St. Barnabas Hospital

All Charges

Charge

Type

Price

CANN CRYSTAL SMOOTH 5.75MMX7CM

Facility OP

$50.00

Hospital Charge Code	40200955
Hospital Revenue Code	270
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$40.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00

CANN DRILL 4.9MM W/AO FITTING

Facility OP

$484.00

Service Code	HCPCS C1713
Hospital Charge Code	40200525
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$508.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$266.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$242.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$278.30
Rate for Payer: Fidelis Medicare Advantage	$508.20
Rate for Payer: Group Health Inc Commercial	$242.00
Rate for Payer: Group Health Inc Medicare	$169.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$242.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$314.60

CANN DRILL 4.9MM W/AO FITTING

Facility IP

$484.00

Service Code	HCPCS C1713
Hospital Charge Code	40200525
Hospital Revenue Code	278
Min. Negotiated Rate	$242.00
Max. Negotiated Rate	$242.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$242.00

CANN DRILL .6MM W/AO FITTING

Facility IP

$484.00

Service Code	HCPCS C1713
Hospital Charge Code	40200526
Hospital Revenue Code	278
Min. Negotiated Rate	$242.00
Max. Negotiated Rate	$242.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$242.00

CANN DRILL .6MM W/AO FITTING

Facility OP

$484.00

Service Code	HCPCS C1713
Hospital Charge Code	40200526
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$508.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$266.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$242.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$278.30
Rate for Payer: Fidelis Medicare Advantage	$508.20
Rate for Payer: Group Health Inc Commercial	$242.00
Rate for Payer: Group Health Inc Medicare	$169.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$242.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$314.60

CANN EXTRACTION BOLT

Facility IP

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	40006158
Hospital Revenue Code	278
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00

CANN EXTRACTION BOLT

Facility OP

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	40006158
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.00
Rate for Payer: Fidelis Medicare Advantage	$420.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.00

CANNISTER MAX W/TUBING & FILTER

Facility OP

$740.00

Hospital Charge Code	64906782
Hospital Revenue Code	270
Min. Negotiated Rate	$259.00
Max. Negotiated Rate	$592.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$407.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$370.00
Rate for Payer: Aetna Government	$370.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$592.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$503.20
Rate for Payer: Group Health Inc Commercial	$370.00
Rate for Payer: Group Health Inc Medicare	$259.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$370.00
Rate for Payer: Hamaspik Choice Inc Medicare	$370.00

CANNISTER REVOLVE VAC

Facility OP

$214.80

Hospital Charge Code	41301569
Hospital Revenue Code	270
Min. Negotiated Rate	$75.18
Max. Negotiated Rate	$171.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$118.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$107.40
Rate for Payer: Aetna Government	$107.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$171.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.06
Rate for Payer: Group Health Inc Commercial	$107.40
Rate for Payer: Group Health Inc Medicare	$75.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.40
Rate for Payer: Hamaspik Choice Inc Medicare	$107.40

CANNLTD BIT DRILL

Facility OP

$487.50

Service Code	HCPCS C1713
Hospital Charge Code	64907008
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$511.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$268.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$280.31
Rate for Payer: Fidelis Medicare Advantage	$511.88
Rate for Payer: Group Health Inc Commercial	$243.75
Rate for Payer: Group Health Inc Medicare	$170.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$316.88

CANNLTD BIT DRILL

Facility IP

$487.50

Service Code	HCPCS C1713
Hospital Charge Code	64907008
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75

CANN SCRWDRIVER W/ELASTOSIL HNDL

Facility OP

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	40200527
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$441.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$210.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$241.50
Rate for Payer: Fidelis Medicare Advantage	$441.00
Rate for Payer: Group Health Inc Commercial	$210.00
Rate for Payer: Group Health Inc Medicare	$147.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$273.00

CANN SCRWDRIVER W/ELASTOSIL HNDL

Facility IP

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	40200527
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00

CANN SCRWDRIVR W/ AO COUPLING

Facility OP

$294.00

Hospital Charge Code	40200641
Hospital Revenue Code	270
Min. Negotiated Rate	$102.90
Max. Negotiated Rate	$235.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$161.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.00
Rate for Payer: Aetna Government	$147.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$199.92
Rate for Payer: Group Health Inc Commercial	$147.00
Rate for Payer: Group Health Inc Medicare	$102.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.00
Rate for Payer: Hamaspik Choice Inc Medicare	$147.00

