St. Barnabas Hospital

All Charges

Charge

Type

Price

ZOLPIDEM 5 MG TAB

Facility OP

$0.08

Hospital Charge Code	41642856
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

ZOLPIDEM 5 MG TAB

Facility OP

$0.08

Hospital Charge Code	41652856
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

ZONAIR BED

Facility OP

$86.47

Hospital Charge Code	40209110
Hospital Revenue Code	270
Min. Negotiated Rate	$30.26
Max. Negotiated Rate	$69.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.24
Rate for Payer: Aetna Government	$43.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$69.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.80
Rate for Payer: Group Health Inc Commercial	$43.24
Rate for Payer: Group Health Inc Medicare	$30.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.24
Rate for Payer: Hamaspik Choice Inc Medicare	$43.24

ZONEAIRE 1155 W/OPT

Facility OP

$99.23

Hospital Charge Code	40209115
Hospital Revenue Code	270
Min. Negotiated Rate	$34.73
Max. Negotiated Rate	$79.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$49.62
Rate for Payer: Aetna Government	$49.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.48
Rate for Payer: Group Health Inc Commercial	$49.62
Rate for Payer: Group Health Inc Medicare	$34.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.62
Rate for Payer: Hamaspik Choice Inc Medicare	$49.62

ZONISAMIDE 100 MG CAP

Facility OP

$1.09

Hospital Charge Code	41654538
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.74
Rate for Payer: Group Health Inc Commercial	$0.55
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55
Rate for Payer: Hamaspik Choice Inc Medicare	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

ZONISAMIDE 100 MG CAP

Facility OP

$1.09

Hospital Charge Code	41644538
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.74
Rate for Payer: Group Health Inc Commercial	$0.55
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55
Rate for Payer: Hamaspik Choice Inc Medicare	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

ZONISAMIDE 10 MG/ML SUSP

Facility OP

$1.00

Hospital Charge Code	41654540
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

ZONISAMIDE 10 MG/ML SUSP

Facility OP

$1.00

Hospital Charge Code	41644540
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

ZONISAMIDE 25 MG CAP

Facility OP

$1.00

Hospital Charge Code	41655500
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

ZONISAMIDE 25 MG CAP

Facility OP

$1.00

Hospital Charge Code	41645500
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

ZR ELVOW 1 VIEW

Facility OP

$766.16

Service Code	HCPCS 76499 TC
Hospital Charge Code	41107502
Hospital Revenue Code	320
Min. Negotiated Rate	$268.16
Max. Negotiated Rate	$612.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$383.08
Rate for Payer: Aetna Government	$383.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.99
Rate for Payer: Group Health Inc Commercial	$383.08
Rate for Payer: Group Health Inc Medicare	$268.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.08
Rate for Payer: Hamaspik Choice Inc Medicare	$383.08

Z SCARF GUIDE

Facility OP

$250.00

Hospital Charge Code	64905959
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

ZZ 14 F X 24CM SPLIT CATH III SET

Facility OP

$860.00

Service Code	HCPCS C1725
Hospital Charge Code	41561878
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$903.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$473.00
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	$430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$494.50
Rate for Payer: Fidelis Medicare Advantage	$903.00
Rate for Payer: Group Health Inc Commercial	$430.00
Rate for Payer: Group Health Inc Medicare	$301.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$559.00

ZZ 14 F X 24CM SPLIT CATH III SET

Facility IP

$860.00

Service Code	HCPCS C1725
Hospital Charge Code	41561878
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00

ZZ 14 F X24CM SPLIT CATH III SET

Facility IP

$860.00

Hospital Charge Code	41501878
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00

ZZ 14 F X24CM SPLIT CATH III SET

Facility OP

$860.00

Hospital Charge Code	41501878
Hospital Revenue Code	278
Min. Negotiated Rate	$301.00
Max. Negotiated Rate	$903.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$473.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$430.00
Rate for Payer: Aetna Government	$430.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$494.50
Rate for Payer: Fidelis Medicare Advantage	$903.00
Rate for Payer: Group Health Inc Commercial	$430.00
Rate for Payer: Group Health Inc Medicare	$301.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$559.00

