St. Barnabas Hospital

All Charges

Charge

Type

Price

XSMALL STAPLE 7.5X1.2MMX1.2MM

Facility IP

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	40200805
Hospital Revenue Code	278
Min. Negotiated Rate	$275.00
Max. Negotiated Rate	$275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00

XSMALL STAPLE 7.5X1.2MMX1.2MM

Facility OP

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	40200805
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$577.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
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	$275.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$316.25
Rate for Payer: Fidelis Medicare Advantage	$577.50
Rate for Payer: Group Health Inc Commercial	$275.00
Rate for Payer: Group Health Inc Medicare	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$357.50

X-STOP IPD IMPLANT TI/14MM

Facility OP

$9,250.00

Hospital Charge Code	40209958
Hospital Revenue Code	272
Min. Negotiated Rate	$3,237.50
Max. Negotiated Rate	$7,400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,087.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,625.00
Rate for Payer: Aetna Government	$4,625.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,290.00
Rate for Payer: Group Health Inc Commercial	$4,625.00
Rate for Payer: Group Health Inc Medicare	$3,237.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,625.00

XYLOCAINE

Facility OP

$9.57

Hospital Charge Code	40207280
Hospital Revenue Code	270
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$7.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.78
Rate for Payer: Aetna Government	$4.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.51
Rate for Payer: Group Health Inc Commercial	$4.78
Rate for Payer: Group Health Inc Medicare	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.78
Rate for Payer: Hamaspik Choice Inc Medicare	$4.78

YANKAUER,BULB TIP,1-PIECE (K86)

Facility OP

$0.02

Hospital Charge Code	64902556
Hospital Revenue Code	270
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

YASARGIL TI STD CLIP

Facility OP

$833.42

Hospital Charge Code	64906545
Hospital Revenue Code	279
Min. Negotiated Rate	$291.70
Max. Negotiated Rate	$666.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$458.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$416.71
Rate for Payer: Aetna Government	$416.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$666.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$566.73
Rate for Payer: Group Health Inc Commercial	$416.71
Rate for Payer: Group Health Inc Medicare	$291.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$416.71
Rate for Payer: Hamaspik Choice Inc Medicare	$416.71

YASARGIL TYPE TMP CLIP SLGHT CRV

Facility OP

$1,022.50

Hospital Charge Code	64905646
Hospital Revenue Code	270
Min. Negotiated Rate	$357.88
Max. Negotiated Rate	$818.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$562.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$511.25
Rate for Payer: Aetna Government	$511.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$818.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$695.30
Rate for Payer: Group Health Inc Commercial	$511.25
Rate for Payer: Group Health Inc Medicare	$357.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$511.25
Rate for Payer: Hamaspik Choice Inc Medicare	$511.25

Y CABLE CONNECTS TO CMP BC10PMO

Facility OP

$1,242.00

Hospital Charge Code	40205297
Hospital Revenue Code	292
Min. Negotiated Rate	$434.70
Max. Negotiated Rate	$993.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$683.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$621.00
Rate for Payer: Aetna Government	$621.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$993.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$844.56
Rate for Payer: Group Health Inc Commercial	$621.00
Rate for Payer: Group Health Inc Medicare	$434.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$621.00
Rate for Payer: Hamaspik Choice Inc Medicare	$621.00

YELLOW FEVER VACCINE

Facility IP

$427.68

Service Code	HCPCS 90717
Hospital Charge Code	41640378
Hospital Revenue Code	636
Min. Negotiated Rate	$213.84
Max. Negotiated Rate	$213.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.84
Rate for Payer: Hamaspik Choice Inc Medicare	$213.84

YELLOW FEVER VACCINE

Facility IP

$146.00

Service Code	HCPCS 90717
Hospital Charge Code	41645955
Hospital Revenue Code	636
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$73.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00

YELLOW FEVER VACCINE

Facility OP

$146.00

Service Code	HCPCS 90717
Hospital Charge Code	41645955
Hospital Revenue Code	636
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$143.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.47
Rate for Payer: Aetna Government	$143.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.95
Rate for Payer: Group Health Inc Commercial	$73.00
Rate for Payer: Group Health Inc Medicare	$51.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.90

YELLOW FEVER VACCINE

Facility OP

$427.68

Service Code	HCPCS 90717
Hospital Charge Code	41640378
Hospital Revenue Code	636
Min. Negotiated Rate	$143.47
Max. Negotiated Rate	$277.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.47
Rate for Payer: Aetna Government	$143.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$213.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$245.92
Rate for Payer: Group Health Inc Commercial	$213.84
Rate for Payer: Group Health Inc Medicare	$149.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.84
Rate for Payer: Hamaspik Choice Inc Medicare	$213.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$277.99

