St. Barnabas Hospital

All Charges

Charge

Type

Price

ACUMED ACTK FIX SYS 20.0MM/2 B/S

Facility OP

$916.00

Service Code	HCPCS C1713
Hospital Charge Code	40205414
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$961.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$503.80
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	$458.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$526.70
Rate for Payer: Fidelis Medicare Advantage	$961.80
Rate for Payer: Group Health Inc Commercial	$458.00
Rate for Payer: Group Health Inc Medicare	$320.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$458.00
Rate for Payer: Hamaspik Choice Inc Medicare	$458.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$595.40

ACUMED ACUTRAK 2.5MM MINI D/B

Facility OP

$530.00

Hospital Charge Code	40205655
Hospital Revenue Code	270
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$424.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$291.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.00
Rate for Payer: Aetna Government	$265.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$424.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.40
Rate for Payer: Group Health Inc Commercial	$265.00
Rate for Payer: Group Health Inc Medicare	$185.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.00
Rate for Payer: Hamaspik Choice Inc Medicare	$265.00

ACUMED ACUTRAK FIX SYS 16.0MM

Facility OP

$916.00

Service Code	HCPCS C1713
Hospital Charge Code	40205440
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$961.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$503.80
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	$458.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$526.70
Rate for Payer: Fidelis Medicare Advantage	$961.80
Rate for Payer: Group Health Inc Commercial	$458.00
Rate for Payer: Group Health Inc Medicare	$320.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$458.00
Rate for Payer: Hamaspik Choice Inc Medicare	$458.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$595.40

ACUMED ACUTRAK FIX SYS 16.0MM

Facility IP

$916.00

Service Code	HCPCS C1713
Hospital Charge Code	40205440
Hospital Revenue Code	278
Min. Negotiated Rate	$458.00
Max. Negotiated Rate	$458.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$458.00
Rate for Payer: Hamaspik Choice Inc Medicare	$458.00

ACUMED GUIDEWIRE .035

Facility OP

$18.00

Service Code	HCPCS C1769
Hospital Charge Code	40200362
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$18.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.35
Rate for Payer: Fidelis Medicare Advantage	$18.90
Rate for Payer: Group Health Inc Commercial	$9.00
Rate for Payer: Group Health Inc Medicare	$6.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.70

ACUMED GUIDEWIRE .035

Facility IP

$18.00

Service Code	HCPCS C1769
Hospital Charge Code	40200362
Hospital Revenue Code	278
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00

ACUMED MINI ACUTRAX X B/S 30MM

Facility OP

$952.00

Service Code	HCPCS C1713
Hospital Charge Code	40205656
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$999.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$523.60
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	$476.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$547.40
Rate for Payer: Fidelis Medicare Advantage	$999.60
Rate for Payer: Group Health Inc Commercial	$476.00
Rate for Payer: Group Health Inc Medicare	$333.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$476.00
Rate for Payer: Hamaspik Choice Inc Medicare	$476.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$618.80

ACUMED MINI ACUTRAX X B/S 30MM

Facility IP

$952.00

Service Code	HCPCS C1713
Hospital Charge Code	40205656
Hospital Revenue Code	278
Min. Negotiated Rate	$476.00
Max. Negotiated Rate	$476.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$476.00
Rate for Payer: Hamaspik Choice Inc Medicare	$476.00

ACUMED OLECRANON PLATE MEDIUM

Facility IP

$1,268.00

Service Code	HCPCS C1713
Hospital Charge Code	40200363
Hospital Revenue Code	278
Min. Negotiated Rate	$634.00
Max. Negotiated Rate	$634.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$634.00
Rate for Payer: Hamaspik Choice Inc Medicare	$634.00

ACUMED OLECRANON PLATE MEDIUM

Facility OP

$1,268.00

Service Code	HCPCS C1713
Hospital Charge Code	40200363
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,331.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$697.40
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	$634.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$729.10
Rate for Payer: Fidelis Medicare Advantage	$1,331.40
Rate for Payer: Group Health Inc Commercial	$634.00
Rate for Payer: Group Health Inc Medicare	$443.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$634.00
Rate for Payer: Hamaspik Choice Inc Medicare	$634.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$824.20

