St. Barnabas Hospital

All Charges

Charge

Type

Price

WATER FOR INJECTION 50 ML

Facility OP

$0.66

Service Code	HCPCS A4216
Hospital Charge Code	41654209
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33

WATER FOR INJECTION BACTERIOSTATIC

Facility OP

$0.92

Service Code	HCPCS A4216
Hospital Charge Code	41643304
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.63
Rate for Payer: Group Health Inc Commercial	$0.46
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46

WATER FOR INJECTION BACTERIOSTATIC

Facility OP

$0.92

Service Code	HCPCS A4216
Hospital Charge Code	41653304
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.63
Rate for Payer: Group Health Inc Commercial	$0.46
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46

WATER FOR IRRIGATION 1500CC

Facility OP

$9.92

Hospital Charge Code	40509791
Hospital Revenue Code	260
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$7.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.96
Rate for Payer: Aetna Government	$4.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.75
Rate for Payer: Group Health Inc Commercial	$4.96
Rate for Payer: Group Health Inc Medicare	$3.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.96
Rate for Payer: Hamaspik Choice Inc Medicare	$4.96

WATERSHED PLATE LEFT

Facility IP

$1,790.00

Service Code	HCPCS C1713
Hospital Charge Code	40202048
Hospital Revenue Code	278
Min. Negotiated Rate	$895.00
Max. Negotiated Rate	$895.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$895.00
Rate for Payer: Hamaspik Choice Inc Medicare	$895.00

WATERSHED PLATE LEFT

Facility OP

$1,790.00

Service Code	HCPCS C1713
Hospital Charge Code	40202048
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,879.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$984.50
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	$895.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,029.25
Rate for Payer: Fidelis Medicare Advantage	$1,879.50
Rate for Payer: Group Health Inc Commercial	$895.00
Rate for Payer: Group Health Inc Medicare	$626.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$895.00
Rate for Payer: Hamaspik Choice Inc Medicare	$895.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,163.50

WATER STERILE 1000ML BTL

Facility OP

$3.49

Hospital Charge Code	64901404
Hospital Revenue Code	270
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$2.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.74
Rate for Payer: Aetna Government	$1.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.37
Rate for Payer: Group Health Inc Commercial	$1.74
Rate for Payer: Group Health Inc Medicare	$1.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.74
Rate for Payer: Hamaspik Choice Inc Medicare	$1.74

WATER STERILE 250ML BTL

Facility OP

$3.28

Hospital Charge Code	64902274
Hospital Revenue Code	270
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$2.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.64
Rate for Payer: Aetna Government	$1.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.23
Rate for Payer: Group Health Inc Commercial	$1.64
Rate for Payer: Group Health Inc Medicare	$1.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.64
Rate for Payer: Hamaspik Choice Inc Medicare	$1.64

WATER STERILE 500ML BAG

Facility OP

$0.18

Hospital Charge Code	64901972
Hospital Revenue Code	270
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09

WATER,STERILE,FOR INJECT,1000

Facility OP

$5.11

Hospital Charge Code	64902265
Hospital Revenue Code	270
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$4.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.56
Rate for Payer: Aetna Government	$2.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.47
Rate for Payer: Group Health Inc Commercial	$2.56
Rate for Payer: Group Health Inc Medicare	$1.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.56
Rate for Payer: Hamaspik Choice Inc Medicare	$2.56

WATER,STERILE,FOR IRRIGA,3000ML

Facility OP

$13.03

Hospital Charge Code	64902558
Hospital Revenue Code	270
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$10.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.52
Rate for Payer: Aetna Government	$6.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.86
Rate for Payer: Group Health Inc Commercial	$6.52
Rate for Payer: Group Health Inc Medicare	$4.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.52
Rate for Payer: Hamaspik Choice Inc Medicare	$6.52

WAVEGUIDE RETRACTOR LIGHTED

Facility OP

$987.50

Hospital Charge Code	64907532
Hospital Revenue Code	270
Min. Negotiated Rate	$345.62
Max. Negotiated Rate	$790.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$543.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$493.75
Rate for Payer: Aetna Government	$493.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$790.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$671.50
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

WAX,BONE, 2.5 GRAMS

Facility OP

$11.33

Hospital Charge Code	64902583
Hospital Revenue Code	270
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$9.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.66
Rate for Payer: Aetna Government	$5.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.70
Rate for Payer: Group Health Inc Commercial	$5.66
Rate for Payer: Group Health Inc Medicare	$3.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.66
Rate for Payer: Hamaspik Choice Inc Medicare	$5.66