YELLOW FEVER VACCINE

Facility OP

$427.68

Service Code	HCPCS 90717
Hospital Charge Code	41650378
Hospital Revenue Code	636
Min. Negotiated Rate	$143.47
Max. Negotiated Rate	$277.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.47
Rate for Payer: Aetna Government	$143.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$213.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$245.92
Rate for Payer: Group Health Inc Commercial	$213.84
Rate for Payer: Group Health Inc Medicare	$149.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.84
Rate for Payer: Hamaspik Choice Inc Medicare	$213.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$277.99

YELLOW FEVER VACCINE

Facility IP

$146.00

Service Code	HCPCS 90717
Hospital Charge Code	41655955
Hospital Revenue Code	636
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$73.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00

YELLOW FEVER VACCINE

Facility IP

$427.68

Service Code	HCPCS 90717
Hospital Charge Code	41650378
Hospital Revenue Code	636
Min. Negotiated Rate	$213.84
Max. Negotiated Rate	$213.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.84
Rate for Payer: Hamaspik Choice Inc Medicare	$213.84

YELLOW FEVER VACCINE

Facility OP

$146.00

Service Code	HCPCS 90717
Hospital Charge Code	41655955
Hospital Revenue Code	636
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$143.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.47
Rate for Payer: Aetna Government	$143.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.95
Rate for Payer: Group Health Inc Commercial	$73.00
Rate for Payer: Group Health Inc Medicare	$51.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.90

YELLOW STRUT

Facility OP

$4,562.50

Hospital Charge Code	64902961
Hospital Revenue Code	279
Min. Negotiated Rate	$1,596.88
Max. Negotiated Rate	$3,650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,509.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,281.25
Rate for Payer: Aetna Government	$2,281.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,650.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,102.50
Rate for Payer: Group Health Inc Commercial	$2,281.25
Rate for Payer: Group Health Inc Medicare	$1,596.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,281.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,281.25

YOUNGSWICK 1MM GUIDE

Facility OP

$250.00

Hospital Charge Code	64903964
Hospital Revenue Code	270
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$125.00
Rate for Payer: Aetna Government	$125.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.00
Rate for Payer: Group Health Inc Commercial	$125.00
Rate for Payer: Group Health Inc Medicare	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00

Y-PLATE

Facility IP

$1,987.50

Service Code	HCPCS C1713
Hospital Charge Code	64907244
Hospital Revenue Code	278
Min. Negotiated Rate	$993.75
Max. Negotiated Rate	$993.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$993.75
Rate for Payer: Hamaspik Choice Inc Medicare	$993.75

Y-PLATE

Facility OP

$1,987.50

Service Code	HCPCS C1713
Hospital Charge Code	64907244
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,086.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,093.12
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	$993.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,142.81
Rate for Payer: Fidelis Medicare Advantage	$2,086.88
Rate for Payer: Group Health Inc Commercial	$993.75
Rate for Payer: Group Health Inc Medicare	$695.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$993.75
Rate for Payer: Hamaspik Choice Inc Medicare	$993.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,291.88

YUKON SCREW POLY STRY

Facility IP

$11,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64906986
Hospital Revenue Code	278
Min. Negotiated Rate	$5,737.50
Max. Negotiated Rate	$5,737.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,737.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5,737.50

YUKON SCREW POLY STRY

Facility OP

$11,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64906986
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$12,048.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,311.25
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	$5,737.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,598.12
Rate for Payer: Fidelis Medicare Advantage	$12,048.75
Rate for Payer: Group Health Inc Commercial	$5,737.50
Rate for Payer: Group Health Inc Medicare	$4,016.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,737.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5,737.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,458.75

Z BALLOON/UT/DIAMOND 7X2X120

Facility IP

$612.36

Service Code	HCPCS C1725
Hospital Charge Code	41569691
Hospital Revenue Code	278
Min. Negotiated Rate	$306.18
Max. Negotiated Rate	$306.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$306.18
Rate for Payer: Hamaspik Choice Inc Medicare	$306.18

Z BALLOON/UT/DIAMOND 7X2X120

Facility OP

$612.36

Service Code	HCPCS C1725
Hospital Charge Code	41569691
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$642.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$336.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$306.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$352.11
Rate for Payer: Fidelis Medicare Advantage	$642.98
Rate for Payer: Group Health Inc Commercial	$306.18
Rate for Payer: Group Health Inc Medicare	$214.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$306.18
Rate for Payer: Hamaspik Choice Inc Medicare	$306.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$398.03

Z CATH COBRA 3 5FR 035-65 CM

Facility OP

$56.00

Service Code	HCPCS C1725
Hospital Charge Code	41569732
Hospital Revenue Code	278
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$58.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.20
Rate for Payer: Fidelis Medicare Advantage	$58.80
Rate for Payer: Group Health Inc Commercial	$28.00
Rate for Payer: Group Health Inc Medicare	$19.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.00
Rate for Payer: Hamaspik Choice Inc Medicare	$28.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.40

Price Transparency.

All Charges