St. Barnabas Hospital

All Charges

Charge

Type

Price

T PALLIDUM AB (FTA-AB)

Facility OP

$33.10

Service Code	HCPCS 86780
Hospital Charge Code	40729381
Hospital Revenue Code	300
Min. Negotiated Rate	$10.59
Max. Negotiated Rate	$21.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.24
Rate for Payer: Aetna Government	$13.24
Rate for Payer: Cash Price	$13.24
Rate for Payer: Cash Price	$13.24
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.81
Rate for Payer: Elderplan Medicare Advantage	$13.24
Rate for Payer: EmblemHealth Commercial	$13.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$11.92
Rate for Payer: Fidelis Essential Plan Aliesa	$11.25
Rate for Payer: Fidelis Essential Plan QHP	$11.78
Rate for Payer: Fidelis Medicare Advantage	$13.24
Rate for Payer: Fidelis Qualified Health Plan	$11.78
Rate for Payer: Group Health Inc Commercial	$13.24
Rate for Payer: Group Health Inc Medicare	$13.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.55
Rate for Payer: Hamaspik Choice Inc Medicare	$13.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$13.24
Rate for Payer: Healthfirst Medicare Advantage	$13.24
Rate for Payer: Healthfirst QHP	$13.24
Rate for Payer: Senior Whole Health Medicare Advantage	$13.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.59
Rate for Payer: Wellcare Medicare	$11.92

TPN CVP DRESSING SET

Facility OP

$6.73

Hospital Charge Code	40207593
Hospital Revenue Code	270
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.58
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36

TPN INFUSION

Facility OP

$181.00

Hospital Charge Code	41641551
Hospital Revenue Code	250
Min. Negotiated Rate	$63.35
Max. Negotiated Rate	$144.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$90.50
Rate for Payer: Aetna Government	$90.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$144.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$123.08
Rate for Payer: Group Health Inc Commercial	$90.50
Rate for Payer: Group Health Inc Medicare	$63.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.50
Rate for Payer: Hamaspik Choice Inc Medicare	$90.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.65

TPN INFUSION

Facility OP

$181.00

Hospital Charge Code	41651551
Hospital Revenue Code	250
Min. Negotiated Rate	$63.35
Max. Negotiated Rate	$144.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$90.50
Rate for Payer: Aetna Government	$90.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$144.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$123.08
Rate for Payer: Group Health Inc Commercial	$90.50
Rate for Payer: Group Health Inc Medicare	$63.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.50
Rate for Payer: Hamaspik Choice Inc Medicare	$90.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.65

TPN INFUSION NEONATAL

Facility OP

$386.00

Hospital Charge Code	41650007
Hospital Revenue Code	250
Min. Negotiated Rate	$135.10
Max. Negotiated Rate	$308.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$212.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$193.00
Rate for Payer: Aetna Government	$193.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$308.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$262.48
Rate for Payer: Group Health Inc Commercial	$193.00
Rate for Payer: Group Health Inc Medicare	$135.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$193.00
Rate for Payer: Hamaspik Choice Inc Medicare	$193.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$250.90

TPN INFUSION NEONATAL

Facility OP

$386.00

Hospital Charge Code	41640007
Hospital Revenue Code	250
Min. Negotiated Rate	$135.10
Max. Negotiated Rate	$308.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$212.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$193.00
Rate for Payer: Aetna Government	$193.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$308.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$262.48
Rate for Payer: Group Health Inc Commercial	$193.00
Rate for Payer: Group Health Inc Medicare	$135.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$193.00
Rate for Payer: Hamaspik Choice Inc Medicare	$193.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$250.90

TRABECULAR CENT CONE X-SM

Facility OP

$12,812.50

Service Code	HCPCS C1889
Hospital Charge Code	64907526
Hospital Revenue Code	278
Min. Negotiated Rate	$4,484.38
Max. Negotiated Rate	$13,453.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,046.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,406.25
Rate for Payer: Aetna Government	$6,406.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,406.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,367.19
Rate for Payer: Fidelis Medicare Advantage	$13,453.12
Rate for Payer: Group Health Inc Commercial	$6,406.25
Rate for Payer: Group Health Inc Medicare	$4,484.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,406.25
Rate for Payer: Hamaspik Choice Inc Medicare	$6,406.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,328.12

TRABECULAR CENT CONE X-SM

Facility IP

$12,812.50

Service Code	HCPCS C1889
Hospital Charge Code	64907526
Hospital Revenue Code	278
Min. Negotiated Rate	$6,406.25
Max. Negotiated Rate	$6,406.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,406.25
Rate for Payer: Hamaspik Choice Inc Medicare	$6,406.25

