St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SMALL VAKU-PAK DRESSING WITH PUMP

Facility

$3,920.00

Service Code	HCPCS E2402
Hospital Charge Code	40208002
Hospital Revenue Code	270
Min. Negotiated Rate	$1,372.00
Max. Negotiated Rate	$9,052.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,156.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9,052.47
Rate for Payer: Aetna Government	$9,052.47
Rate for Payer: Brighton Health Commercial	$2,940.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,136.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,665.60
Rate for Payer: Group Health Inc Commercial	$1,960.00
Rate for Payer: Group Health Inc Medicare	$1,372.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,960.00

SMALL VAKU-PAK DRESSING W/O PUMP

Facility

$3,269.00

Hospital Charge Code	40208004
Hospital Revenue Code	270
Min. Negotiated Rate	$1,144.15
Max. Negotiated Rate	$2,615.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,797.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,634.50
Rate for Payer: Aetna Government	$1,634.50
Rate for Payer: Brighton Health Commercial	$2,451.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,615.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,222.92
Rate for Payer: Group Health Inc Commercial	$1,634.50
Rate for Payer: Group Health Inc Medicare	$1,144.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,634.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,634.50

SMARTLOCK HMMF HMMF SCR/2.0X6MM

Facility

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40203410
Hospital Revenue Code	278
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$264.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$151.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.90
Rate for Payer: EmblemHealth Commercial	$126.00
Rate for Payer: Fidelis Medicare Advantage	$264.60
Rate for Payer: Group Health Inc Commercial	$126.00
Rate for Payer: Group Health Inc Medicare	$88.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.80

SMARTLOCK HMMF HMMF SCR/2.0X6MM

Facility

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40203410
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00

SMARTLOCK HMMF HMMF SCR/2.0X8MM

Facility

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40203409
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00

SMARTLOCK HMMF HMMF SCR/2.0X8MM

Facility

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40203409
Hospital Revenue Code	278
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$264.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$151.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.90
Rate for Payer: EmblemHealth Commercial	$126.00
Rate for Payer: Fidelis Medicare Advantage	$264.60
Rate for Payer: Group Health Inc Commercial	$126.00
Rate for Payer: Group Health Inc Medicare	$88.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.80

SMARTLOCK HMMF PLATE

Facility

$1,170.00

Service Code	HCPCS C1713
Hospital Charge Code	40005857
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,228.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$643.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$702.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$585.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$672.75
Rate for Payer: EmblemHealth Commercial	$585.00
Rate for Payer: Fidelis Medicare Advantage	$1,228.50
Rate for Payer: Group Health Inc Commercial	$585.00
Rate for Payer: Group Health Inc Medicare	$409.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$585.00
Rate for Payer: Hamaspik Choice Inc Medicare	$585.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$760.50

SMARTLOCK HMMF PLATE

Facility

$1,170.00

Service Code	HCPCS C1713
Hospital Charge Code	40005857
Hospital Revenue Code	278
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$585.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$585.00
Rate for Payer: Hamaspik Choice Inc Medicare	$585.00

SMARTLOCK HMMF PLATE SCR/2.0X8MM

Facility

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40203406
Hospital Revenue Code	278
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$264.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$151.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.90
Rate for Payer: EmblemHealth Commercial	$126.00
Rate for Payer: Fidelis Medicare Advantage	$264.60
Rate for Payer: Group Health Inc Commercial	$126.00
Rate for Payer: Group Health Inc Medicare	$88.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.80

SMARTLOCK HMMF PLATE SCR/2.0X8MM

Facility

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40203406
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00

SMARTLOCK HMMF PLATE SM

Facility

$825.00

Service Code	HCPCS C1713
Hospital Charge Code	64903291
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$866.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$453.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$495.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$412.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$474.38
Rate for Payer: EmblemHealth Commercial	$412.50
Rate for Payer: Fidelis Medicare Advantage	$866.25
Rate for Payer: Group Health Inc Commercial	$412.50
Rate for Payer: Group Health Inc Medicare	$288.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$412.50
Rate for Payer: Hamaspik Choice Inc Medicare	$412.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$536.25

SMARTLOCK HMMF PLATE SM

Facility

$825.00

Service Code	HCPCS C1713
Hospital Charge Code	64903291
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$412.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$412.50
Rate for Payer: Hamaspik Choice Inc Medicare	$412.50

SMARTLOCK HMMF PLATE SMALL

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	40203405
Hospital Revenue Code	278
Min. Negotiated Rate	$330.00
Max. Negotiated Rate	$330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$330.00
Rate for Payer: Hamaspik Choice Inc Medicare	$330.00

SMARTLOCK HMMF PLATE SMALL

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	40203405
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$693.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$363.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$396.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$330.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$379.50
Rate for Payer: EmblemHealth Commercial	$330.00
Rate for Payer: Fidelis Medicare Advantage	$693.00
Rate for Payer: Group Health Inc Commercial	$330.00
Rate for Payer: Group Health Inc Medicare	$231.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$330.00
Rate for Payer: Hamaspik Choice Inc Medicare	$330.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$429.00

SMEAR FLUORESCENT/ACID STAI

Facility

$13.48

Service Code	HCPCS 87206
Hospital Charge Code	40614332
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.39