CANN SCRW SS 5.0X80 MM 1

Facility OP

$330.00

Service Code	HCPCS C1776
Hospital Charge Code	40200911
Hospital Revenue Code	278
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$346.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.50
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	$165.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.75
Rate for Payer: Fidelis Medicare Advantage	$346.50
Rate for Payer: Group Health Inc Commercial	$165.00
Rate for Payer: Group Health Inc Medicare	$115.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00
Rate for Payer: Hamaspik Choice Inc Medicare	$165.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$214.50

CANN SCRW SS 5.0X80 MM 1

Facility IP

$330.00

Service Code	HCPCS C1776
Hospital Charge Code	40200911
Hospital Revenue Code	278
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00
Rate for Payer: Hamaspik Choice Inc Medicare	$165.00

CANN TREPHINE

Facility OP

$997.50

Hospital Charge Code	64907306
Hospital Revenue Code	270
Min. Negotiated Rate	$349.12
Max. Negotiated Rate	$798.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$548.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$498.75
Rate for Payer: Aetna Government	$498.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$798.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$678.30
Rate for Payer: Group Health Inc Commercial	$498.75
Rate for Payer: Group Health Inc Medicare	$349.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$498.75
Rate for Payer: Hamaspik Choice Inc Medicare	$498.75

CANNULA 5.75 X 7

Facility OP

$62.50

Service Code	HCPCS C1713
Hospital Charge Code	64903082
Hospital Revenue Code	278
Min. Negotiated Rate	$21.88
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.94
Rate for Payer: Fidelis Medicare Advantage	$65.62
Rate for Payer: Group Health Inc Commercial	$31.25
Rate for Payer: Group Health Inc Medicare	$21.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.25
Rate for Payer: Hamaspik Choice Inc Medicare	$31.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$40.62

CANNULA 5.75 X 7

Facility IP

$62.50

Service Code	HCPCS C1713
Hospital Charge Code	64903082
Hospital Revenue Code	278
Min. Negotiated Rate	$31.25
Max. Negotiated Rate	$31.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.25
Rate for Payer: Hamaspik Choice Inc Medicare	$31.25

CANNULA CAPO CO2 ORAL

Facility OP

$28.49

Hospital Charge Code	64903679
Hospital Revenue Code	270
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$22.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.24
Rate for Payer: Aetna Government	$14.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.37
Rate for Payer: Group Health Inc Commercial	$14.24
Rate for Payer: Group Health Inc Medicare	$9.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.24
Rate for Payer: Hamaspik Choice Inc Medicare	$14.24

CANNULA CONNOR ANESTHESIA

Facility OP

$460.00

Hospital Charge Code	64901301
Hospital Revenue Code	270
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$368.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$253.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$230.00
Rate for Payer: Aetna Government	$230.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$368.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$312.80
Rate for Payer: Group Health Inc Commercial	$230.00
Rate for Payer: Group Health Inc Medicare	$161.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00

CANNULA CRYSTAL

Facility OP

$62.50

Hospital Charge Code	64902739
Hospital Revenue Code	270
Min. Negotiated Rate	$21.88
Max. Negotiated Rate	$50.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.25
Rate for Payer: Aetna Government	$31.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.50
Rate for Payer: Group Health Inc Commercial	$31.25
Rate for Payer: Group Health Inc Medicare	$21.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.25
Rate for Payer: Hamaspik Choice Inc Medicare	$31.25

CANNULA CRYSTAL SMOOTH 5.75MMX7CM

Facility IP

$62.50

Service Code	HCPCS C1713
Hospital Charge Code	64901210
Hospital Revenue Code	278
Min. Negotiated Rate	$31.25
Max. Negotiated Rate	$31.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.25
Rate for Payer: Hamaspik Choice Inc Medicare	$31.25

CANNULA CRYSTAL SMOOTH 5.75MMX7CM

Facility OP

$62.50

Service Code	HCPCS C1713
Hospital Charge Code	64901210
Hospital Revenue Code	278
Min. Negotiated Rate	$21.88
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.94
Rate for Payer: Fidelis Medicare Advantage	$65.62
Rate for Payer: Group Health Inc Commercial	$31.25
Rate for Payer: Group Health Inc Medicare	$21.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.25
Rate for Payer: Hamaspik Choice Inc Medicare	$31.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$40.62

CANNULA DISP INNER SIZE 6

Facility OP

$154.00

Service Code	HCPCS C1713
Hospital Charge Code	64901614
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: Cigna HMO/Network Benefit Plan/Open Access	$77.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.55
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

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