St. Barnabas Hospital

All Charges

Charge

Type

Price

VIT. B1, WHOLE BLOOD

Facility OP

$30.38

Hospital Charge Code	40609166
Hospital Revenue Code	300
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$24.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.19
Rate for Payer: Aetna Government	$15.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.66
Rate for Payer: Group Health Inc Commercial	$15.19
Rate for Payer: Group Health Inc Medicare	$10.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.19
Rate for Payer: Hamaspik Choice Inc Medicare	$15.19

VITOSS 10CC BIMODAL ORTHO

Facility OP

$13,991.25

Service Code	HCPCS C1713
Hospital Charge Code	64906985
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$14,690.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,695.19
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	$6,995.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$8,044.97
Rate for Payer: Fidelis Medicare Advantage	$14,690.81
Rate for Payer: Group Health Inc Commercial	$6,995.62
Rate for Payer: Group Health Inc Medicare	$4,896.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,995.62
Rate for Payer: Hamaspik Choice Inc Medicare	$6,995.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9,094.31

VITOSS 10CC BIMODAL ORTHO

Facility IP

$13,991.25

Service Code	HCPCS C1713
Hospital Charge Code	64906985
Hospital Revenue Code	278
Min. Negotiated Rate	$6,995.62
Max. Negotiated Rate	$6,995.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,995.62
Rate for Payer: Hamaspik Choice Inc Medicare	$6,995.62

VITOSS 5CC PACK

Facility OP

$6,187.50

Hospital Charge Code	64902658
Hospital Revenue Code	279
Min. Negotiated Rate	$2,165.62
Max. Negotiated Rate	$4,950.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,403.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,093.75
Rate for Payer: Aetna Government	$3,093.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,207.50
Rate for Payer: Group Health Inc Commercial	$3,093.75
Rate for Payer: Group Health Inc Medicare	$2,165.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,093.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,093.75

VITOSS BIMODAL

Facility OP

$9,340.83

Hospital Charge Code	64904783
Hospital Revenue Code	279
Min. Negotiated Rate	$3,269.29
Max. Negotiated Rate	$7,472.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,137.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,670.42
Rate for Payer: Aetna Government	$4,670.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,472.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,351.76
Rate for Payer: Group Health Inc Commercial	$4,670.42
Rate for Payer: Group Health Inc Medicare	$3,269.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,670.42
Rate for Payer: Hamaspik Choice Inc Medicare	$4,670.42

VITOSS BIMODAL 25CC

Facility OP

$2,672.58

Service Code	HCPCS C1713
Hospital Charge Code	64905417
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,806.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,469.92
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	$1,336.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,536.73
Rate for Payer: Fidelis Medicare Advantage	$2,806.21
Rate for Payer: Group Health Inc Commercial	$1,336.29
Rate for Payer: Group Health Inc Medicare	$935.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,336.29
Rate for Payer: Hamaspik Choice Inc Medicare	$1,336.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,737.18

VITOSS BIMODAL 25CC

Facility IP

$2,672.58

Service Code	HCPCS C1713
Hospital Charge Code	64905417
Hospital Revenue Code	278
Min. Negotiated Rate	$1,336.29
Max. Negotiated Rate	$1,336.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,336.29
Rate for Payer: Hamaspik Choice Inc Medicare	$1,336.29

VITOSS BIMODAL 2.5CC FOAM PACK

Facility IP

$2,138.00

Service Code	HCPCS C1776
Hospital Charge Code	40001786
Hospital Revenue Code	278
Min. Negotiated Rate	$1,069.00
Max. Negotiated Rate	$1,069.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,069.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,069.00

VITOSS BIMODAL 2.5CC FOAM PACK

Facility OP

$2,138.00

Service Code	HCPCS C1776
Hospital Charge Code	40001786
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,244.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,175.90
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	$1,069.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,229.35
Rate for Payer: Fidelis Medicare Advantage	$2,244.90
Rate for Payer: Group Health Inc Commercial	$1,069.00
Rate for Payer: Group Health Inc Medicare	$748.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,069.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,069.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,389.70

