St. Barnabas Hospital

All Charges

Charge

Type

Price

COUPLING EXT FIXATION MULT

Facility OP

$943.25

Service Code	HCPCS C1713
Hospital Charge Code	64901275
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$990.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$518.79
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	$471.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$542.37
Rate for Payer: Fidelis Medicare Advantage	$990.41
Rate for Payer: Group Health Inc Commercial	$471.62
Rate for Payer: Group Health Inc Medicare	$330.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$471.62
Rate for Payer: Hamaspik Choice Inc Medicare	$471.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$613.11

COUPLING EXT FIXATION REPR

Facility OP

$511.00

Service Code	HCPCS C1713
Hospital Charge Code	64901249
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$536.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$281.05
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	$255.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$293.82
Rate for Payer: Fidelis Medicare Advantage	$536.55
Rate for Payer: Group Health Inc Commercial	$255.50
Rate for Payer: Group Health Inc Medicare	$178.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.50
Rate for Payer: Hamaspik Choice Inc Medicare	$255.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$332.15

COUPLING EXT FIXATION REPR

Facility IP

$511.00

Service Code	HCPCS C1713
Hospital Charge Code	64901249
Hospital Revenue Code	278
Min. Negotiated Rate	$255.50
Max. Negotiated Rate	$255.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.50
Rate for Payer: Hamaspik Choice Inc Medicare	$255.50

COUPLING EXT FIXATION TIBI

Facility IP

$1,629.25

Service Code	HCPCS C1713
Hospital Charge Code	64902948
Hospital Revenue Code	278
Min. Negotiated Rate	$814.62
Max. Negotiated Rate	$814.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$814.62
Rate for Payer: Hamaspik Choice Inc Medicare	$814.62

COUPLING EXT FIXATION TIBI

Facility OP

$1,629.25

Service Code	HCPCS C1713
Hospital Charge Code	64902948
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,710.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$896.09
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	$814.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$936.82
Rate for Payer: Fidelis Medicare Advantage	$1,710.71
Rate for Payer: Group Health Inc Commercial	$814.62
Rate for Payer: Group Health Inc Medicare	$570.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$814.62
Rate for Payer: Hamaspik Choice Inc Medicare	$814.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,059.01

COUPLING EXT FIXATION TUBE

Facility OP

$715.00

Service Code	HCPCS C1713
Hospital Charge Code	64901757
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$750.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$393.25
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	$357.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$411.12
Rate for Payer: Fidelis Medicare Advantage	$750.75
Rate for Payer: Group Health Inc Commercial	$357.50
Rate for Payer: Group Health Inc Medicare	$250.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$357.50
Rate for Payer: Hamaspik Choice Inc Medicare	$357.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$464.75

COUPLING EXT FIXATION TUBE

Facility IP

$715.00

Service Code	HCPCS C1713
Hospital Charge Code	64901757
Hospital Revenue Code	278
Min. Negotiated Rate	$357.50
Max. Negotiated Rate	$357.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$357.50
Rate for Payer: Hamaspik Choice Inc Medicare	$357.50

COUPLING ROD-TO-ROD

Facility IP

$2,013.75

Service Code	HCPCS C1713
Hospital Charge Code	64901714
Hospital Revenue Code	278
Min. Negotiated Rate	$1,006.88
Max. Negotiated Rate	$1,006.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,006.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1,006.88

COUPLING ROD-TO-ROD

Facility OP

$2,013.75

Service Code	HCPCS C1713
Hospital Charge Code	64901714
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,114.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,107.56
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	$1,006.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,157.91
Rate for Payer: Fidelis Medicare Advantage	$2,114.44
Rate for Payer: Group Health Inc Commercial	$1,006.88
Rate for Payer: Group Health Inc Medicare	$704.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,006.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1,006.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,308.94

