St. Barnabas Hospital

All Charges

Charge

Type

Price

SYSTEM ANCHORLOK SOFT TISSUE

Facility OP

$987.50

Service Code	HCPCS C1713
Hospital Charge Code	64901137
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,036.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$543.12
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	$493.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$567.81
Rate for Payer: Fidelis Medicare Advantage	$1,036.88
Rate for Payer: Group Health Inc Commercial	$493.75
Rate for Payer: Group Health Inc Medicare	$345.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$493.75
Rate for Payer: Hamaspik Choice Inc Medicare	$493.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$641.88

SYSTEM ANCHORLOK SOFT TISSUE

Facility IP

$987.50

Service Code	HCPCS C1713
Hospital Charge Code	64901137
Hospital Revenue Code	278
Min. Negotiated Rate	$493.75
Max. Negotiated Rate	$493.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$493.75
Rate for Payer: Hamaspik Choice Inc Medicare	$493.75

SYSTEM ANKLE FRACT

Facility OP

$6,485.00

Hospital Charge Code	64907153
Hospital Revenue Code	279
Min. Negotiated Rate	$2,269.75
Max. Negotiated Rate	$5,188.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,566.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,242.50
Rate for Payer: Aetna Government	$3,242.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,188.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,409.80
Rate for Payer: Group Health Inc Commercial	$3,242.50
Rate for Payer: Group Health Inc Medicare	$2,269.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,242.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,242.50

SYSTEM BALLOON INF ENDO 60ML

Facility IP

$550.20

Service Code	HCPCS C1727
Hospital Charge Code	64905371
Hospital Revenue Code	278
Min. Negotiated Rate	$275.10
Max. Negotiated Rate	$275.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.10
Rate for Payer: Hamaspik Choice Inc Medicare	$275.10

SYSTEM BALLOON INF ENDO 60ML

Facility OP

$550.20

Service Code	HCPCS C1727
Hospital Charge Code	64905371
Hospital Revenue Code	278
Min. Negotiated Rate	$70.85
Max. Negotiated Rate	$577.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.85
Rate for Payer: Aetna Government	$70.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$275.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$316.36
Rate for Payer: Fidelis Medicare Advantage	$577.71
Rate for Payer: Group Health Inc Commercial	$275.10
Rate for Payer: Group Health Inc Medicare	$192.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.10
Rate for Payer: Hamaspik Choice Inc Medicare	$275.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$357.63

SYSTEM BLADE PATELLA REAMING

Facility OP

$480.00

Hospital Charge Code	64901313
Hospital Revenue Code	279
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$384.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$264.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$240.00
Rate for Payer: Aetna Government	$240.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$384.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$326.40
Rate for Payer: Group Health Inc Commercial	$240.00
Rate for Payer: Group Health Inc Medicare	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.00
Rate for Payer: Hamaspik Choice Inc Medicare	$240.00

SYSTEM CABLE CERCLAGE 1.8MM

Facility OP

$1,440.00

Hospital Charge Code	64905807
Hospital Revenue Code	270
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$1,152.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$792.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$720.00
Rate for Payer: Aetna Government	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,152.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$979.20
Rate for Payer: Group Health Inc Commercial	$720.00
Rate for Payer: Group Health Inc Medicare	$504.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$720.00
Rate for Payer: Hamaspik Choice Inc Medicare	$720.00

SYSTEM CIDEX STRL DISSECT

Facility OP

$462.65

Hospital Charge Code	64903139
Hospital Revenue Code	270
Min. Negotiated Rate	$161.93
Max. Negotiated Rate	$370.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$254.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.32
Rate for Payer: Aetna Government	$231.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$370.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$314.60
Rate for Payer: Group Health Inc Commercial	$231.32
Rate for Payer: Group Health Inc Medicare	$161.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.32
Rate for Payer: Hamaspik Choice Inc Medicare	$231.32

SYSTEM,CLEARLINK,CONTFLO,W/FILT

Facility OP

$10.13

Hospital Charge Code	64901293
Hospital Revenue Code	270
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$8.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.06
Rate for Payer: Aetna Government	$5.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.89
Rate for Payer: Group Health Inc Commercial	$5.06
Rate for Payer: Group Health Inc Medicare	$3.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.06
Rate for Payer: Hamaspik Choice Inc Medicare	$5.06

SYSTEM COLLECTION SAFE-TOUCH

Facility OP

$43.19

Hospital Charge Code	64902877
Hospital Revenue Code	270
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$34.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.60
Rate for Payer: Aetna Government	$21.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.37
Rate for Payer: Group Health Inc Commercial	$21.60
Rate for Payer: Group Health Inc Medicare	$15.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.60
Rate for Payer: Hamaspik Choice Inc Medicare	$21.60

SYSTEM DELIVERY VACUUM PALM PUMP

Facility OP

$60.00

Hospital Charge Code	64903517
Hospital Revenue Code	270
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$48.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.80
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00

SYSTEM DRAIN CATH EXTERNAL EDS3

Facility OP

$767.50

Hospital Charge Code	64904557
Hospital Revenue Code	279
Min. Negotiated Rate	$268.62
Max. Negotiated Rate	$614.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$422.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$383.75
Rate for Payer: Aetna Government	$383.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$614.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.90
Rate for Payer: Group Health Inc Commercial	$383.75
Rate for Payer: Group Health Inc Medicare	$268.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.75
Rate for Payer: Hamaspik Choice Inc Medicare	$383.75

