St. Barnabas Hospital

All Charges

Charge

Type

Price

CAP EXTERNAL FIXATION 5MM D

Facility OP

$121.88

Service Code	HCPCS C1713
Hospital Charge Code	64902226
Hospital Revenue Code	278
Min. Negotiated Rate	$42.66
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.03
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	$60.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$70.08
Rate for Payer: Fidelis Medicare Advantage	$127.97
Rate for Payer: Group Health Inc Commercial	$60.94
Rate for Payer: Group Health Inc Medicare	$42.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.94
Rate for Payer: Hamaspik Choice Inc Medicare	$60.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$79.22

CAP HYDRA BOT AIR/WATER

Facility OP

$21.42

Hospital Charge Code	64906819
Hospital Revenue Code	270
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$17.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.71
Rate for Payer: Aetna Government	$10.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.57
Rate for Payer: Group Health Inc Commercial	$10.71
Rate for Payer: Group Health Inc Medicare	$7.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.71
Rate for Payer: Hamaspik Choice Inc Medicare	$10.71

CAPIO SUTURE

Facility OP

$1,435.50

Hospital Charge Code	64907132
Hospital Revenue Code	270
Min. Negotiated Rate	$502.42
Max. Negotiated Rate	$1,148.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$789.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$717.75
Rate for Payer: Aetna Government	$717.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,148.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$976.14
Rate for Payer: Group Health Inc Commercial	$717.75
Rate for Payer: Group Health Inc Medicare	$502.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$717.75
Rate for Payer: Hamaspik Choice Inc Medicare	$717.75

CAP KIT

Facility OP

$8,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64907454
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,187.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,812.50
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	$4,375.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,031.25
Rate for Payer: Fidelis Medicare Advantage	$9,187.50
Rate for Payer: Group Health Inc Commercial	$4,375.00
Rate for Payer: Group Health Inc Medicare	$3,062.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,375.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,687.50

CAP KIT

Facility IP

$8,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64907454
Hospital Revenue Code	278
Min. Negotiated Rate	$4,375.00
Max. Negotiated Rate	$4,375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,375.00

CAP MINI W/POVIDONE IODINE

Facility OP

$164.48

Hospital Charge Code	64902084
Hospital Revenue Code	270
Min. Negotiated Rate	$57.57
Max. Negotiated Rate	$131.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$82.24
Rate for Payer: Aetna Government	$82.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$131.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$111.85
Rate for Payer: Group Health Inc Commercial	$82.24
Rate for Payer: Group Health Inc Medicare	$57.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.24
Rate for Payer: Hamaspik Choice Inc Medicare	$82.24

CAPREOMYCIN 1000 MG INJ

Facility OP

$274.00

Hospital Charge Code	41640442
Hospital Revenue Code	250
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$219.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$137.00
Rate for Payer: Aetna Government	$137.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$219.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.32
Rate for Payer: Group Health Inc Commercial	$137.00
Rate for Payer: Group Health Inc Medicare	$95.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$178.10

CAPREOMYCIN 1000 MG INJ

Facility OP

$274.00

Hospital Charge Code	41650442
Hospital Revenue Code	250
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$219.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$137.00
Rate for Payer: Aetna Government	$137.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$219.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.32
Rate for Payer: Group Health Inc Commercial	$137.00
Rate for Payer: Group Health Inc Medicare	$95.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$178.10

CAPSAICIN CRM 0.075% 2G

Facility OP

$0.38

Hospital Charge Code	41646638
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.26
Rate for Payer: Group Health Inc Commercial	$0.19
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19
Rate for Payer: Hamaspik Choice Inc Medicare	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

CAPSAICIN CRM 0.075% 2G

Facility OP

$0.38

Hospital Charge Code	41656638
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.26
Rate for Payer: Group Health Inc Commercial	$0.19
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19
Rate for Payer: Hamaspik Choice Inc Medicare	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

CAPSAICIN CRM 0.1% 2G

Facility OP

$1.26

Hospital Charge Code	41646644
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$1.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: Group Health Inc Commercial	$0.63
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.82

CAPSAICIN CRM 0.1% 2G

Facility OP

$1.26

Hospital Charge Code	41656644
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$1.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: Group Health Inc Commercial	$0.63
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.82

CAPSAICIN CRM 0.1% 42.5G

Facility OP

$26.50

Hospital Charge Code	41656645
Hospital Revenue Code	250
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$21.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.25
Rate for Payer: Aetna Government	$13.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.02
Rate for Payer: Group Health Inc Commercial	$13.25
Rate for Payer: Group Health Inc Medicare	$9.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.25
Rate for Payer: Hamaspik Choice Inc Medicare	$13.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.22