COUPLING ROD TO ROD 5MM/8MM

Facility OP

$903.13

Service Code	HCPCS C1713
Hospital Charge Code	64901259
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$948.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$496.72
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	$451.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$519.30
Rate for Payer: Fidelis Medicare Advantage	$948.29
Rate for Payer: Group Health Inc Commercial	$451.56
Rate for Payer: Group Health Inc Medicare	$316.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$451.56
Rate for Payer: Hamaspik Choice Inc Medicare	$451.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$587.03

COUPLING ROD TO ROD 5MM/8MM

Facility IP

$903.13

Service Code	HCPCS C1713
Hospital Charge Code	64901259
Hospital Revenue Code	278
Min. Negotiated Rate	$451.56
Max. Negotiated Rate	$451.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$451.56
Rate for Payer: Hamaspik Choice Inc Medicare	$451.56

COV-2/FLLU/RSV XPRT XPRS-CEPHEID

Facility OP

$130.00

Service Code	HCPCS 87637
Hospital Charge Code	40601157
Hospital Revenue Code	306
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$142.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$142.63
Rate for Payer: Aetna Government	$142.63
Rate for Payer: Cash Price	$142.63
Rate for Payer: Cash Price	$142.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$142.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.40
Rate for Payer: Elderplan Medicare Advantage	$142.63
Rate for Payer: EmblemHealth Commercial	$142.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$128.37
Rate for Payer: Fidelis Essential Plan Aliesa	$121.24
Rate for Payer: Fidelis Essential Plan QHP	$126.94
Rate for Payer: Fidelis Medicare Advantage	$142.63
Rate for Payer: Fidelis Qualified Health Plan	$126.94
Rate for Payer: Group Health Inc Commercial	$142.63
Rate for Payer: Group Health Inc Medicare	$142.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$142.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$142.63
Rate for Payer: Healthfirst Medicare Advantage	$142.63
Rate for Payer: Healthfirst QHP	$142.63
Rate for Payer: Senior Whole Health Medicare Advantage	$142.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$142.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$114.10
Rate for Payer: Wellcare Medicare	$128.37

COVADERM DRESSING 6X8

Facility OP

$58.14

Hospital Charge Code	41809545
Hospital Revenue Code	270
Min. Negotiated Rate	$20.35
Max. Negotiated Rate	$46.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.07
Rate for Payer: Aetna Government	$29.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.54
Rate for Payer: Group Health Inc Commercial	$29.07
Rate for Payer: Group Health Inc Medicare	$20.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.07
Rate for Payer: Hamaspik Choice Inc Medicare	$29.07

COVADERM DRESSING 6X8

Facility OP

$58.14

Hospital Charge Code	41709545
Hospital Revenue Code	270
Min. Negotiated Rate	$20.35
Max. Negotiated Rate	$46.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.07
Rate for Payer: Aetna Government	$29.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.54
Rate for Payer: Group Health Inc Commercial	$29.07
Rate for Payer: Group Health Inc Medicare	$20.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.07
Rate for Payer: Hamaspik Choice Inc Medicare	$29.07

COVADERM PLUS

Facility OP

$65.96

Hospital Charge Code	40209488
Hospital Revenue Code	270
Min. Negotiated Rate	$23.09
Max. Negotiated Rate	$52.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.98
Rate for Payer: Aetna Government	$32.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.85
Rate for Payer: Group Health Inc Commercial	$32.98
Rate for Payer: Group Health Inc Medicare	$23.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.98
Rate for Payer: Hamaspik Choice Inc Medicare	$32.98

COVERALL, BRTHBL, ELASTC WR

Facility OP

$7.35

Hospital Charge Code	64902044
Hospital Revenue Code	270
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$5.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.68
Rate for Payer: Aetna Government	$3.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.00
Rate for Payer: Group Health Inc Commercial	$3.68
Rate for Payer: Group Health Inc Medicare	$2.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.68
Rate for Payer: Hamaspik Choice Inc Medicare	$3.68