TRABECULAR METAL MONOBLOCK TIBIAL

Facility OP

$8,824.00

Service Code	HCPCS C1776
Hospital Charge Code	40206096
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,265.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,853.20
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	$4,412.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,073.80
Rate for Payer: Fidelis Medicare Advantage	$9,265.20
Rate for Payer: Group Health Inc Commercial	$4,412.00
Rate for Payer: Group Health Inc Medicare	$3,088.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,412.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,412.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,735.60

TRABECULAR METAL MONOBLOCK TIBIAL

Facility IP

$8,824.00

Service Code	HCPCS C1776
Hospital Charge Code	40206096
Hospital Revenue Code	278
Min. Negotiated Rate	$4,412.00
Max. Negotiated Rate	$4,412.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,412.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,412.00

TRABECULAR MTL MONOBLOCK PATELLA

Facility IP

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40209917
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.60
Max. Negotiated Rate	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.60

TRABECULAR MTL MONOBLOCK PATELLA

Facility OP

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40209917
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,329.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,744.16
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	$1,585.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,823.44
Rate for Payer: Fidelis Medicare Advantage	$3,329.76
Rate for Payer: Group Health Inc Commercial	$1,585.60
Rate for Payer: Group Health Inc Medicare	$1,109.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,061.28

TRAB METAL ST PR 7 10MM

Facility IP

$9,710.00

Service Code	HCPCS C1713
Hospital Charge Code	64904820
Hospital Revenue Code	278
Min. Negotiated Rate	$4,855.00
Max. Negotiated Rate	$4,855.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,855.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,855.00

TRAB METAL ST PR 7 10MM

Facility OP

$9,710.00

Service Code	HCPCS C1713
Hospital Charge Code	64904820
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$10,195.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,340.50
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	$4,855.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,583.25
Rate for Payer: Fidelis Medicare Advantage	$10,195.50
Rate for Payer: Group Health Inc Commercial	$4,855.00
Rate for Payer: Group Health Inc Medicare	$3,398.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,855.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,855.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,311.50

TRAB MTL MNBLCK TIB COMPONENT SZ4

Facility OP

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40200051
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,156.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,272.40
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	$3,884.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,466.60
Rate for Payer: Fidelis Medicare Advantage	$8,156.40
Rate for Payer: Group Health Inc Commercial	$3,884.00
Rate for Payer: Group Health Inc Medicare	$2,718.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,049.20

TRAB MTL MNBLCK TIB COMPONENT SZ4

Facility IP

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40200051
Hospital Revenue Code	278
Min. Negotiated Rate	$3,884.00
Max. Negotiated Rate	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00

TRAB MTL MNBLCK TIB COMPONENT SZ5

Facility OP

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40200052
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,156.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,272.40
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	$3,884.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,466.60
Rate for Payer: Fidelis Medicare Advantage	$8,156.40
Rate for Payer: Group Health Inc Commercial	$3,884.00
Rate for Payer: Group Health Inc Medicare	$2,718.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,049.20

TRAB MTL MNBLCK TIB COMPONENT SZ5

Facility IP

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40200052
Hospital Revenue Code	278
Min. Negotiated Rate	$3,884.00
Max. Negotiated Rate	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00

TRAB MTL MNBLCK TRIB METAL MTL ST

Facility IP

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40200053
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.60
Max. Negotiated Rate	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.60

TRAB MTL MNBLCK TRIB METAL MTL ST

Facility OP

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40200053
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,329.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,744.16
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	$1,585.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,823.44
Rate for Payer: Fidelis Medicare Advantage	$3,329.76
Rate for Payer: Group Health Inc Commercial	$1,585.60
Rate for Payer: Group Health Inc Medicare	$1,109.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,061.28

TRAB MTL MONOBLK TIB COMP SZ 6

Facility IP

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40200054
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.60
Max. Negotiated Rate	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.60

TRAB MTL MONOBLK TIB COMP SZ 6

Facility OP

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40200054
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,329.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,744.16
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	$1,585.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,823.44
Rate for Payer: Fidelis Medicare Advantage	$3,329.76
Rate for Payer: Group Health Inc Commercial	$1,585.60
Rate for Payer: Group Health Inc Medicare	$1,109.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,061.28

TRAB MT MOBK TIB 5FEM C-H 10MM HT

Facility IP

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40009107
Hospital Revenue Code	278
Min. Negotiated Rate	$3,884.00
Max. Negotiated Rate	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00

TRAB MT MOBK TIB 5FEM C-H 10MM HT

Facility OP

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40009107
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,156.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,272.40
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	$3,884.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,466.60
Rate for Payer: Fidelis Medicare Advantage	$8,156.40
Rate for Payer: Group Health Inc Commercial	$3,884.00
Rate for Payer: Group Health Inc Medicare	$2,718.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,049.20

TRACE ELEMENTS

Facility IP

$49.99

Service Code	HCPCS J3490
Hospital Charge Code	41640203
Hospital Revenue Code	636
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$25.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00

Price Transparency.

All Charges