VITOSS BIMODAL 2.5CC FOAM PK

Facility OP

$2,138.00

Service Code	HCPCS C1776
Hospital Charge Code	40001797
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,244.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,175.90
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	$1,069.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,229.35
Rate for Payer: Fidelis Medicare Advantage	$2,244.90
Rate for Payer: Group Health Inc Commercial	$1,069.00
Rate for Payer: Group Health Inc Medicare	$748.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,069.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,069.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,389.70

VITOSS BIMODAL 2.5CC FOAM PK

Facility IP

$2,138.00

Service Code	HCPCS C1776
Hospital Charge Code	40001797
Hospital Revenue Code	278
Min. Negotiated Rate	$1,069.00
Max. Negotiated Rate	$1,069.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,069.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,069.00

VITOSS BIMODAL FOAM PACK 10CC

Facility OP

$3,700.00

Service Code	HCPCS C1776
Hospital Charge Code	40001799
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,885.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,035.00
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	$1,850.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,127.50
Rate for Payer: Fidelis Medicare Advantage	$3,885.00
Rate for Payer: Group Health Inc Commercial	$1,850.00
Rate for Payer: Group Health Inc Medicare	$1,295.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,850.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,405.00

VITOSS BIMODAL FOAM PACK 10CC

Facility IP

$3,700.00

Service Code	HCPCS C1776
Hospital Charge Code	40001799
Hospital Revenue Code	278
Min. Negotiated Rate	$1,850.00
Max. Negotiated Rate	$1,850.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,850.00

VITOSS BIMODAL FOAM PACK 5CC

Facility OP

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	40001798
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,750.00
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	$2,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,875.00
Rate for Payer: Fidelis Medicare Advantage	$5,250.00
Rate for Payer: Group Health Inc Commercial	$2,500.00
Rate for Payer: Group Health Inc Medicare	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,250.00

VITOSS BIMODAL FOAM PACK 5CC

Facility IP

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	40001798
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00

VITRECTOMY

Facility OP

$6,123.70

Service Code	HCPCS 67010
Hospital Charge Code	40072565
Hospital Revenue Code	360
Min. Negotiated Rate	$577.31
Max. Negotiated Rate	$3,061.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,694.88
Rate for Payer: Aetna Government	$2,694.88
Rate for Payer: Cash Price	$2,694.88
Rate for Payer: Cash Price	$2,694.88
Rate for Payer: Cash Price	$2,694.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,694.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$2,694.88
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$577.31
Rate for Payer: Fidelis Essential Plan Aliesa	$2,290.65
Rate for Payer: Fidelis Essential Plan QHP	$2,398.44
Rate for Payer: Fidelis Medicare Advantage	$2,694.88
Rate for Payer: Fidelis Qualified Health Plan	$2,398.44
Rate for Payer: Group Health Inc Commercial	$2,694.88
Rate for Payer: Group Health Inc Medicare	$2,694.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,061.85
Rate for Payer: Hamaspik Choice Inc Medicare	$2,694.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$641.46
Rate for Payer: Healthfirst Medicare Advantage	$2,290.65
Rate for Payer: Healthfirst QHP	$2,694.88
Rate for Payer: Senior Whole Health Medicare Advantage	$2,694.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,694.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,155.90
Rate for Payer: Wellcare Medicare	$2,560.14

VIVACIT-E HICR PO R 12MM

Facility OP

$4,250.00

Hospital Charge Code	64905311
Hospital Revenue Code	279
Min. Negotiated Rate	$1,487.50
Max. Negotiated Rate	$3,400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,125.00
Rate for Payer: Aetna Government	$2,125.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,890.00
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

VIVACIT-E HICR PO R 29MM

Facility OP

$2,000.00

Hospital Charge Code	64905314
Hospital Revenue Code	279
Min. Negotiated Rate	$700.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,000.00
Rate for Payer: Aetna Government	$1,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,360.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