CAPSAICIN CRM 0.15 42.5G

Facility OP

$26.50

Hospital Charge Code	41646645
Hospital Revenue Code	250
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$21.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.25
Rate for Payer: Aetna Government	$13.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.02
Rate for Payer: Group Health Inc Commercial	$13.25
Rate for Payer: Group Health Inc Medicare	$9.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.25
Rate for Payer: Hamaspik Choice Inc Medicare	$13.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.22

CAPS BIOPSY CHANNEL

Facility OP

$5.61

Hospital Charge Code	64904072
Hospital Revenue Code	270
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$4.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.80
Rate for Payer: Aetna Government	$2.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.81
Rate for Payer: Group Health Inc Commercial	$2.80
Rate for Payer: Group Health Inc Medicare	$1.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.80
Rate for Payer: Hamaspik Choice Inc Medicare	$2.80

CAPSCAICIN 0.075% CREAM

Facility OP

$11.55

Hospital Charge Code	41656633
Hospital Revenue Code	250
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$9.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.78
Rate for Payer: Aetna Government	$5.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.85
Rate for Payer: Group Health Inc Commercial	$5.78
Rate for Payer: Group Health Inc Medicare	$4.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.78
Rate for Payer: Hamaspik Choice Inc Medicare	$5.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.51

CAPSCAICIN 0.075% CREAM

Facility OP

$11.55

Hospital Charge Code	41646633
Hospital Revenue Code	250
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$9.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.78
Rate for Payer: Aetna Government	$5.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.85
Rate for Payer: Group Health Inc Commercial	$5.78
Rate for Payer: Group Health Inc Medicare	$4.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.78
Rate for Payer: Hamaspik Choice Inc Medicare	$5.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.51

CAP SCREW LCKING NCB(0203150300)

Facility IP

$159.45

Service Code	HCPCS C1713
Hospital Charge Code	64906411
Hospital Revenue Code	278
Min. Negotiated Rate	$79.72
Max. Negotiated Rate	$79.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.72
Rate for Payer: Hamaspik Choice Inc Medicare	$79.72

CAP SCREW LCKING NCB(0203150300)

Facility OP

$159.45

Service Code	HCPCS C1713
Hospital Charge Code	64906411
Hospital Revenue Code	278
Min. Negotiated Rate	$55.81
Max. Negotiated Rate	$167.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.70
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	$79.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.68
Rate for Payer: Fidelis Medicare Advantage	$167.42
Rate for Payer: Group Health Inc Commercial	$79.72
Rate for Payer: Group Health Inc Medicare	$55.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.72
Rate for Payer: Hamaspik Choice Inc Medicare	$79.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.64

CAP SM ROUND 12MM

Facility OP

$957.18

Hospital Charge Code	64904429
Hospital Revenue Code	270
Min. Negotiated Rate	$335.01
Max. Negotiated Rate	$765.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$526.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$478.59
Rate for Payer: Aetna Government	$478.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$765.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$650.88
Rate for Payer: Group Health Inc Commercial	$478.59
Rate for Payer: Group Health Inc Medicare	$335.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$478.59
Rate for Payer: Hamaspik Choice Inc Medicare	$478.59

CAPS- STANDAND

Facility OP

$250.00

Service Code	HCPCS C1889
Hospital Charge Code	40007505
Hospital Revenue Code	278
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$262.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$125.00
Rate for Payer: Aetna Government	$125.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$143.75
Rate for Payer: Fidelis Medicare Advantage	$262.50
Rate for Payer: Group Health Inc Commercial	$125.00
Rate for Payer: Group Health Inc Medicare	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$162.50

CAPS- STANDAND

Facility IP

$250.00

Service Code	HCPCS C1889
Hospital Charge Code	40007505
Hospital Revenue Code	278
Min. Negotiated Rate	$125.00
Max. Negotiated Rate	$125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00

CAPS STANDARD

Facility OP

$250.00

Hospital Charge Code	40005334
Hospital Revenue Code	272
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$125.00
Rate for Payer: Aetna Government	$125.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.00
Rate for Payer: Group Health Inc Commercial	$125.00
Rate for Payer: Group Health Inc Medicare	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00

CAPS, STANDARD

Facility OP

$312.50

Hospital Charge Code	64905474
Hospital Revenue Code	270
Min. Negotiated Rate	$109.38
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$156.25
Rate for Payer: Aetna Government	$156.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.50
Rate for Payer: Group Health Inc Commercial	$156.25
Rate for Payer: Group Health Inc Medicare	$109.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$156.25

CAPS- STANDARD

Facility OP

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	40204586
Hospital Revenue Code	278
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$262.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
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	$125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$143.75
Rate for Payer: Fidelis Medicare Advantage	$262.50
Rate for Payer: Group Health Inc Commercial	$125.00
Rate for Payer: Group Health Inc Medicare	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$162.50

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