St. Barnabas Hospital

All Charges

Charge

Type

Price

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

CANNULA DISP INNER SIZE 8

Facility OP

$12.88

Service Code	HCPCS C1713
Hospital Charge Code	64901188
Hospital Revenue Code	278
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.08
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	$6.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.41
Rate for Payer: Fidelis Medicare Advantage	$13.52
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.37

CANNULA DISP INNER SIZE 8

Facility IP

$12.88

Service Code	HCPCS C1713
Hospital Charge Code	64901188
Hospital Revenue Code	278
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$6.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.44
Rate for Payer: Hamaspik Choice Inc Medicare	$6.44

CANNULA DISP SHOULDER ARTHROSCOPY

Facility OP

$63.00

Hospital Charge Code	64903133
Hospital Revenue Code	270
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$50.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.50
Rate for Payer: Aetna Government	$31.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.84
Rate for Payer: Group Health Inc Commercial	$31.50
Rate for Payer: Group Health Inc Medicare	$22.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.50
Rate for Payer: Hamaspik Choice Inc Medicare	$31.50

CANNULA DRIL-LOK 6.5

Facility OP

$54.78

Service Code	HCPCS C1713
Hospital Charge Code	64906915
Hospital Revenue Code	278
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.13
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	$27.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.50
Rate for Payer: Fidelis Medicare Advantage	$57.52
Rate for Payer: Group Health Inc Commercial	$27.39
Rate for Payer: Group Health Inc Medicare	$19.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.39
Rate for Payer: Hamaspik Choice Inc Medicare	$27.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.61

CANNULA DRIL-LOK 6.5

Facility IP

$54.78

Service Code	HCPCS C1713
Hospital Charge Code	64906915
Hospital Revenue Code	278
Min. Negotiated Rate	$27.39
Max. Negotiated Rate	$27.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.39
Rate for Payer: Hamaspik Choice Inc Medicare	$27.39

CANNULA DRI-LOK 5X75MM NONTH

Facility OP

$60.00

Service Code	HCPCS C1713
Hospital Charge Code	64902919
Hospital Revenue Code	278
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.00
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	$30.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.50
Rate for Payer: Fidelis Medicare Advantage	$63.00
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.00

CANNULA DRI-LOK 5X75MM NONTH

Facility IP

$60.00

Service Code	HCPCS C1713
Hospital Charge Code	64902919
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00

CANNULA DRI-LOK 6.5X75MM

Facility IP

$33.51

Service Code	HCPCS C1713
Hospital Charge Code	64902752
Hospital Revenue Code	278
Min. Negotiated Rate	$16.76
Max. Negotiated Rate	$16.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.76
Rate for Payer: Hamaspik Choice Inc Medicare	$16.76

CANNULA DRI-LOK 6.5X75MM

Facility OP

$33.51

Service Code	HCPCS C1713
Hospital Charge Code	64902752
Hospital Revenue Code	278
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.43
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	$16.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.27
Rate for Payer: Fidelis Medicare Advantage	$35.19
Rate for Payer: Group Health Inc Commercial	$16.76
Rate for Payer: Group Health Inc Medicare	$11.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.76
Rate for Payer: Hamaspik Choice Inc Medicare	$16.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.78

CANNULA INNER 7MM ID XLT SHILEY

Facility OP

$154.00

Hospital Charge Code	64904416
Hospital Revenue Code	270
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$123.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.00
Rate for Payer: Aetna Government	$77.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$123.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.72
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

CANNULA INNER F/5.0MM TRA DSP

Facility OP

$10.48

Hospital Charge Code	64901539
Hospital Revenue Code	270
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$8.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.24
Rate for Payer: Aetna Government	$5.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.13
Rate for Payer: Group Health Inc Commercial	$5.24
Rate for Payer: Group Health Inc Medicare	$3.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.24
Rate for Payer: Hamaspik Choice Inc Medicare	$5.24

CANNULA INNER F/6.4MM TRA DSP

Facility OP

$10.26

Hospital Charge Code	64901541
Hospital Revenue Code	270
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$8.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.13
Rate for Payer: Aetna Government	$5.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.98
Rate for Payer: Group Health Inc Commercial	$5.13
Rate for Payer: Group Health Inc Medicare	$3.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.13
Rate for Payer: Hamaspik Choice Inc Medicare	$5.13

CANNULA INNER F/7.6MM

Facility OP

$7.18

Hospital Charge Code	64901258
Hospital Revenue Code	270
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$5.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.59
Rate for Payer: Aetna Government	$3.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.88
Rate for Payer: Group Health Inc Commercial	$3.59
Rate for Payer: Group Health Inc Medicare	$2.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.59
Rate for Payer: Hamaspik Choice Inc Medicare	$3.59

