St. Barnabas Hospital

All Charges

Charge

Type

Price

ACCESSION OF BRUSH BIOPSY

Facility OP

$150.00

Service Code	HCPCS D0486
Hospital Charge Code	42303418
Hospital Revenue Code	361
Min. Negotiated Rate	$35.27
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.27
Rate for Payer: Aetna Government	$35.27
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: 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

ACCESSION OF TISSUE, GROSS EXAM

Facility OP

$136.08

Service Code	HCPCS D0472
Hospital Charge Code	42303277
Hospital Revenue Code	361
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.12
Rate for Payer: Aetna Government	$20.12
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: Group Health Inc Commercial	$68.04
Rate for Payer: Group Health Inc Medicare	$47.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.04
Rate for Payer: Hamaspik Choice Inc Medicare	$68.04

ACCESSION OF TISSUE, GROSS/M

Facility OP

$177.19

Service Code	HCPCS D0473
Hospital Charge Code	42303390
Hospital Revenue Code	361
Min. Negotiated Rate	$42.48
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$97.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.48
Rate for Payer: Aetna Government	$42.48
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: Group Health Inc Commercial	$88.60
Rate for Payer: Group Health Inc Medicare	$62.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$88.60
Rate for Payer: Hamaspik Choice Inc Medicare	$88.60

ACCETABULAR DOME HOLE PLUG

Facility OP

$198.00

Hospital Charge Code	40200752
Hospital Revenue Code	270
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$158.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$108.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$99.00
Rate for Payer: Aetna Government	$99.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$158.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$134.64
Rate for Payer: Group Health Inc Commercial	$99.00
Rate for Payer: Group Health Inc Medicare	$69.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.00
Rate for Payer: Hamaspik Choice Inc Medicare	$99.00

ACC. OF TISSUE,GROSS/MICRO W/BORD

Facility OP

$217.50

Service Code	HCPCS D0474
Hospital Charge Code	42303334
Hospital Revenue Code	361
Min. Negotiated Rate	$47.69
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.69
Rate for Payer: Aetna Government	$47.69
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: Group Health Inc Commercial	$108.75
Rate for Payer: Group Health Inc Medicare	$76.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.75
Rate for Payer: Hamaspik Choice Inc Medicare	$108.75

ACCOLADE TMZF PLUS HIP STEM#3

Facility IP

$12,656.00

Service Code	HCPCS C1776
Hospital Charge Code	40202041
Hospital Revenue Code	278
Min. Negotiated Rate	$6,328.00
Max. Negotiated Rate	$6,328.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,328.00

ACCOLADE TMZF PLUS HIP STEM#3

Facility OP

$12,656.00

Service Code	HCPCS C1776
Hospital Charge Code	40202041
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$13,288.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,960.80
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	$6,328.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,277.20
Rate for Payer: Fidelis Medicare Advantage	$13,288.80
Rate for Payer: Group Health Inc Commercial	$6,328.00
Rate for Payer: Group Health Inc Medicare	$4,429.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,328.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,226.40

ACCOMLADE TMZF HIP STWEM #4

Facility OP

$9,830.00

Hospital Charge Code	40200854
Hospital Revenue Code	270
Min. Negotiated Rate	$3,440.50
Max. Negotiated Rate	$7,864.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,406.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,915.00
Rate for Payer: Aetna Government	$4,915.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,864.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,684.40
Rate for Payer: Group Health Inc Commercial	$4,915.00
Rate for Payer: Group Health Inc Medicare	$3,440.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,915.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,915.00

ACCUCAIR MATTRESS

Facility OP

$52.80

Hospital Charge Code	40201000
Hospital Revenue Code	270
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$42.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.40
Rate for Payer: Aetna Government	$26.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.90
Rate for Payer: Group Health Inc Commercial	$26.40
Rate for Payer: Group Health Inc Medicare	$18.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.40
Rate for Payer: Hamaspik Choice Inc Medicare	$26.40

ACCUCUT STANDARD

Facility OP

$250.00

Hospital Charge Code	64904660
Hospital Revenue Code	270
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

ACE BANDAGE

Facility OP

$8.86

Hospital Charge Code	40190320
Hospital Revenue Code	710
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$7.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.43
Rate for Payer: Aetna Government	$4.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.02
Rate for Payer: Group Health Inc Commercial	$4.43
Rate for Payer: Group Health Inc Medicare	$3.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.43
Rate for Payer: Hamaspik Choice Inc Medicare	$4.43

ACE BANDAGES 2

Facility OP

$12.05

Hospital Charge Code	40200302
Hospital Revenue Code	270
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$9.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.02
Rate for Payer: Aetna Government	$6.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.19
Rate for Payer: Group Health Inc Commercial	$6.02
Rate for Payer: Group Health Inc Medicare	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.02
Rate for Payer: Hamaspik Choice Inc Medicare	$6.02

ACE BANDAGES 3

Facility OP

$17.01

Hospital Charge Code	40200304
Hospital Revenue Code	270
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.57
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

ACE BANDAGES 4

Facility OP

$18.78

Hospital Charge Code	40200305
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

ACE BANDAGES 6

Facility OP

$18.78

Hospital Charge Code	40200306
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

ACE BANDGES 2 1/2

Facility OP

$17.01

Hospital Charge Code	40200303
Hospital Revenue Code	270
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.57
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

ACETABULAR DOME HOLE PLUG

Facility OP

$198.00

Service Code	HCPCS C1776
Hospital Charge Code	40200568
Hospital Revenue Code	278
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$108.90
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	$99.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.85
Rate for Payer: Fidelis Medicare Advantage	$207.90
Rate for Payer: Group Health Inc Commercial	$99.00
Rate for Payer: Group Health Inc Medicare	$69.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.00
Rate for Payer: Hamaspik Choice Inc Medicare	$99.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$128.70

ACETABULAR DOME HOLE PLUG

Facility IP

$198.00

Service Code	HCPCS C1776
Hospital Charge Code	40200568
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$99.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.00
Rate for Payer: Hamaspik Choice Inc Medicare	$99.00

ACETABULAR SYSTEM

Facility IP

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64907455
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

ACETABULAR SYSTEM

Facility OP

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64907455
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
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	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

ACETAMIN-CODEINE 120-12MG/5ML 473

Facility OP

$1.00

Hospital Charge Code	41657101
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

ACETAMIN-CODEINE 120-12MG/5ML 473

Facility OP

$1.00

Hospital Charge Code	41647101
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

ACETAMINOPHEN

Facility OP

$107.50

Service Code	HCPCS 80329
Hospital Charge Code	40602050
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$86.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.10
Rate for Payer: Group Health Inc Commercial	$53.75
Rate for Payer: Group Health Inc Medicare	$37.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.75
Rate for Payer: Hamaspik Choice Inc Medicare	$53.75

ACETAMINOPHEN 10MG/ML INJ

Facility IP

$1.00

Service Code	HCPCS J0131
Hospital Charge Code	41645659
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

ACETAMINOPHEN 10MG/ML INJ

Facility OP

$1.00

Service Code	HCPCS J0131
Hospital Charge Code	41645659
Hospital Revenue Code	636
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.08
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: Healthfirst CHP/FHP/Medicaid	$0.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.05
Rate for Payer: SOMOS Essential	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

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