1776
Hospital Charge Code	40209849
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,933.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,012.77
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	$920.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,058.80
Rate for Payer: Fidelis Medicare Advantage	$1,933.47
Rate for Payer: Group Health Inc Commercial	$920.70
Rate for Payer: Group Health Inc Medicare	$644.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$920.70
Rate for Payer: Hamaspik Choice Inc Medicare	$920.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,196.91

SYMMETRIC PATELLA S29X8MM

Facility IP

$1,841.40

Service Code	HCPCS C1776
Hospital Charge Code	40209849
Hospital Revenue Code	278
Min. Negotiated Rate	$920.70
Max. Negotiated Rate	$920.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$920.70
Rate for Payer: Hamaspik Choice Inc Medicare	$920.70

SYMPHONY BREASTMILK INIT KIT

Facility OP

$60.79

Hospital Charge Code	64901599
Hospital Revenue Code	270
Min. Negotiated Rate	$21.28
Max. Negotiated Rate	$48.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.40
Rate for Payer: Aetna Government	$30.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$41.34
Rate for Payer: Group Health Inc Commercial	$30.40
Rate for Payer: Group Health Inc Medicare	$21.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.40
Rate for Payer: Hamaspik Choice Inc Medicare	$30.40

SYMPHONY PROCESS DISPOSE

Facility OP

$1,762.50

Hospital Charge Code	64904217
Hospital Revenue Code	270
Min. Negotiated Rate	$616.88
Max. Negotiated Rate	$1,410.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$969.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$881.25
Rate for Payer: Aetna Government	$881.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,410.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,198.50
Rate for Payer: Group Health Inc Commercial	$881.25
Rate for Payer: Group Health Inc Medicare	$616.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$881.25
Rate for Payer: Hamaspik Choice Inc Medicare	$881.25

SYMPHONY SPRAY APPLICATOR

Facility OP

$237.50

Hospital Charge Code	64904219
Hospital Revenue Code	270
Min. Negotiated Rate	$83.12
Max. Negotiated Rate	$190.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$118.75
Rate for Payer: Aetna Government	$118.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.50
Rate for Payer: Group Health Inc Commercial	$118.75
Rate for Payer: Group Health Inc Medicare	$83.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$118.75

SYN 10MM TI CANN TIB 345MM S

Facility IP

$2,815.70

Service Code	HCPCS C1776
Hospital Charge Code	40206078
Hospital Revenue Code	278
Min. Negotiated Rate	$1,407.85
Max. Negotiated Rate	$1,407.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,407.85
Rate for Payer: Hamaspik Choice Inc Medicare	$1,407.85

SYN 10MM TI CANN TIB 345MM S

Facility OP

$2,815.70

Service Code	HCPCS C1776
Hospital Charge Code	40206078
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,956.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,548.64
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	$1,407.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,619.03
Rate for Payer: Fidelis Medicare Advantage	$2,956.48
Rate for Payer: Group Health Inc Commercial	$1,407.85
Rate for Payer: Group Health Inc Medicare	$985.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,407.85
Rate for Payer: Hamaspik Choice Inc Medicare	$1,407.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,830.20

SYN 5.0MM TI LSCRW W/T25 SDF/IM N

Facility IP

$437.40

Service Code	HCPCS C1776
Hospital Charge Code	40206079
Hospital Revenue Code	278
Min. Negotiated Rate	$218.70
Max. Negotiated Rate	$218.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$218.70
Rate for Payer: Hamaspik Choice Inc Medicare	$218.70

SYN 5.0MM TI LSCRW W/T25 SDF/IM N

Facility OP

$437.40

Service Code	HCPCS C1776
Hospital Charge Code	40206079
Hospital Revenue Code	278
Min. Negotiated Rate	$153.09
Max. Negotiated Rate	$459.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$240.57
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	$218.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$251.50
Rate for Payer: Fidelis Medicare Advantage	$459.27
Rate for Payer: Group Health Inc Commercial	$218.70
Rate for Payer: Group Health Inc Medicare	$153.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$218.70
Rate for Payer: Hamaspik Choice Inc Medicare	$218.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$284.31

SYNAPTOPHYSIN AM363-5M

Facility OP

$663.20

Hospital Charge Code	64902719
Hospital Revenue Code	270
Min. Negotiated Rate	$232.12
Max. Negotiated Rate	$530.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$364.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$331.60
Rate for Payer: Aetna Government	$331.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$530.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$450.98
Rate for Payer: Group Health Inc Commercial	$331.60
Rate for Payer: Group Health Inc Medicare	$232.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$331.60
Rate for Payer: Hamaspik Choice Inc Medicare	$331.60

SYNCHROMED II PUMP

Facility IP

$22,400.00

Service Code	HCPCS C2626
Hospital Charge Code	40202340
Hospital Revenue Code	278
Min. Negotiated Rate	$11,200.00
Max. Negotiated Rate	$11,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,200.00

SYNCHROMED II PUMP

Facility OP

$22,400.00

Service Code	HCPCS C2626
Hospital Charge Code	40202340
Hospital Revenue Code	278
Min. Negotiated Rate	$468.08
Max. Negotiated Rate	$23,520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,320.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$468.08
Rate for Payer: Aetna Government	$468.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,880.00
Rate for Payer: Fidelis Medicare Advantage	$23,520.00
Rate for Payer: Group Health Inc Commercial	$11,200.00
Rate for Payer: Group Health Inc Medicare	$7,840.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14,560.00

SYNCHROMED II PUMPS

Facility OP

$11,200.00

Service Code	HCPCS C2626
Hospital Charge Code	40206085
Hospital Revenue Code	278
Min. Negotiated Rate	$468.08
Max. Negotiated Rate	$11,760.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,160.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$468.08
Rate for Payer: Aetna Government	$468.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,440.00
Rate for Payer: Fidelis Medicare Advantage	$11,760.00
Rate for Payer: Group Health Inc Commercial	$5,600.00
Rate for Payer: Group Health Inc Medicare	$3,920.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,280.00

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