St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SPONGE CMPR LG 16X5X23MM

Facility

$4,413.98

Service Code	HCPCS C1713
Hospital Charge Code	64905403
Hospital Revenue Code	278
Min. Negotiated Rate	$2,206.99
Max. Negotiated Rate	$2,206.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,206.99
Rate for Payer: Hamaspik Choice Inc Medicare	$2,206.99

SPONGE CMPR LG 16X5X23MM

Facility

$4,413.98

Service Code	HCPCS C1713
Hospital Charge Code	64905403
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,634.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,427.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,648.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,206.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,538.04
Rate for Payer: EmblemHealth Commercial	$2,206.99
Rate for Payer: Fidelis Medicare Advantage	$4,634.68
Rate for Payer: Group Health Inc Commercial	$2,206.99
Rate for Payer: Group Health Inc Medicare	$1,544.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,206.99
Rate for Payer: Hamaspik Choice Inc Medicare	$2,206.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,869.09

SPONGE CMPR MD 15X5X16MM

Facility

$6,397.50

Service Code	HCPCS C1713
Hospital Charge Code	64905401
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,717.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,518.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,838.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,198.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,678.56
Rate for Payer: EmblemHealth Commercial	$3,198.75
Rate for Payer: Fidelis Medicare Advantage	$6,717.38
Rate for Payer: Group Health Inc Commercial	$3,198.75
Rate for Payer: Group Health Inc Medicare	$2,239.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,198.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,198.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,158.38

SPONGE CMPR MD 15X5X16MM

Facility

$6,397.50

Service Code	HCPCS C1713
Hospital Charge Code	64905401
Hospital Revenue Code	278
Min. Negotiated Rate	$3,198.75
Max. Negotiated Rate	$3,198.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,198.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,198.75

SPONGE CMPR SM TALL 10X10X16MM

Facility

$2,693.43

Service Code	HCPCS C1713
Hospital Charge Code	64905399
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.72
Max. Negotiated Rate	$1,346.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,346.72
Rate for Payer: Hamaspik Choice Inc Medicare	$1,346.72

SPONGE CMPR SM TALL 10X10X16MM

Facility

$2,693.43

Service Code	HCPCS C1713
Hospital Charge Code	64905399
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,828.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,481.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,616.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,346.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,548.72
Rate for Payer: EmblemHealth Commercial	$1,346.72
Rate for Payer: Fidelis Medicare Advantage	$2,828.10
Rate for Payer: Group Health Inc Commercial	$1,346.72
Rate for Payer: Group Health Inc Medicare	$942.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,346.72
Rate for Payer: Hamaspik Choice Inc Medicare	$1,346.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,750.73

SPONGE CMPR STRIP 30X10X7MM SM

Facility

$4,098.70

Service Code	HCPCS C1713
Hospital Charge Code	64905405
Hospital Revenue Code	278
Min. Negotiated Rate	$2,049.35
Max. Negotiated Rate	$2,049.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,049.35
Rate for Payer: Hamaspik Choice Inc Medicare	$2,049.35

SPONGE CMPR STRIP 30X10X7MM SM

Facility

$4,098.70

Service Code	HCPCS C1713
Hospital Charge Code	64905405
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,303.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,254.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,459.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,049.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,356.75
Rate for Payer: EmblemHealth Commercial	$2,049.35
Rate for Payer: Fidelis Medicare Advantage	$4,303.64
Rate for Payer: Group Health Inc Commercial	$2,049.35
Rate for Payer: Group Health Inc Medicare	$1,434.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,049.35
Rate for Payer: Hamaspik Choice Inc Medicare	$2,049.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,664.16

SPONGE CMPR STRIP 30X20X7MM MD

Facility

$5,308.35

Service Code	HCPCS C1713
Hospital Charge Code	64905406
Hospital Revenue Code	278
Min. Negotiated Rate	$2,654.18
Max. Negotiated Rate	$2,654.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,654.18
Rate for Payer: Hamaspik Choice Inc Medicare	$2,654.18

