St. Barnabas Hospital

All Charges

Charge

Type

Price

BURN TRAY

Facility OP

$18.78

Hospital Charge Code	40200670
Hospital Revenue Code	270
Min. Negotiated Rate	$6.57
Max. Negotiated Rate	$15.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.39
Rate for Payer: Aetna Government	$9.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.77
Rate for Payer: Group Health Inc Commercial	$9.39
Rate for Payer: Group Health Inc Medicare	$6.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.39
Rate for Payer: Hamaspik Choice Inc Medicare	$9.39

BUR OVAL 4.0 X 55MM BRASSELER

Facility OP

$35.53

Hospital Charge Code	64904121
Hospital Revenue Code	270
Min. Negotiated Rate	$12.44
Max. Negotiated Rate	$28.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.76
Rate for Payer: Aetna Government	$17.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.16
Rate for Payer: Group Health Inc Commercial	$17.76
Rate for Payer: Group Health Inc Medicare	$12.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.76
Rate for Payer: Hamaspik Choice Inc Medicare	$17.76

BUR OVAL 4.0X55MM BRASSELER

Facility OP

$28.00

Hospital Charge Code	40201015
Hospital Revenue Code	270
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$22.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.00
Rate for Payer: Aetna Government	$14.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.04
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00

BURR HOLES

Facility OP

$3,512.48

Service Code	HCPCS 61154
Hospital Charge Code	40000145
Hospital Revenue Code	360
Min. Negotiated Rate	$1,229.37
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,931.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,602.03
Rate for Payer: Aetna Government	$1,602.03
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,577.62
Rate for Payer: Group Health Inc Commercial	$1,756.24
Rate for Payer: Group Health Inc Medicare	$1,229.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,756.24
Rate for Payer: Hamaspik Choice Inc Medicare	$1,756.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,752.91

BUR ROUND 3.2MM

Facility OP

$160.68

Hospital Charge Code	64904986
Hospital Revenue Code	270
Min. Negotiated Rate	$56.24
Max. Negotiated Rate	$128.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.34
Rate for Payer: Aetna Government	$80.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$128.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$109.26
Rate for Payer: Group Health Inc Commercial	$80.34
Rate for Payer: Group Health Inc Medicare	$56.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.34
Rate for Payer: Hamaspik Choice Inc Medicare	$80.34

BUR ROUND 4.0MM DIAMOND MED

Facility OP

$382.80

Hospital Charge Code	64904182
Hospital Revenue Code	270
Min. Negotiated Rate	$133.98
Max. Negotiated Rate	$306.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$191.40
Rate for Payer: Aetna Government	$191.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$306.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$260.30
Rate for Payer: Group Health Inc Commercial	$191.40
Rate for Payer: Group Health Inc Medicare	$133.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.40
Rate for Payer: Hamaspik Choice Inc Medicare	$191.40

BUR ROUND 6 FLUTE 4.0MM

Facility OP

$100.00

Hospital Charge Code	64904980
Hospital Revenue Code	270
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$80.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.00
Rate for Payer: Aetna Government	$50.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

BUR ROUND CARBIDE 2.3 X 44.5MM

Facility OP

$12.88

Hospital Charge Code	64904855
Hospital Revenue Code	270
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$10.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.44
Rate for Payer: Aetna Government	$6.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.76
Rate for Payer: Group Health Inc Commercial	$6.44
Rate for Payer: Group Health Inc Medicare	$4.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.44
Rate for Payer: Hamaspik Choice Inc Medicare	$6.44

BUR SERRATED STAINLESS 2.3X67MM

Facility OP

$60.00

Hospital Charge Code	64904084
Hospital Revenue Code	270
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$48.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.80
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00

BUR TAPERED 1.2

Facility OP

$12.00

Hospital Charge Code	40201016
Hospital Revenue Code	270
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: 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