SMEAR FLUORESCENT/ACID STAI

Facility

$13.48

Service Code	HCPCS 87206
Hospital Charge Code	40614332
Hospital Revenue Code	300
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$10.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.39
Rate for Payer: Aetna Government	$5.39
Rate for Payer: Brighton Health Commercial	$10.11
Rate for Payer: Cash Price	$5.39
Rate for Payer: Cash Price	$5.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.22
Rate for Payer: Elderplan Medicare Advantage	$5.39
Rate for Payer: EmblemHealth Commercial	$5.39
Rate for Payer: Fidelis Essential Plan Aliesa	$4.58
Rate for Payer: Fidelis Essential Plan QHP	$4.80
Rate for Payer: Fidelis Medicare Advantage	$5.39
Rate for Payer: Fidelis Qualified Health Plan	$4.80
Rate for Payer: Group Health Inc Commercial	$5.39
Rate for Payer: Group Health Inc Medicare	$5.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.74
Rate for Payer: Hamaspik Choice Inc Medicare	$5.39
Rate for Payer: Healthfirst Medicare Advantage	$5.39
Rate for Payer: Healthfirst QHP	$5.39
Rate for Payer: Senior Whole Health Medicare Advantage	$5.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.31
Rate for Payer: Wellcare Medicare	$4.85

SMEAR GRAM STAIN

Facility

$10.68

Service Code	HCPCS 87205
Hospital Charge Code	40614331
Hospital Revenue Code	300
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$8.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.27
Rate for Payer: Aetna Government	$4.27
Rate for Payer: Brighton Health Commercial	$8.01
Rate for Payer: Cash Price	$4.27
Rate for Payer: Cash Price	$4.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.74
Rate for Payer: Elderplan Medicare Advantage	$4.27
Rate for Payer: EmblemHealth Commercial	$4.27
Rate for Payer: Fidelis Essential Plan Aliesa	$3.63
Rate for Payer: Fidelis Essential Plan QHP	$3.80
Rate for Payer: Fidelis Medicare Advantage	$4.27
Rate for Payer: Fidelis Qualified Health Plan	$3.80
Rate for Payer: Group Health Inc Commercial	$4.27
Rate for Payer: Group Health Inc Medicare	$4.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.34
Rate for Payer: Hamaspik Choice Inc Medicare	$4.27
Rate for Payer: Healthfirst Medicare Advantage	$4.27
Rate for Payer: Healthfirst QHP	$4.27
Rate for Payer: Senior Whole Health Medicare Advantage	$4.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.42
Rate for Payer: Wellcare Medicare	$3.84

SMEAR GRAM STAIN

Facility

$10.68

Service Code	HCPCS 87205
Hospital Charge Code	40614331
Hospital Revenue Code	300
Rate for Payer: Cash Price	$4.27

SMEAR WET MOUNT SALINE/INK

Facility

$14.52

Service Code	HCPCS 87210
Hospital Charge Code	40614333
Hospital Revenue Code	300
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$10.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.82
Rate for Payer: Aetna Government	$5.82
Rate for Payer: Brighton Health Commercial	$10.89
Rate for Payer: Cash Price	$5.82
Rate for Payer: Cash Price	$5.82
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.74
Rate for Payer: Elderplan Medicare Advantage	$5.82
Rate for Payer: EmblemHealth Commercial	$5.82
Rate for Payer: Fidelis Essential Plan Aliesa	$4.95
Rate for Payer: Fidelis Essential Plan QHP	$5.18
Rate for Payer: Fidelis Medicare Advantage	$5.82
Rate for Payer: Fidelis Qualified Health Plan	$5.18
Rate for Payer: Group Health Inc Commercial	$5.82
Rate for Payer: Group Health Inc Medicare	$5.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.26
Rate for Payer: Hamaspik Choice Inc Medicare	$5.82
Rate for Payer: Healthfirst Medicare Advantage	$5.82
Rate for Payer: Healthfirst QHP	$5.82
Rate for Payer: Senior Whole Health Medicare Advantage	$5.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.66
Rate for Payer: Wellcare Medicare	$5.24

SMEAR WET MOUNT SALINE/INK

Facility

$14.52

Service Code	HCPCS 87210
Hospital Charge Code	40614333
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.82

SMF PLT1.5MM TIT CRNL RGD MSH30MM

Facility

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	40202337
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00

SMF PLT1.5MM TIT CRNL RGD MSH30MM

Facility

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	40202337
Hospital Revenue Code	278
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$352.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$201.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$193.20
Rate for Payer: EmblemHealth Commercial	$168.00
Rate for Payer: Fidelis Medicare Advantage	$352.80
Rate for Payer: Group Health Inc Commercial	$168.00
Rate for Payer: Group Health Inc Medicare	$117.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$218.40

SMITH PETERSON NAIL

Facility

$55.64

Service Code	HCPCS C1713
Hospital Charge Code	40205725
Hospital Revenue Code	278
Min. Negotiated Rate	$19.47
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$33.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.99
Rate for Payer: EmblemHealth Commercial	$27.82
Rate for Payer: Fidelis Medicare Advantage	$58.42
Rate for Payer: Group Health Inc Commercial	$27.82
Rate for Payer: Group Health Inc Medicare	$19.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.82
Rate for Payer: Hamaspik Choice Inc Medicare	$27.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.17

SMITH PETERSON NAIL

Facility

$55.64

Service Code	HCPCS C1713
Hospital Charge Code	40205725
Hospital Revenue Code	278
Min. Negotiated Rate	$27.82
Max. Negotiated Rate	$27.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.82
Rate for Payer: Hamaspik Choice Inc Medicare	$27.82

SMITH TAC ABSOR. FIX. W/SPIKES

Facility

$380.94

Hospital Charge Code	40203352
Hospital Revenue Code	270
Min. Negotiated Rate	$133.33
Max. Negotiated Rate	$304.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$190.47
Rate for Payer: Aetna Government	$190.47
Rate for Payer: Brighton Health Commercial	$285.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$304.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$259.04
Rate for Payer: Group Health Inc Commercial	$190.47
Rate for Payer: Group Health Inc Medicare	$133.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.47
Rate for Payer: Hamaspik Choice Inc Medicare	$190.47

Know your out-of-pocket cost for care.

All Charges