St. Barnabas Hospital

All Charges

Charge

Type

Price

CONJUGATED ESTROGENS 25 MG INJ

Facility IP

$700.00

Service Code	HCPCS J1410
Hospital Charge Code	41640134
Hospital Revenue Code	636
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$350.00
Rate for Payer: Cash Price	$372.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

CONJUGATED ESTROGENS 25 MG INJ

Facility IP

$700.00

Service Code	HCPCS J1410
Hospital Charge Code	41650134
Hospital Revenue Code	636
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$350.00
Rate for Payer: Cash Price	$372.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

CONJUGATED ESTROGENS VAGINAL CREAM 42.5

Facility OP

$205.00

Hospital Charge Code	41650987
Hospital Revenue Code	250
Min. Negotiated Rate	$71.75
Max. Negotiated Rate	$164.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$112.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$102.50
Rate for Payer: Aetna Government	$102.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$139.40
Rate for Payer: Group Health Inc Commercial	$102.50
Rate for Payer: Group Health Inc Medicare	$71.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.50
Rate for Payer: Hamaspik Choice Inc Medicare	$102.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$133.25

CONJUGATED ESTROGENS VAGINAL CREAM 42.5

Facility OP

$205.00

Hospital Charge Code	41640987
Hospital Revenue Code	250
Min. Negotiated Rate	$71.75
Max. Negotiated Rate	$164.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$112.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$102.50
Rate for Payer: Aetna Government	$102.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$139.40
Rate for Payer: Group Health Inc Commercial	$102.50
Rate for Payer: Group Health Inc Medicare	$71.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.50
Rate for Payer: Hamaspik Choice Inc Medicare	$102.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$133.25

CONJUGATE+HEP B VFC DIP,TET,PERT

Facility OP

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640265
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
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	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

CONJUGATE+HEP B VFC DIP,TET,PERT

Facility OP

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650265
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
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	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

CONJUGATE+HEP B VFC DIP,TET,PERT

Facility IP

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640265
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

CONJUGATE+HEP B VFC DIP,TET,PERT

Facility IP

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650265
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

CONMED 6.0X16.5MM DUET SUTUR ANCH

Facility OP

$1,033.13

Service Code	HCPCS C1713
Hospital Charge Code	40205651
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,084.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$568.22
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	$516.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$594.05
Rate for Payer: Fidelis Medicare Advantage	$1,084.79
Rate for Payer: Group Health Inc Commercial	$516.56
Rate for Payer: Group Health Inc Medicare	$361.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$516.56
Rate for Payer: Hamaspik Choice Inc Medicare	$516.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$671.53

CONMED 6.0X16.5MM DUET SUTUR ANCH

Facility IP

$1,033.13

Service Code	HCPCS C1713
Hospital Charge Code	40205651
Hospital Revenue Code	278
Min. Negotiated Rate	$516.56
Max. Negotiated Rate	$516.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$516.56
Rate for Payer: Hamaspik Choice Inc Medicare	$516.56

CONMED ANCHOR BIO PRE-LOAD BIOABS

Facility IP

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	40203347
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

CONMED ANCHOR BIO PRE-LOAD BIOABS

Facility OP

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	40203347
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

CONMED ANCHOR BIO PRE-LOAD BIOABS

Facility OP

$250.00

Hospital Charge Code	40009330
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

CONMED BLADE OSCIL INTRA ORAL

Facility OP

$296.00

Hospital Charge Code	40009355
Hospital Revenue Code	272
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$236.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$148.00
Rate for Payer: Aetna Government	$148.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$236.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.28
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

CONMED BLADE OSCIL INTRA ORAL

Facility OP

$296.00

Hospital Charge Code	40203371
Hospital Revenue Code	272
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$236.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$148.00
Rate for Payer: Aetna Government	$148.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$236.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.28
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

CONMED LINVATEC BIO ANCHR3.5X10.5

Facility IP

$458.00

Service Code	HCPCS C1713
Hospital Charge Code	40202006
Hospital Revenue Code	278
Min. Negotiated Rate	$229.00
Max. Negotiated Rate	$229.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.00
Rate for Payer: Hamaspik Choice Inc Medicare	$229.00

CONMED LINVATEC BIO ANCHR3.5X10.5

Facility OP

$458.00

Service Code	HCPCS C1713
Hospital Charge Code	40202006
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$480.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$251.90
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	$229.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$263.35
Rate for Payer: Fidelis Medicare Advantage	$480.90
Rate for Payer: Group Health Inc Commercial	$229.00
Rate for Payer: Group Health Inc Medicare	$160.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.00
Rate for Payer: Hamaspik Choice Inc Medicare	$229.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$297.70

CONMED V- CARE SM VAGINAL C

Facility OP

$100.00

Hospital Charge Code	40208126
Hospital Revenue Code	270
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$80.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.00
Rate for Payer: Aetna Government	$50.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

CONNECTING NUT - SHORT - M8

Facility OP

$60.00

Hospital Charge Code	64905263
Hospital Revenue Code	270
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$48.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.80
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

CONNECTING ROD EXT FIX 100

Facility IP

$238.00

Service Code	HCPCS C1713
Hospital Charge Code	64901253
Hospital Revenue Code	278
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$119.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$119.00

CONNECTING ROD EXT FIX 100

Facility OP

$238.00

Service Code	HCPCS C1713
Hospital Charge Code	64901253
Hospital Revenue Code	278
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$249.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.90
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	$119.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.85
Rate for Payer: Fidelis Medicare Advantage	$249.90
Rate for Payer: Group Health Inc Commercial	$119.00
Rate for Payer: Group Health Inc Medicare	$83.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$119.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.70

CONNECTING ROD EXT FIX 150

Facility IP

$586.25

Service Code	HCPCS C1713
Hospital Charge Code	64901254
Hospital Revenue Code	278
Min. Negotiated Rate	$293.12
Max. Negotiated Rate	$293.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.12
Rate for Payer: Hamaspik Choice Inc Medicare	$293.12

CONNECTING ROD EXT FIX 150

Facility OP

$586.25

Service Code	HCPCS C1713
Hospital Charge Code	64901254
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$615.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$322.44
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	$293.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$337.09
Rate for Payer: Fidelis Medicare Advantage	$615.56
Rate for Payer: Group Health Inc Commercial	$293.12
Rate for Payer: Group Health Inc Medicare	$205.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.12
Rate for Payer: Hamaspik Choice Inc Medicare	$293.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$381.06

CONNECTING ROD EXT FIX 200

Facility IP

$637.00

Service Code	HCPCS C1713
Hospital Charge Code	64901256
Hospital Revenue Code	278
Min. Negotiated Rate	$318.50
Max. Negotiated Rate	$318.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.50
Rate for Payer: Hamaspik Choice Inc Medicare	$318.50

CONNECTING ROD EXT FIX 200

Facility OP

$637.00

Service Code	HCPCS C1713
Hospital Charge Code	64901256
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$668.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$350.35
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	$318.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$366.28
Rate for Payer: Fidelis Medicare Advantage	$668.85
Rate for Payer: Group Health Inc Commercial	$318.50
Rate for Payer: Group Health Inc Medicare	$222.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.50
Rate for Payer: Hamaspik Choice Inc Medicare	$318.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$414.05

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