BUSHING FEMUR HINGE HMRS

Facility OP

$1,635.00

Service Code	HCPCS C1776
Hospital Charge Code	64907266
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,716.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$899.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$817.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$940.12
Rate for Payer: Fidelis Medicare Advantage	$1,716.75
Rate for Payer: Group Health Inc Commercial	$817.50
Rate for Payer: Group Health Inc Medicare	$572.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$817.50
Rate for Payer: Hamaspik Choice Inc Medicare	$817.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,062.75

BUSHING FEMUR HINGE HMRS

Facility IP

$1,635.00

Service Code	HCPCS C1776
Hospital Charge Code	64907266
Hospital Revenue Code	278
Min. Negotiated Rate	$817.50
Max. Negotiated Rate	$817.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$817.50
Rate for Payer: Hamaspik Choice Inc Medicare	$817.50

BUSHING KRH DURATION

Facility OP

$1,031.25

Service Code	HCPCS C1776
Hospital Charge Code	64907265
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,082.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$567.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$515.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$592.97
Rate for Payer: Fidelis Medicare Advantage	$1,082.81
Rate for Payer: Group Health Inc Commercial	$515.62
Rate for Payer: Group Health Inc Medicare	$360.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.62
Rate for Payer: Hamaspik Choice Inc Medicare	$515.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$670.31

BUSHING KRH DURATION

Facility IP

$1,031.25

Service Code	HCPCS C1776
Hospital Charge Code	64907265
Hospital Revenue Code	278
Min. Negotiated Rate	$515.62
Max. Negotiated Rate	$515.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$515.62
Rate for Payer: Hamaspik Choice Inc Medicare	$515.62

BUSPIRONE 10 MG TAB

Facility OP

$1.00

Hospital Charge Code	41650563
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

BUSPIRONE 10 MG TAB

Facility OP

$1.00

Hospital Charge Code	41640563
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

BUSPIRONE 15 MG TAB

Facility OP

$0.16

Hospital Charge Code	41645096
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

BUSPIRONE 15 MG TAB

Facility OP

$0.16

Hospital Charge Code	41655096
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

BUSPIRONE 5 MG TAB

Facility OP

$0.13

Hospital Charge Code	41644053
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

BUSPIRONE 5 MG TAB

Facility OP

$0.13

Hospital Charge Code	41654053
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

BUSPIRONE 7.5 MG TAB

Facility OP

$1.80

Hospital Charge Code	41652793
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.90
Rate for Payer: Aetna Government	$0.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.22
Rate for Payer: Group Health Inc Commercial	$0.90
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.17

BUSPIRONE 7.5 MG TAB

Facility OP

$1.80

Hospital Charge Code	41642793
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.90
Rate for Payer: Aetna Government	$0.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.22
Rate for Payer: Group Health Inc Commercial	$0.90
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.17

BUTORPHANOL SD 2MG/ML

Facility IP

$14.52

Service Code	HCPCS J0595
Hospital Charge Code	41640382
Hospital Revenue Code	636
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$7.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.26
Rate for Payer: Hamaspik Choice Inc Medicare	$7.26

BUTORPHANOL SD 2MG/ML

Facility OP

$14.52

Service Code	HCPCS J0595
Hospital Charge Code	41640382
Hospital Revenue Code	636
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$9.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.94
Rate for Payer: Aetna Government	$2.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.54
Rate for Payer: Group Health Inc Commercial	$7.26
Rate for Payer: Group Health Inc Medicare	$5.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.26
Rate for Payer: Hamaspik Choice Inc Medicare	$7.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.79
Rate for Payer: SOMOS Essential	$3.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.44

BUTORPHANOL SD 2MG/ML

Facility OP

$14.52

Service Code	HCPCS J0595
Hospital Charge Code	41650382
Hospital Revenue Code	636
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$9.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.94
Rate for Payer: Aetna Government	$2.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.54
Rate for Payer: Group Health Inc Commercial	$7.26
Rate for Payer: Group Health Inc Medicare	$5.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.26
Rate for Payer: Hamaspik Choice Inc Medicare	$7.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.79
Rate for Payer: SOMOS Essential	$3.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.44

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