St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

STARGRAFT DEM 10CC PUTTY

Facility

$4,325.00

Service Code	HCPCS C1713
Hospital Charge Code	64904124
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,541.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,378.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,595.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,162.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,486.88
Rate for Payer: EmblemHealth Commercial	$2,162.50
Rate for Payer: Fidelis Medicare Advantage	$4,541.25
Rate for Payer: Group Health Inc Commercial	$2,162.50
Rate for Payer: Group Health Inc Medicare	$1,513.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,162.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,162.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,811.25

STATIN THERAPY/CURRENTLY TKN

Facility

$0.01

Service Code	HCPCS 4013F
Hospital Charge Code	30300373
Hospital Revenue Code	969
Max. Negotiated Rate	$2,915.00
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: Brighton Health Commercial	$0.01
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: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

STATLOCK CV PLUS SECUREMENT ORD

Facility

$29.04

Hospital Charge Code	64902516
Hospital Revenue Code	270
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$23.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.52
Rate for Payer: Aetna Government	$14.52
Rate for Payer: Brighton Health Commercial	$21.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.75
Rate for Payer: Group Health Inc Commercial	$14.52
Rate for Payer: Group Health Inc Medicare	$10.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.52
Rate for Payer: Hamaspik Choice Inc Medicare	$14.52

STATLOCK,SWIVEL TRICOT

Facility

$7.38

Hospital Charge Code	64901909
Hospital Revenue Code	270
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$5.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.69
Rate for Payer: Aetna Government	$3.69
Rate for Payer: Brighton Health Commercial	$5.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.02
Rate for Payer: Group Health Inc Commercial	$3.69
Rate for Payer: Group Health Inc Medicare	$2.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.69
Rate for Payer: Hamaspik Choice Inc Medicare	$3.69

STAVUDINE 15 MG CAP

Facility

$2.43

Hospital Charge Code	41641069
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.22
Rate for Payer: Aetna Government	$1.22
Rate for Payer: Brighton Health Commercial	$1.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.65
Rate for Payer: Group Health Inc Commercial	$1.22
Rate for Payer: Group Health Inc Medicare	$0.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.58

STAVUDINE 15 MG CAP

Facility

$2.43

Hospital Charge Code	41651069
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.22
Rate for Payer: Aetna Government	$1.22
Rate for Payer: Brighton Health Commercial	$1.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.65
Rate for Payer: Group Health Inc Commercial	$1.22
Rate for Payer: Group Health Inc Medicare	$0.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.58

STAVUDINE 1 MG/ML LIQUID

Facility

$0.76

Hospital Charge Code	41652445
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

STAVUDINE 1 MG/ML LIQUID

Facility

$0.76

Hospital Charge Code	41642445
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

STAVUDINE 20 MG CAP

Facility

$12.00

Hospital Charge Code	41650222
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.00
Rate for Payer: Aetna Government	$6.00
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

STAVUDINE 20 MG CAP

Facility

$12.00

Hospital Charge Code	41640222
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.00
Rate for Payer: Aetna Government	$6.00
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

STAVUDINE 30 MG CAP

Facility

$3.00

Hospital Charge Code	41640250
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

STAVUDINE 30 MG CAP

Facility

$3.00

Hospital Charge Code	41650250
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

STAVUDINE 40 MG CAP

Facility

$2.30

Hospital Charge Code	41641534
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.15
Rate for Payer: Aetna Government	$1.15
Rate for Payer: Brighton Health Commercial	$1.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.56
Rate for Payer: Group Health Inc Commercial	$1.15
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.15
Rate for Payer: Hamaspik Choice Inc Medicare	$1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.50

STAVUDINE 40 MG CAP

Facility

$2.30

Hospital Charge Code	41651534
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.15
Rate for Payer: Aetna Government	$1.15
Rate for Payer: Brighton Health Commercial	$1.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.56
Rate for Payer: Group Health Inc Commercial	$1.15
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.15
Rate for Payer: Hamaspik Choice Inc Medicare	$1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.50