CANNULA INNER F/7.6MM TRACH DSP

Facility OP

$33.70

Hospital Charge Code	64901264
Hospital Revenue Code	270
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$26.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.85
Rate for Payer: Aetna Government	$16.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.92
Rate for Payer: Group Health Inc Commercial	$16.85
Rate for Payer: Group Health Inc Medicare	$11.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.85
Rate for Payer: Hamaspik Choice Inc Medicare	$16.85

CANNULA INNER F/8.9MM

Facility OP

$8.13

Hospital Charge Code	64901270
Hospital Revenue Code	270
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$6.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.06
Rate for Payer: Aetna Government	$4.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.53
Rate for Payer: Group Health Inc Commercial	$4.06
Rate for Payer: Group Health Inc Medicare	$2.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.06
Rate for Payer: Hamaspik Choice Inc Medicare	$4.06

CANNULA INNER F/89.MM TRA DSP

Facility OP

$10.26

Hospital Charge Code	64901543
Hospital Revenue Code	270
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$8.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.13
Rate for Payer: Aetna Government	$5.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.98
Rate for Payer: Group Health Inc Commercial	$5.13
Rate for Payer: Group Health Inc Medicare	$3.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.13
Rate for Payer: Hamaspik Choice Inc Medicare	$5.13

CANNULA INNER F/8MM ID TRACH DSP

Facility OP

$83.45

Hospital Charge Code	64902807
Hospital Revenue Code	270
Min. Negotiated Rate	$29.21
Max. Negotiated Rate	$66.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.72
Rate for Payer: Aetna Government	$41.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$66.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.75
Rate for Payer: Group Health Inc Commercial	$41.72
Rate for Payer: Group Health Inc Medicare	$29.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.72
Rate for Payer: Hamaspik Choice Inc Medicare	$41.72

CANNULA,INNER,SHILEY,SZ 4,DISP

Facility OP

$7.18

Hospital Charge Code	64901252
Hospital Revenue Code	270
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$5.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.59
Rate for Payer: Aetna Government	$3.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.88
Rate for Payer: Group Health Inc Commercial	$3.59
Rate for Payer: Group Health Inc Medicare	$2.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.59
Rate for Payer: Hamaspik Choice Inc Medicare	$3.59

CANNULA,INNER,SHILEY,SZ 6,DISP

Facility OP

$7.18

Hospital Charge Code	64901255
Hospital Revenue Code	270
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$5.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.59
Rate for Payer: Aetna Government	$3.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.88
Rate for Payer: Group Health Inc Commercial	$3.59
Rate for Payer: Group Health Inc Medicare	$2.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.59
Rate for Payer: Hamaspik Choice Inc Medicare	$3.59

CANNULA MICROPUNCT TR 5FR 10CM

Facility OP

$121.93

Hospital Charge Code	64905737
Hospital Revenue Code	270
Min. Negotiated Rate	$42.68
Max. Negotiated Rate	$97.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$60.96
Rate for Payer: Aetna Government	$60.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$97.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.91
Rate for Payer: Group Health Inc Commercial	$60.96
Rate for Payer: Group Health Inc Medicare	$42.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.96
Rate for Payer: Hamaspik Choice Inc Medicare	$60.96

CANNULA NASAL BIFLO W/SAMPLE LINE

Facility OP

$152.00

Hospital Charge Code	40201036
Hospital Revenue Code	270
Min. Negotiated Rate	$53.20
Max. Negotiated Rate	$121.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$76.00
Rate for Payer: Aetna Government	$76.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$121.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$103.36
Rate for Payer: Group Health Inc Commercial	$76.00
Rate for Payer: Group Health Inc Medicare	$53.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.00
Rate for Payer: Hamaspik Choice Inc Medicare	$76.00

CANNULA NASAL BIFLO W/S LINE

Facility OP

$1,229.75

Hospital Charge Code	64904163
Hospital Revenue Code	270
Min. Negotiated Rate	$430.41
Max. Negotiated Rate	$983.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$676.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$614.88
Rate for Payer: Aetna Government	$614.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$983.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$836.23
Rate for Payer: Group Health Inc Commercial	$614.88
Rate for Payer: Group Health Inc Medicare	$430.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$614.88
Rate for Payer: Hamaspik Choice Inc Medicare	$614.88

CANNULA,PASSPORT BUTTON

Facility OP

$150.00

Hospital Charge Code	64906963
Hospital Revenue Code	270
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.00
Rate for Payer: Aetna Government	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.00
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

CANNULA PS BU

Facility OP

$115.00

Service Code	HCPCS C1713
Hospital Charge Code	64903638
Hospital Revenue Code	278
Min. Negotiated Rate	$40.25
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.25
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	$57.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.12
Rate for Payer: Fidelis Medicare Advantage	$120.75
Rate for Payer: Group Health Inc Commercial	$57.50
Rate for Payer: Group Health Inc Medicare	$40.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.50
Rate for Payer: Hamaspik Choice Inc Medicare	$57.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.75

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