SPONGE CMPR STRIP 30X20X7MM MD

Facility

$5,308.35

Service Code	HCPCS C1713
Hospital Charge Code	64905406
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,573.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,919.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,185.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,654.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,052.30
Rate for Payer: EmblemHealth Commercial	$2,654.18
Rate for Payer: Fidelis Medicare Advantage	$5,573.77
Rate for Payer: Group Health Inc Commercial	$2,654.18
Rate for Payer: Group Health Inc Medicare	$1,857.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,654.18
Rate for Payer: Hamaspik Choice Inc Medicare	$2,654.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,450.43

SPONGE CMPR STRIP 50X10X7MM LG

Facility

$5,738.18

Service Code	HCPCS C1713
Hospital Charge Code	64905408
Hospital Revenue Code	278
Min. Negotiated Rate	$2,869.09
Max. Negotiated Rate	$2,869.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,869.09
Rate for Payer: Hamaspik Choice Inc Medicare	$2,869.09

SPONGE CMPR STRIP 50X10X7MM LG

Facility

$5,738.18

Service Code	HCPCS C1713
Hospital Charge Code	64905408
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,025.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,156.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,442.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,869.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,299.45
Rate for Payer: EmblemHealth Commercial	$2,869.09
Rate for Payer: Fidelis Medicare Advantage	$6,025.09
Rate for Payer: Group Health Inc Commercial	$2,869.09
Rate for Payer: Group Health Inc Medicare	$2,008.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,869.09
Rate for Payer: Hamaspik Choice Inc Medicare	$2,869.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,729.82

SPONGE CMPR STRIP 50X20X7MM XL

Facility

$7,673.00

Service Code	HCPCS C1713
Hospital Charge Code	64905409
Hospital Revenue Code	278
Min. Negotiated Rate	$3,836.50
Max. Negotiated Rate	$3,836.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,836.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,836.50

SPONGE CMPR STRIP 50X20X7MM XL

Facility

$7,673.00

Service Code	HCPCS C1713
Hospital Charge Code	64905409
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,056.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,220.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,603.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,836.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,411.98
Rate for Payer: EmblemHealth Commercial	$3,836.50
Rate for Payer: Fidelis Medicare Advantage	$8,056.65
Rate for Payer: Group Health Inc Commercial	$3,836.50
Rate for Payer: Group Health Inc Medicare	$2,685.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,836.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,836.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,987.45

SPONGE, COMPRES 8X8X10MM

Facility

$2,800.00

Hospital Charge Code	40005119
Hospital Revenue Code	272
Min. Negotiated Rate	$980.00
Max. Negotiated Rate	$2,240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,540.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,400.00
Rate for Payer: Aetna Government	$1,400.00
Rate for Payer: Brighton Health Commercial	$2,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,904.00
Rate for Payer: Group Health Inc Commercial	$1,400.00
Rate for Payer: Group Health Inc Medicare	$980.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,400.00

SPONGE COMPRESSIBLE LG 15X5X23MM

Facility

$5,830.00

Hospital Charge Code	40005122
Hospital Revenue Code	272
Min. Negotiated Rate	$2,040.50
Max. Negotiated Rate	$4,664.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,206.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,915.00
Rate for Payer: Aetna Government	$2,915.00
Rate for Payer: Brighton Health Commercial	$4,372.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,664.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,964.40
Rate for Payer: Group Health Inc Commercial	$2,915.00
Rate for Payer: Group Health Inc Medicare	$2,040.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,915.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,915.00

SPONGE COMPRESSIBLE MD 15X5X16MM

Facility

$5,118.00

Hospital Charge Code	40005121
Hospital Revenue Code	272
Min. Negotiated Rate	$1,791.30
Max. Negotiated Rate	$4,094.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,814.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,559.00
Rate for Payer: Aetna Government	$2,559.00
Rate for Payer: Brighton Health Commercial	$3,838.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,094.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,480.24
Rate for Payer: Group Health Inc Commercial	$2,559.00
Rate for Payer: Group Health Inc Medicare	$1,791.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,559.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,559.00

