St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BIPIV 0.0625% NS 250ML

Facility

$6.00

Service Code	HCPCS J3490
Hospital Charge Code	41655937
Hospital Revenue Code	636
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00

BIPIV 0.125%+FENT 1250MCG NS250ML

Facility

$16.00

Service Code	HCPCS J3490
Hospital Charge Code	41645933
Hospital Revenue Code	636
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00

BIPIV 0.125%+FENT 1250MCG NS250ML

Facility

$16.00

Service Code	HCPCS J3490
Hospital Charge Code	41655933
Hospital Revenue Code	636
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00

BIPIV 0.125%+FENT 1250MCG NS250ML

Facility

$16.00

Service Code	HCPCS J3490
Hospital Charge Code	41655933
Hospital Revenue Code	636
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Brighton Health Commercial	$9.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.20
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

BIPIV 0.125%+FENT 1250MCG NS250ML

Facility

$16.00

Service Code	HCPCS J3490
Hospital Charge Code	41645933
Hospital Revenue Code	636
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Brighton Health Commercial	$9.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.20
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

BIPIV 0.125%+FENT 250MCG NS 250ML

Facility

$9.00

Service Code	HCPCS J3490
Hospital Charge Code	41655939
Hospital Revenue Code	636
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50

BIPIV 0.125%+FENT 250MCG NS 250ML

Facility

$9.00

Service Code	HCPCS J3490
Hospital Charge Code	41655939
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$5.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.18
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

BIPIV 0.125%+FENT 250MCG NS 250ML

Facility

$9.00

Service Code	HCPCS J3490
Hospital Charge Code	41645939
Hospital Revenue Code	636
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50

BIPIV 0.125%+FENT 250MCG NS 250ML

Facility

$9.00

Service Code	HCPCS J3490
Hospital Charge Code	41645939
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$5.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.18
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

BIPIV 0.125% NS 250ML

Facility

$7.00

Service Code	HCPCS J3490
Hospital Charge Code	41645941
Hospital Revenue Code	636
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$4.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$4.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.02
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

BIPIV 0.125% NS 250ML

Facility

$7.00

Service Code	HCPCS J3490
Hospital Charge Code	41655941
Hospital Revenue Code	636
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50

BIPIV 0.125% NS 250ML

Facility

$7.00

Service Code	HCPCS J3490
Hospital Charge Code	41645941
Hospital Revenue Code	636
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50

BIPIV 0.125% NS 250ML

Facility

$7.00

Service Code	HCPCS J3490
Hospital Charge Code	41655941
Hospital Revenue Code	636
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$4.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$4.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.02
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

BIPIV 0.25%/NS 250ML

Facility

$12.00

Service Code	HCPCS J3490
Hospital Charge Code	41645931
Hospital Revenue Code	636
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$7.80
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	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
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

BIPIV 0.25%/NS 250ML

Facility

$12.00

Service Code	HCPCS J3490
Hospital Charge Code	41655931
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

BIPIV 0.25%/NS 250ML

Facility

$12.00

Service Code	HCPCS J3490
Hospital Charge Code	41645931
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

BIPIV 0.25%/NS 250ML

Facility

$12.00

Service Code	HCPCS J3490
Hospital Charge Code	41655931
Hospital Revenue Code	636
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$7.80
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	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
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

BIPOLAR CABLE

Facility

$695.13

Hospital Charge Code	64905815
Hospital Revenue Code	270
Min. Negotiated Rate	$243.30
Max. Negotiated Rate	$556.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$382.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$347.56
Rate for Payer: Aetna Government	$347.56
Rate for Payer: Brighton Health Commercial	$521.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$556.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$472.69
Rate for Payer: Group Health Inc Commercial	$347.56
Rate for Payer: Group Health Inc Medicare	$243.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$347.56
Rate for Payer: Hamaspik Choice Inc Medicare	$347.56

BIPOLAR COMPONENT/HEAD/RING

Facility

$2,758.60

Service Code	HCPCS C1776
Hospital Charge Code	40203094
Hospital Revenue Code	278
Min. Negotiated Rate	$1,379.30
Max. Negotiated Rate	$1,379.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,379.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1,379.30

BIPOLAR COMPONENT/HEAD/RING

Facility

$2,758.60

Service Code	HCPCS C1776
Hospital Charge Code	40203094
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,896.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,517.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,655.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,379.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,586.20
Rate for Payer: EmblemHealth Commercial	$1,379.30
Rate for Payer: Fidelis Medicare Advantage	$2,896.53
Rate for Payer: Group Health Inc Commercial	$1,379.30
Rate for Payer: Group Health Inc Medicare	$965.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,379.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1,379.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,793.09

BIPOLAR CUP

Facility

$2,194.00

Hospital Charge Code	40202254
Hospital Revenue Code	270
Min. Negotiated Rate	$767.90
Max. Negotiated Rate	$1,755.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,206.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,097.00
Rate for Payer: Aetna Government	$1,097.00
Rate for Payer: Brighton Health Commercial	$1,645.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,755.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,491.92
Rate for Payer: Group Health Inc Commercial	$1,097.00
Rate for Payer: Group Health Inc Medicare	$767.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,097.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,097.00

BIPOLAR FRCPS DSP 8 .5MM STR

Facility

$2,125.00

Hospital Charge Code	64906298
Hospital Revenue Code	270
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$1,700.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,168.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,062.50
Rate for Payer: Aetna Government	$1,062.50
Rate for Payer: Brighton Health Commercial	$1,593.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,445.00
Rate for Payer: Group Health Inc Commercial	$1,062.50
Rate for Payer: Group Health Inc Medicare	$743.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,062.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,062.50

BI POLAR HEAD 28X51

Facility

$2,085.63

Service Code	HCPCS C1713
Hospital Charge Code	64903639
Hospital Revenue Code	278
Min. Negotiated Rate	$1,042.82
Max. Negotiated Rate	$1,042.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,042.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1,042.82

BI POLAR HEAD 28X51

Facility

$2,085.63

Service Code	HCPCS C1713
Hospital Charge Code	64903639
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,189.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,147.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,251.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,042.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,199.24
Rate for Payer: EmblemHealth Commercial	$1,042.82
Rate for Payer: Fidelis Medicare Advantage	$2,189.91
Rate for Payer: Group Health Inc Commercial	$1,042.82
Rate for Payer: Group Health Inc Medicare	$729.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,042.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1,042.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,355.66

BIPOLAR HIP PROSTHESIS

Facility

$3,944.00

Service Code	HCPCS 27125
Hospital Charge Code	40021425
Hospital Revenue Code	360
Min. Negotiated Rate	$1,171.35
Max. Negotiated Rate	$2,958.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,169.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,171.35
Rate for Payer: Aetna Government	$1,171.35
Rate for Payer: Brighton Health Commercial	$2,958.00
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: Group Health Inc Commercial	$1,972.00
Rate for Payer: Group Health Inc Medicare	$1,380.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,972.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,972.00
Rate for Payer: United Healthcare Commercial	$2,546.00

Know your out-of-pocket cost for care.

All Charges