VIVA XI CARDIOVERTER DEFIBRILLATO

Facility OP

$53,144.00

Service Code	HCPCS C1882
Hospital Charge Code	66576908
Hospital Revenue Code	275
Min. Negotiated Rate	$4,752.01
Max. Negotiated Rate	$55,801.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29,229.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,752.01
Rate for Payer: Aetna Government	$4,752.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26,572.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$30,557.80
Rate for Payer: Fidelis Medicare Advantage	$55,801.20
Rate for Payer: Group Health Inc Commercial	$26,572.00
Rate for Payer: Group Health Inc Medicare	$18,600.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,572.00
Rate for Payer: Hamaspik Choice Inc Medicare	$26,572.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34,543.60

VIVA XI CARDIOVERTER DEFIBRILLATO

Facility OP

$22,868.00

Service Code	HCPCS C1882
Hospital Charge Code	41646657
Hospital Revenue Code	275
Min. Negotiated Rate	$4,752.01
Max. Negotiated Rate	$24,011.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,577.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,752.01
Rate for Payer: Aetna Government	$4,752.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11,434.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,149.10
Rate for Payer: Fidelis Medicare Advantage	$24,011.40
Rate for Payer: Group Health Inc Commercial	$11,434.00
Rate for Payer: Group Health Inc Medicare	$8,003.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,434.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,434.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14,864.20

VMA, RANDOM URINE

Facility OP

$12.95

Service Code	HCPCS 82570
Hospital Charge Code	40609061
Hospital Revenue Code	300
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$8.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.18
Rate for Payer: Aetna Government	$5.18
Rate for Payer: Cash Price	$5.18
Rate for Payer: Cash Price	$5.18
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.96
Rate for Payer: Elderplan Medicare Advantage	$5.18
Rate for Payer: EmblemHealth Commercial	$5.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.66
Rate for Payer: Fidelis Essential Plan Aliesa	$4.40
Rate for Payer: Fidelis Essential Plan QHP	$4.61
Rate for Payer: Fidelis Medicare Advantage	$5.18
Rate for Payer: Fidelis Qualified Health Plan	$4.61
Rate for Payer: Group Health Inc Commercial	$5.18
Rate for Payer: Group Health Inc Medicare	$5.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.48
Rate for Payer: Hamaspik Choice Inc Medicare	$5.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.18
Rate for Payer: Healthfirst Medicare Advantage	$5.18
Rate for Payer: Healthfirst QHP	$5.18
Rate for Payer: Senior Whole Health Medicare Advantage	$5.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.14
Rate for Payer: Wellcare Medicare	$4.66

VNGRD DCM CRTIB BEAR 10MMX63/67MM

Facility OP

$2,298.00

Service Code	HCPCS C1776
Hospital Charge Code	40202214
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,412.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,263.90
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	$1,149.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,321.35
Rate for Payer: Fidelis Medicare Advantage	$2,412.90
Rate for Payer: Group Health Inc Commercial	$1,149.00
Rate for Payer: Group Health Inc Medicare	$804.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,149.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,149.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,493.70

VNGRD DCM CRTIB BEAR 10MMX63/67MM

Facility IP

$2,298.00

Service Code	HCPCS C1776
Hospital Charge Code	40202214
Hospital Revenue Code	278
Min. Negotiated Rate	$1,149.00
Max. Negotiated Rate	$1,149.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,149.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,149.00

VNGRD DCM CRTIB BEAR 14MMX63/67MM

Facility OP

$2,208.00

Service Code	HCPCS C1776
Hospital Charge Code	40202215
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,318.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,214.40
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	$1,104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,269.60
Rate for Payer: Fidelis Medicare Advantage	$2,318.40
Rate for Payer: Group Health Inc Commercial	$1,104.00
Rate for Payer: Group Health Inc Medicare	$772.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,104.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,104.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,435.20

VNGRD DCM CRTIB BEAR 14MMX63/67MM

Facility IP

$2,208.00

Service Code	HCPCS C1776
Hospital Charge Code	40202215
Hospital Revenue Code	278
Min. Negotiated Rate	$1,104.00
Max. Negotiated Rate	$1,104.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,104.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,104.00

Price Transparency.

All Charges