ACUMED POSTERIOR PLATE

Facility OP

$1,268.00

Service Code	HCPCS C1713
Hospital Charge Code	40200364
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,331.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$697.40
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	$634.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$729.10
Rate for Payer: Fidelis Medicare Advantage	$1,331.40
Rate for Payer: Group Health Inc Commercial	$634.00
Rate for Payer: Group Health Inc Medicare	$443.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$634.00
Rate for Payer: Hamaspik Choice Inc Medicare	$634.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$824.20

ACUMED POSTERIOR PLATE

Facility IP

$1,268.00

Service Code	HCPCS C1713
Hospital Charge Code	40200364
Hospital Revenue Code	278
Min. Negotiated Rate	$634.00
Max. Negotiated Rate	$634.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$634.00
Rate for Payer: Hamaspik Choice Inc Medicare	$634.00

ACUMED SCREW CORTICAL 3.5

Facility OP

$185.50

Service Code	HCPCS C1713
Hospital Charge Code	40205658
Hospital Revenue Code	278
Min. Negotiated Rate	$64.92
Max. Negotiated Rate	$194.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$102.02
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	$92.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.66
Rate for Payer: Fidelis Medicare Advantage	$194.78
Rate for Payer: Group Health Inc Commercial	$92.75
Rate for Payer: Group Health Inc Medicare	$64.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.75
Rate for Payer: Hamaspik Choice Inc Medicare	$92.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.58

ACUMED SCREW CORTICAL 3.5

Facility IP

$185.50

Service Code	HCPCS C1713
Hospital Charge Code	40205658
Hospital Revenue Code	278
Min. Negotiated Rate	$92.75
Max. Negotiated Rate	$92.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.75
Rate for Payer: Hamaspik Choice Inc Medicare	$92.75

ACUMED SCREW CORTICAL 3.5X60MM

Facility IP

$620.00

Service Code	HCPCS C1713
Hospital Charge Code	40205659
Hospital Revenue Code	278
Min. Negotiated Rate	$310.00
Max. Negotiated Rate	$310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$310.00

ACUMED SCREW CORTICAL 3.5X60MM

Facility OP

$620.00

Service Code	HCPCS C1713
Hospital Charge Code	40205659
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$651.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$341.00
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	$310.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$356.50
Rate for Payer: Fidelis Medicare Advantage	$651.00
Rate for Payer: Group Health Inc Commercial	$310.00
Rate for Payer: Group Health Inc Medicare	$217.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$310.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$403.00

ACUMED SCRW CORT 2.7

Facility OP

$162.50

Service Code	HCPCS C1713
Hospital Charge Code	40205657
Hospital Revenue Code	278
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$170.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.38
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	$81.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.44
Rate for Payer: Fidelis Medicare Advantage	$170.62
Rate for Payer: Group Health Inc Commercial	$81.25
Rate for Payer: Group Health Inc Medicare	$56.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.25
Rate for Payer: Hamaspik Choice Inc Medicare	$81.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.62

ACUMED SCRW CORT 2.7

Facility IP

$162.50

Service Code	HCPCS C1713
Hospital Charge Code	40205657
Hospital Revenue Code	278
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$81.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.25
Rate for Payer: Hamaspik Choice Inc Medicare	$81.25

ACUMED SCRW LCK 2.7

Facility IP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	40205660
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25

ACUMED SCRW LCK 2.7

Facility OP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	40205660
Hospital Revenue Code	278
Min. Negotiated Rate	$91.88
Max. Negotiated Rate	$275.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.38
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	$131.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.94
Rate for Payer: Fidelis Medicare Advantage	$275.62
Rate for Payer: Group Health Inc Commercial	$131.25
Rate for Payer: Group Health Inc Medicare	$91.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$170.62