STEEL WASHERS

Facility

$57.40

Hospital Charge Code	40209841
Hospital Revenue Code	270
Min. Negotiated Rate	$20.09
Max. Negotiated Rate	$45.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.70
Rate for Payer: Aetna Government	$28.70
Rate for Payer: Brighton Health Commercial	$43.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$45.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.03
Rate for Payer: Group Health Inc Commercial	$28.70
Rate for Payer: Group Health Inc Medicare	$20.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.70
Rate for Payer: Hamaspik Choice Inc Medicare	$28.70

STEINMANN PIN 9/64X9

Facility

$154.00

Service Code	HCPCS C1713
Hospital Charge Code	40202046
Hospital Revenue Code	278
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$161.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$92.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$77.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.55
Rate for Payer: EmblemHealth Commercial	$77.00
Rate for Payer: Fidelis Medicare Advantage	$161.70
Rate for Payer: Group Health Inc Commercial	$77.00
Rate for Payer: Group Health Inc Medicare	$53.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.00
Rate for Payer: Hamaspik Choice Inc Medicare	$77.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.10

STEINMANN PIN 9/64X9

Facility

$154.00

Service Code	HCPCS C1713
Hospital Charge Code	40202046
Hospital Revenue Code	278
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.00
Rate for Payer: Hamaspik Choice Inc Medicare	$77.00

STEM 3 STD, AVENIR MULL

Facility

$11,670.00

Service Code	HCPCS C1776
Hospital Charge Code	64905556
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$12,253.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,418.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$7,002.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,835.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,710.25
Rate for Payer: EmblemHealth Commercial	$5,835.00
Rate for Payer: Fidelis Medicare Advantage	$12,253.50
Rate for Payer: Group Health Inc Commercial	$5,835.00
Rate for Payer: Group Health Inc Medicare	$4,084.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,835.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,835.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,585.50

STEM 3 STD, AVENIR MULL

Facility

$11,670.00

Service Code	HCPCS C1776
Hospital Charge Code	64905556
Hospital Revenue Code	278
Min. Negotiated Rate	$5,835.00
Max. Negotiated Rate	$5,835.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,835.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,835.00

STEM ACCOLADE II 132DEG NECK

Facility

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64905674
Hospital Revenue Code	278
Min. Negotiated Rate	$8,557.88
Max. Negotiated Rate	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicare	$8,557.88

STEM ACCOLADE II 132DEG NECK

Facility

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64905674
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$17,971.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,413.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$10,269.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,557.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,841.56
Rate for Payer: EmblemHealth Commercial	$8,557.88
Rate for Payer: Fidelis Medicare Advantage	$17,971.54
Rate for Payer: Group Health Inc Commercial	$8,557.88
Rate for Payer: Group Health Inc Medicare	$5,990.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicare	$8,557.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,125.24

STEM, ADV 132 SZ 11 SECR-FT

Facility

$7,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907386
Hospital Revenue Code	278
Min. Negotiated Rate	$3,625.00
Max. Negotiated Rate	$3,625.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,625.00

STEM, ADV 132 SZ 11 SECR-FT

Facility

$7,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907386
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,612.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,987.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,350.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,625.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,168.75
Rate for Payer: EmblemHealth Commercial	$3,625.00
Rate for Payer: Fidelis Medicare Advantage	$7,612.50
Rate for Payer: Group Health Inc Commercial	$3,625.00
Rate for Payer: Group Health Inc Medicare	$2,537.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,625.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,712.50

STEM AVENIR LAT HA 12/14

Facility

$9,336.00

Service Code	HCPCS C1776
Hospital Charge Code	64906917
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,802.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,134.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$5,601.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,668.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,368.20
Rate for Payer: EmblemHealth Commercial	$4,668.00
Rate for Payer: Fidelis Medicare Advantage	$9,802.80
Rate for Payer: Group Health Inc Commercial	$4,668.00
Rate for Payer: Group Health Inc Medicare	$3,267.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,668.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,068.40

STEM AVENIR LAT HA 12/14

Facility

$9,336.00

Service Code	HCPCS C1776
Hospital Charge Code	64906917
Hospital Revenue Code	278
Min. Negotiated Rate	$4,668.00
Max. Negotiated Rate	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,668.00

Know your out-of-pocket cost for care.

All Charges