SYSTEM,EDGE,ELECTR,QC CONN

Facility OP

$28.21

Hospital Charge Code	64903511
Hospital Revenue Code	270
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$22.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.10
Rate for Payer: Aetna Government	$14.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.18
Rate for Payer: Group Health Inc Commercial	$14.10
Rate for Payer: Group Health Inc Medicare	$9.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.10
Rate for Payer: Hamaspik Choice Inc Medicare	$14.10

SYSTEM ENSNARE

Facility OP

$900.00

Service Code	HCPCS C1773
Hospital Charge Code	64902327
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$945.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.00
Rate for Payer: Aetna Government	$70.00
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

SYSTEM ENSNARE

Facility IP

$900.00

Service Code	HCPCS C1773
Hospital Charge Code	64902327
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

SYSTEM EXTERNAL DRAIN EDS 3

Facility OP

$780.95

Hospital Charge Code	64901120
Hospital Revenue Code	270
Min. Negotiated Rate	$273.33
Max. Negotiated Rate	$624.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$429.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$390.48
Rate for Payer: Aetna Government	$390.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$624.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$531.05
Rate for Payer: Group Health Inc Commercial	$390.48
Rate for Payer: Group Health Inc Medicare	$273.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$390.48
Rate for Payer: Hamaspik Choice Inc Medicare	$390.48

SYSTEM,FMS,FLEXI SEAL,ODOR CTRL

Facility OP

$309.74

Hospital Charge Code	64901098
Hospital Revenue Code	270
Min. Negotiated Rate	$108.41
Max. Negotiated Rate	$247.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$170.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$154.87
Rate for Payer: Aetna Government	$154.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$247.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.62
Rate for Payer: Group Health Inc Commercial	$154.87
Rate for Payer: Group Health Inc Medicare	$108.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.87
Rate for Payer: Hamaspik Choice Inc Medicare	$154.87

SYSTEM GRAFT DELIVERY (GDP)

Facility OP

$1,500.00

Hospital Charge Code	64901923
Hospital Revenue Code	279
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$750.00
Rate for Payer: Aetna Government	$750.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,020.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

SYSTEM, HIP FEMORAL HEAD

Facility OP

$1,328.00

Service Code	HCPCS C1776
Hospital Charge Code	40007513
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,394.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$730.40
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	$664.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$763.60
Rate for Payer: Fidelis Medicare Advantage	$1,394.40
Rate for Payer: Group Health Inc Commercial	$664.00
Rate for Payer: Group Health Inc Medicare	$464.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$664.00
Rate for Payer: Hamaspik Choice Inc Medicare	$664.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$863.20

SYSTEM, HIP FEMORAL HEAD

Facility IP

$1,328.00

Service Code	HCPCS C1776
Hospital Charge Code	40204594
Hospital Revenue Code	278
Min. Negotiated Rate	$664.00
Max. Negotiated Rate	$664.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$664.00
Rate for Payer: Hamaspik Choice Inc Medicare	$664.00

SYSTEM, HIP FEMORAL HEAD

Facility OP

$1,328.00

Service Code	HCPCS C1776
Hospital Charge Code	40204594
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,394.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$730.40
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	$664.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$763.60
Rate for Payer: Fidelis Medicare Advantage	$1,394.40
Rate for Payer: Group Health Inc Commercial	$664.00
Rate for Payer: Group Health Inc Medicare	$464.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$664.00
Rate for Payer: Hamaspik Choice Inc Medicare	$664.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$863.20

SYSTEM, HIP FEMORAL HEAD

Facility IP

$1,328.00

Service Code	HCPCS C1776
Hospital Charge Code	40007513
Hospital Revenue Code	278
Min. Negotiated Rate	$664.00
Max. Negotiated Rate	$664.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$664.00
Rate for Payer: Hamaspik Choice Inc Medicare	$664.00

SYSTEM, HIP FEMORAL HEAD

Facility OP

$1,660.00

Service Code	HCPCS C1776
Hospital Charge Code	64905503
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,743.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$913.00
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	$830.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$954.50
Rate for Payer: Fidelis Medicare Advantage	$1,743.00
Rate for Payer: Group Health Inc Commercial	$830.00
Rate for Payer: Group Health Inc Medicare	$581.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$830.00
Rate for Payer: Hamaspik Choice Inc Medicare	$830.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,079.00

SYSTEM, HIP FEMORAL HEAD

Facility IP

$1,660.00

Service Code	HCPCS C1776
Hospital Charge Code	64905503
Hospital Revenue Code	278
Min. Negotiated Rate	$830.00
Max. Negotiated Rate	$830.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$830.00
Rate for Payer: Hamaspik Choice Inc Medicare	$830.00

SYSTEM IMP FIX

Facility OP

$1,812.50

Service Code	HCPCS C1776
Hospital Charge Code	64907364
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,903.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$996.88
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	$906.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,042.19
Rate for Payer: Fidelis Medicare Advantage	$1,903.12
Rate for Payer: Group Health Inc Commercial	$906.25
Rate for Payer: Group Health Inc Medicare	$634.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$906.25
Rate for Payer: Hamaspik Choice Inc Medicare	$906.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,178.12

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