WAX BONE NON ABSORB

Facility OP

$11.35

Hospital Charge Code	64907097
Hospital Revenue Code	270
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$9.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.68
Rate for Payer: Aetna Government	$5.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.72
Rate for Payer: Group Health Inc Commercial	$5.68
Rate for Payer: Group Health Inc Medicare	$3.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.68
Rate for Payer: Hamaspik Choice Inc Medicare	$5.68

W/CO2 OUTPT

Facility OP

$766.58

Service Code	HCPCS 94681 TC
Hospital Charge Code	30301323
Hospital Revenue Code	460
Min. Negotiated Rate	$42.07
Max. Negotiated Rate	$613.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$383.29
Rate for Payer: Aetna Government	$383.29
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42.07
Rate for Payer: Group Health Inc Commercial	$383.29
Rate for Payer: Group Health Inc Medicare	$268.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$383.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$46.74

W/ COLPOSCOPY (ADD ON)

Facility OP

$134.13

Service Code	HCPCS 58110
Hospital Charge Code	30301265
Hospital Revenue Code	510
Min. Negotiated Rate	$44.33
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.26
Rate for Payer: Aetna Government	$50.26
Rate for Payer: Brighton Health Commercial	$233.00
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: Fidelis CHP/HARP/Medicaid	$44.33
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.06
Rate for Payer: Hamaspik Choice Inc Medicare	$67.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$49.26

W DRL/1.6MM 7MM STRYKER

Facility OP

$294.48

Hospital Charge Code	40005859
Hospital Revenue Code	272
Min. Negotiated Rate	$103.07
Max. Negotiated Rate	$235.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$161.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.24
Rate for Payer: Aetna Government	$147.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$200.25
Rate for Payer: Group Health Inc Commercial	$147.24
Rate for Payer: Group Health Inc Medicare	$103.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.24
Rate for Payer: Hamaspik Choice Inc Medicare	$147.24

WEANING PARAMETERS

Facility OP

$419.03

Service Code	HCPCS 94150 TC
Hospital Charge Code	40305410
Hospital Revenue Code	460
Min. Negotiated Rate	$146.66
Max. Negotiated Rate	$335.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$209.52
Rate for Payer: Aetna Government	$209.52
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.94
Rate for Payer: Group Health Inc Commercial	$209.52
Rate for Payer: Group Health Inc Medicare	$146.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$209.52

WEBRIL

Facility OP

$8.51

Hospital Charge Code	40000440
Hospital Revenue Code	272
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$6.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.26
Rate for Payer: Aetna Government	$4.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.79
Rate for Payer: Group Health Inc Commercial	$4.26
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.26
Rate for Payer: Hamaspik Choice Inc Medicare	$4.26

WEDGE ALL P

Facility OP

$5,242.50

Service Code	HCPCS C1713
Hospital Charge Code	64904703
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,504.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,883.38
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	$2,621.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,014.44
Rate for Payer: Fidelis Medicare Advantage	$5,504.62
Rate for Payer: Group Health Inc Commercial	$2,621.25
Rate for Payer: Group Health Inc Medicare	$1,834.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,621.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,621.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,407.62

WEDGE ALL P

Facility IP

$5,242.50

Service Code	HCPCS C1713
Hospital Charge Code	64904703
Hospital Revenue Code	278
Min. Negotiated Rate	$2,621.25
Max. Negotiated Rate	$2,621.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,621.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,621.25

WEDGE HMRS

Facility OP

$2,010.00

Service Code	HCPCS C1776
Hospital Charge Code	64907249
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,110.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,105.50
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	$1,005.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,155.75
Rate for Payer: Fidelis Medicare Advantage	$2,110.50
Rate for Payer: Group Health Inc Commercial	$1,005.00
Rate for Payer: Group Health Inc Medicare	$703.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,005.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,005.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,306.50

WEDGE HMRS

Facility IP

$2,010.00

Service Code	HCPCS C1776
Hospital Charge Code	64907249
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,005.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,005.00

WEDGE PLEXUR 40X15MM X 10DEG

Facility IP

$1,712.50

Service Code	HCPCS C1713
Hospital Charge Code	64904656
Hospital Revenue Code	278
Min. Negotiated Rate	$856.25
Max. Negotiated Rate	$856.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$856.25
Rate for Payer: Hamaspik Choice Inc Medicare	$856.25

WEDGE PLEXUR 40X15MM X 10DEG

Facility OP

$1,712.50

Service Code	HCPCS C1713
Hospital Charge Code	64904656
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,798.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$941.88
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	$856.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$984.69
Rate for Payer: Fidelis Medicare Advantage	$1,798.12
Rate for Payer: Group Health Inc Commercial	$856.25
Rate for Payer: Group Health Inc Medicare	$599.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$856.25
Rate for Payer: Hamaspik Choice Inc Medicare	$856.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,113.12

Price Transparency.

All Charges