COVERALL,MULTILYR,WH,XL

Facility OP

$5.31

Hospital Charge Code	64901516
Hospital Revenue Code	270
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$4.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.66
Rate for Payer: Aetna Government	$2.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.61
Rate for Payer: Group Health Inc Commercial	$2.66
Rate for Payer: Group Health Inc Medicare	$1.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.66
Rate for Payer: Hamaspik Choice Inc Medicare	$2.66

COVERALL, PROTECTIVE KG 2X-LG

Facility OP

$62.78

Hospital Charge Code	64901772
Hospital Revenue Code	270
Min. Negotiated Rate	$21.97
Max. Negotiated Rate	$50.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.39
Rate for Payer: Aetna Government	$31.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.69
Rate for Payer: Group Health Inc Commercial	$31.39
Rate for Payer: Group Health Inc Medicare	$21.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.39
Rate for Payer: Hamaspik Choice Inc Medicare	$31.39

COVERALL, PROTECTIVE KG LARGE

Facility OP

$59.29

Hospital Charge Code	64901768
Hospital Revenue Code	270
Min. Negotiated Rate	$20.75
Max. Negotiated Rate	$47.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.64
Rate for Payer: Aetna Government	$29.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.32
Rate for Payer: Group Health Inc Commercial	$29.64
Rate for Payer: Group Health Inc Medicare	$20.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.64
Rate for Payer: Hamaspik Choice Inc Medicare	$29.64

COVERALL, PROTECTIVE KG X-LARGE

Facility OP

$711.50

Hospital Charge Code	64901770
Hospital Revenue Code	270
Min. Negotiated Rate	$249.02
Max. Negotiated Rate	$569.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$391.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$355.75
Rate for Payer: Aetna Government	$355.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$569.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$483.82
Rate for Payer: Group Health Inc Commercial	$355.75
Rate for Payer: Group Health Inc Medicare	$249.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.75
Rate for Payer: Hamaspik Choice Inc Medicare	$355.75

COVERALL,SPUNBND,E,WH,XL

Facility OP

$2.70

Hospital Charge Code	64906041
Hospital Revenue Code	270
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.35
Rate for Payer: Aetna Government	$1.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.84
Rate for Payer: Group Health Inc Commercial	$1.35
Rate for Payer: Group Health Inc Medicare	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.35
Rate for Payer: Hamaspik Choice Inc Medicare	$1.35

COVERALL,SPUNBOND,E,WH,2X

Facility OP

$2.86

Hospital Charge Code	64906042
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.94
Rate for Payer: Group Health Inc Commercial	$1.43
Rate for Payer: Group Health Inc Medicare	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43
Rate for Payer: Hamaspik Choice Inc Medicare	$1.43

COVER BOOT NONSKID BLUE REG

Facility OP

$1.15

Hospital Charge Code	64903460
Hospital Revenue Code	270
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.58
Rate for Payer: Aetna Government	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: Group Health Inc Commercial	$0.58
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58
Rate for Payer: Hamaspik Choice Inc Medicare	$0.58

COVER BURR HOLE 10MM

Facility OP

$509.13

Service Code	HCPCS C1713
Hospital Charge Code	64904850
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$534.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$280.02
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	$254.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$292.75
Rate for Payer: Fidelis Medicare Advantage	$534.59
Rate for Payer: Group Health Inc Commercial	$254.56
Rate for Payer: Group Health Inc Medicare	$178.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$254.56
Rate for Payer: Hamaspik Choice Inc Medicare	$254.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$330.93

COVER BURR HOLE 10MM

Facility IP

$509.13

Service Code	HCPCS C1713
Hospital Charge Code	64904850
Hospital Revenue Code	278
Min. Negotiated Rate	$254.56
Max. Negotiated Rate	$254.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$254.56
Rate for Payer: Hamaspik Choice Inc Medicare	$254.56

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All Charges