ZZ 18G DOUBLE WALL NEEDLE

Facility OP

$18.07

Hospital Charge Code	41567505
Hospital Revenue Code	270
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$14.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.04
Rate for Payer: Aetna Government	$9.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.29
Rate for Payer: Group Health Inc Commercial	$9.04
Rate for Payer: Group Health Inc Medicare	$6.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.04
Rate for Payer: Hamaspik Choice Inc Medicare	$9.04

ZZ 19G PERC NDL 18 15 04

Facility OP

$55.28

Hospital Charge Code	41567008
Hospital Revenue Code	270
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$44.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.64
Rate for Payer: Aetna Government	$27.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.59
Rate for Payer: Group Health Inc Commercial	$27.64
Rate for Payer: Group Health Inc Medicare	$19.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.64
Rate for Payer: Hamaspik Choice Inc Medicare	$27.64

ZZ 36-260-3 BH EXCHG WR

Facility OP

$59.18

Service Code	HCPCS C1769
Hospital Charge Code	41567109
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$62.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.03
Rate for Payer: Fidelis Medicare Advantage	$62.14
Rate for Payer: Group Health Inc Commercial	$29.59
Rate for Payer: Group Health Inc Medicare	$20.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.59
Rate for Payer: Hamaspik Choice Inc Medicare	$29.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.47

ZZ 36-260-3 BH EXCHG WR

Facility IP

$59.18

Service Code	HCPCS C1769
Hospital Charge Code	41567109
Hospital Revenue Code	278
Min. Negotiated Rate	$29.59
Max. Negotiated Rate	$29.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.59
Rate for Payer: Hamaspik Choice Inc Medicare	$29.59

ZZ 38-260-BH EXCH WR 15 2

Facility IP

$61.31

Service Code	HCPCS C1769
Hospital Charge Code	41567107
Hospital Revenue Code	278
Min. Negotiated Rate	$30.66
Max. Negotiated Rate	$30.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.66
Rate for Payer: Hamaspik Choice Inc Medicare	$30.66

ZZ 38-260-BH EXCH WR 15 2

Facility OP

$61.31

Service Code	HCPCS C1769
Hospital Charge Code	41567107
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$64.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.25
Rate for Payer: Fidelis Medicare Advantage	$64.38
Rate for Payer: Group Health Inc Commercial	$30.66
Rate for Payer: Group Health Inc Medicare	$21.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.66
Rate for Payer: Hamaspik Choice Inc Medicare	$30.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.85

ZZ 38-260-BH EXCH WR 30 2

Facility OP

$61.31

Service Code	HCPCS C1769
Hospital Charge Code	41567108
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$64.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.25
Rate for Payer: Fidelis Medicare Advantage	$64.38
Rate for Payer: Group Health Inc Commercial	$30.66
Rate for Payer: Group Health Inc Medicare	$21.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.66
Rate for Payer: Hamaspik Choice Inc Medicare	$30.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.85

ZZ 38-260-BH EXCH WR 30 2

Facility IP

$61.31

Service Code	HCPCS C1769
Hospital Charge Code	41567108
Hospital Revenue Code	278
Min. Negotiated Rate	$30.66
Max. Negotiated Rate	$30.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.66
Rate for Payer: Hamaspik Choice Inc Medicare	$30.66

ZZ 4 FR MICRO ACC KIT

Facility OP

$104.33

Hospital Charge Code	41569819
Hospital Revenue Code	270
Min. Negotiated Rate	$36.52
Max. Negotiated Rate	$83.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.16
Rate for Payer: Aetna Government	$52.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$83.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$70.94
Rate for Payer: Group Health Inc Commercial	$52.16
Rate for Payer: Group Health Inc Medicare	$36.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.16
Rate for Payer: Hamaspik Choice Inc Medicare	$52.16

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