ACUMED SCRW LCKNG 3.5X

Facility IP

$317.50

Service Code	HCPCS C1776
Hospital Charge Code	40208165
Hospital Revenue Code	278
Min. Negotiated Rate	$158.75
Max. Negotiated Rate	$158.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.75
Rate for Payer: Hamaspik Choice Inc Medicare	$158.75

ACUMED SCRW LCKNG 3.5X

Facility OP

$317.50

Service Code	HCPCS C1776
Hospital Charge Code	40208165
Hospital Revenue Code	278
Min. Negotiated Rate	$111.12
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$174.62
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	$158.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.56
Rate for Payer: Fidelis Medicare Advantage	$333.38
Rate for Payer: Group Health Inc Commercial	$158.75
Rate for Payer: Group Health Inc Medicare	$111.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.75
Rate for Payer: Hamaspik Choice Inc Medicare	$158.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$206.38

ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION

Facility IP

$20,976.95

Service Code	MS-DRG 880
Min. Negotiated Rate	$905.00
Max. Negotiated Rate	$20,976.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,859.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,565.64
Rate for Payer: Aetna Government	$20,565.64
Rate for Payer: Brighton Health Commercial	$13,841.70
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20,976.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16,484.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,604.12
Rate for Payer: Elderplan Medicare Advantage	$19,537.36
Rate for Payer: EmblemHealth Commercial	$905.00
Rate for Payer: Fidelis Medicare Advantage	$20,565.64
Rate for Payer: Group Health Inc Commercial	$20,565.64
Rate for Payer: Group Health Inc Medicare	$20,565.64
Rate for Payer: Hamaspik Choice Inc Medicare	$20,565.64
Rate for Payer: Healthfirst Medicare Advantage	$9,563.02
Rate for Payer: Senior Whole Health Medicare Advantage	$20,565.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20,565.64
Rate for Payer: Wellcare Medicare	$19,537.36

ACUTE AND SUBACUTE ENDOCARDITIS WITH CC

Facility IP

$28,376.07

Service Code	MS-DRG 289
Min. Negotiated Rate	$12,671.30
Max. Negotiated Rate	$28,376.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21,788.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27,819.68
Rate for Payer: Aetna Government	$27,819.68
Rate for Payer: Brighton Health Commercial	$21,426.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$28,376.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25,518.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$21,058.88
Rate for Payer: Elderplan Medicare Advantage	$26,428.70
Rate for Payer: EmblemHealth Commercial	$12,671.30
Rate for Payer: Fidelis Medicare Advantage	$27,819.68
Rate for Payer: Group Health Inc Commercial	$27,819.68
Rate for Payer: Group Health Inc Medicare	$27,819.68
Rate for Payer: Hamaspik Choice Inc Medicare	$27,819.68
Rate for Payer: Healthfirst Medicare Advantage	$12,936.15
Rate for Payer: Senior Whole Health Medicare Advantage	$27,819.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27,819.68
Rate for Payer: Wellcare Medicare	$26,428.70

ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC

Facility IP

$44,778.52

Service Code	MS-DRG 288
Min. Negotiated Rate	$20,127.98
Max. Negotiated Rate	$44,778.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38,233.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43,285.97
Rate for Payer: Aetna Government	$43,285.97
Rate for Payer: Brighton Health Commercial	$37,598.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$44,151.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44,778.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$36,953.15
Rate for Payer: Elderplan Medicare Advantage	$41,121.67
Rate for Payer: EmblemHealth Commercial	$22,235.00
Rate for Payer: Fidelis Medicare Advantage	$43,285.97
Rate for Payer: Group Health Inc Commercial	$43,285.97
Rate for Payer: Group Health Inc Medicare	$43,285.97
Rate for Payer: Hamaspik Choice Inc Medicare	$43,285.97
Rate for Payer: Healthfirst Medicare Advantage	$20,127.98
Rate for Payer: Senior Whole Health Medicare Advantage	$43,285.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43,285.97
Rate for Payer: Wellcare Medicare	$41,121.67

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