SPONGE,COMPRES SM TALL 10X10X16MM

Facility

$3,864.00

Hospital Charge Code	40005120
Hospital Revenue Code	272
Min. Negotiated Rate	$1,352.40
Max. Negotiated Rate	$3,091.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,125.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,932.00
Rate for Payer: Aetna Government	$1,932.00
Rate for Payer: Brighton Health Commercial	$2,898.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,091.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,627.52
Rate for Payer: Group Health Inc Commercial	$1,932.00
Rate for Payer: Group Health Inc Medicare	$1,352.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,932.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,932.00

SPONGE COMPRES STRIP 30X10X7MM SM

Facility

$4,850.00

Hospital Charge Code	40005123
Hospital Revenue Code	272
Min. Negotiated Rate	$1,697.50
Max. Negotiated Rate	$3,880.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,667.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,425.00
Rate for Payer: Aetna Government	$2,425.00
Rate for Payer: Brighton Health Commercial	$3,637.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,880.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,298.00
Rate for Payer: Group Health Inc Commercial	$2,425.00
Rate for Payer: Group Health Inc Medicare	$1,697.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,425.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,425.00

SPONGE COMPRES STRIP 30X20X7MM MD

Facility

$7,112.00

Hospital Charge Code	40005124
Hospital Revenue Code	272
Min. Negotiated Rate	$2,489.20
Max. Negotiated Rate	$5,689.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,911.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,556.00
Rate for Payer: Aetna Government	$3,556.00
Rate for Payer: Brighton Health Commercial	$5,334.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,689.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,836.16
Rate for Payer: Group Health Inc Commercial	$3,556.00
Rate for Payer: Group Health Inc Medicare	$2,489.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,556.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,556.00

SPONGE COMPRES STRIP 50X10X7MM LG

Facility

$6,800.00

Hospital Charge Code	40005125
Hospital Revenue Code	272
Min. Negotiated Rate	$2,380.00
Max. Negotiated Rate	$5,440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,740.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,400.00
Rate for Payer: Aetna Government	$3,400.00
Rate for Payer: Brighton Health Commercial	$5,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,624.00
Rate for Payer: Group Health Inc Commercial	$3,400.00
Rate for Payer: Group Health Inc Medicare	$2,380.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,400.00

SPONGE COMPRES STRIP 50X20X7MM XL

Facility

$10,700.00

Hospital Charge Code	40005126
Hospital Revenue Code	272
Min. Negotiated Rate	$3,745.00
Max. Negotiated Rate	$8,560.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,885.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,350.00
Rate for Payer: Aetna Government	$5,350.00
Rate for Payer: Brighton Health Commercial	$8,025.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,560.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,276.00
Rate for Payer: Group Health Inc Commercial	$5,350.00
Rate for Payer: Group Health Inc Medicare	$3,745.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,350.00

SPONGE LAP STERILE W/RING 402

Facility

$0.78

Hospital Charge Code	64901082
Hospital Revenue Code	270
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39

SPONGE NEURO 1/2 X 1/2

Facility

$1.16

Hospital Charge Code	64904672
Hospital Revenue Code	270
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.58
Rate for Payer: Aetna Government	$0.58
Rate for Payer: Brighton Health Commercial	$0.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.79
Rate for Payer: Group Health Inc Commercial	$0.58
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58
Rate for Payer: Hamaspik Choice Inc Medicare	$0.58

SPONGE NEURO 1/2X 3 DEROYAL

Facility

$1.16

Hospital Charge Code	64903038
Hospital Revenue Code	270
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.58
Rate for Payer: Aetna Government	$0.58
Rate for Payer: Brighton Health Commercial	$0.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.79
Rate for Payer: Group Health Inc Commercial	$0.58
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58
Rate for Payer: Hamaspik Choice Inc Medicare	$0.58

Know your out-of-pocket cost for care.

All Charges