St. Barnabas Hospital

All Charges

Charge

Type

Price

COVER BURR HOLE 14MM DIAMETER

Facility OP

$378.00

Service Code	HCPCS C1713
Hospital Charge Code	64906637
Hospital Revenue Code	278
Min. Negotiated Rate	$132.30
Max. Negotiated Rate	$396.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$207.90
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	$189.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$217.35
Rate for Payer: Fidelis Medicare Advantage	$396.90
Rate for Payer: Group Health Inc Commercial	$189.00
Rate for Payer: Group Health Inc Medicare	$132.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.00
Rate for Payer: Hamaspik Choice Inc Medicare	$189.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$245.70

COVER BURR HOLE 14MM DIAMETER

Facility IP

$378.00

Service Code	HCPCS C1713
Hospital Charge Code	64906637
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$189.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.00
Rate for Payer: Hamaspik Choice Inc Medicare	$189.00

COVER BURR HOLE 20MM DIAMETER

Facility IP

$378.76

Service Code	HCPCS C1713
Hospital Charge Code	64906635
Hospital Revenue Code	278
Min. Negotiated Rate	$189.38
Max. Negotiated Rate	$189.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.38
Rate for Payer: Hamaspik Choice Inc Medicare	$189.38

COVER BURR HOLE 20MM DIAMETER

Facility OP

$378.76

Service Code	HCPCS C1713
Hospital Charge Code	64906635
Hospital Revenue Code	278
Min. Negotiated Rate	$132.57
Max. Negotiated Rate	$397.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$208.32
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	$189.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$217.79
Rate for Payer: Fidelis Medicare Advantage	$397.70
Rate for Payer: Group Health Inc Commercial	$189.38
Rate for Payer: Group Health Inc Medicare	$132.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.38
Rate for Payer: Hamaspik Choice Inc Medicare	$189.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.19

COVER BURR HOLE 7MM DIAMETER

Facility OP

$778.68

Service Code	HCPCS C1713
Hospital Charge Code	64906640
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$817.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$428.27
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	$389.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$447.74
Rate for Payer: Fidelis Medicare Advantage	$817.61
Rate for Payer: Group Health Inc Commercial	$389.34
Rate for Payer: Group Health Inc Medicare	$272.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$389.34
Rate for Payer: Hamaspik Choice Inc Medicare	$389.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$506.14

COVER BURR HOLE 7MM DIAMETER

Facility IP

$778.68

Service Code	HCPCS C1713
Hospital Charge Code	64906640
Hospital Revenue Code	278
Min. Negotiated Rate	$389.34
Max. Negotiated Rate	$389.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$389.34
Rate for Payer: Hamaspik Choice Inc Medicare	$389.34

COVER BURRHOLE UN3 14MM W-TAB

Facility OP

$509.13

Service Code	HCPCS C1713
Hospital Charge Code	64905899
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 BURRHOLE UN3 14MM W-TAB

Facility IP

$509.13

Service Code	HCPCS C1713
Hospital Charge Code	64905899
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

COVER BURRHOLE UN3 24MM W-TAB

Facility OP

$247.20

Service Code	HCPCS C1713
Hospital Charge Code	64906507
Hospital Revenue Code	278
Min. Negotiated Rate	$86.52
Max. Negotiated Rate	$259.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$135.96
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	$123.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$142.14
Rate for Payer: Fidelis Medicare Advantage	$259.56
Rate for Payer: Group Health Inc Commercial	$123.60
Rate for Payer: Group Health Inc Medicare	$86.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.60
Rate for Payer: Hamaspik Choice Inc Medicare	$123.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$160.68

COVER BURRHOLE UN3 24MM W-TAB

Facility IP

$247.20

Service Code	HCPCS C1713
Hospital Charge Code	64906507
Hospital Revenue Code	278
Min. Negotiated Rate	$123.60
Max. Negotiated Rate	$123.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.60
Rate for Payer: Hamaspik Choice Inc Medicare	$123.60

COVER BURRHOLE UN3 7MM TAB

Facility IP

$203.65

Service Code	HCPCS C1713
Hospital Charge Code	64906505
Hospital Revenue Code	278
Min. Negotiated Rate	$101.82
Max. Negotiated Rate	$101.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$101.82
Rate for Payer: Hamaspik Choice Inc Medicare	$101.82

COVER BURRHOLE UN3 7MM TAB

Facility OP

$203.65

Service Code	HCPCS C1713
Hospital Charge Code	64906505
Hospital Revenue Code	278
Min. Negotiated Rate	$71.28
Max. Negotiated Rate	$213.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$112.01
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	$101.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$117.10
Rate for Payer: Fidelis Medicare Advantage	$213.83
Rate for Payer: Group Health Inc Commercial	$101.82
Rate for Payer: Group Health Inc Medicare	$71.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$101.82
Rate for Payer: Hamaspik Choice Inc Medicare	$101.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$132.37

COVER CASSETTE X-RAY

Facility OP

$15.86

Hospital Charge Code	40200403
Hospital Revenue Code	270
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$12.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.93
Rate for Payer: Aetna Government	$7.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.78
Rate for Payer: Group Health Inc Commercial	$7.93
Rate for Payer: Group Health Inc Medicare	$5.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.93
Rate for Payer: Hamaspik Choice Inc Medicare	$7.93

COVER DUST 16X22#SBW830

Facility OP

$248.00

Hospital Charge Code	40200405
Hospital Revenue Code	270
Min. Negotiated Rate	$86.80
Max. Negotiated Rate	$198.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$136.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$124.00
Rate for Payer: Aetna Government	$124.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$198.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$168.64
Rate for Payer: Group Health Inc Commercial	$124.00
Rate for Payer: Group Health Inc Medicare	$86.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$124.00
Rate for Payer: Hamaspik Choice Inc Medicare	$124.00

COVER DUST 25X37 #SBW845

Facility OP

$121.24

Hospital Charge Code	40200406
Hospital Revenue Code	270
Min. Negotiated Rate	$42.43
Max. Negotiated Rate	$96.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$60.62
Rate for Payer: Aetna Government	$60.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.44
Rate for Payer: Group Health Inc Commercial	$60.62
Rate for Payer: Group Health Inc Medicare	$42.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.62
Rate for Payer: Hamaspik Choice Inc Medicare	$60.62

COVER FOOT SWITCH 16X18

Facility OP

$613.43

Hospital Charge Code	64906068
Hospital Revenue Code	270
Min. Negotiated Rate	$214.70
Max. Negotiated Rate	$490.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$337.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$306.72
Rate for Payer: Aetna Government	$306.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$490.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$417.13
Rate for Payer: Group Health Inc Commercial	$306.72
Rate for Payer: Group Health Inc Medicare	$214.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$306.72
Rate for Payer: Hamaspik Choice Inc Medicare	$306.72

COVER LIGHT HANDLE FLEXIBLE

Facility OP

$1.57

Hospital Charge Code	64901837
Hospital Revenue Code	270
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.07
Rate for Payer: Group Health Inc Commercial	$0.79
Rate for Payer: Group Health Inc Medicare	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.79
Rate for Payer: Hamaspik Choice Inc Medicare	$0.79

COVER MAYO STAND 23W PLASTIC

Facility OP

$1.98

Hospital Charge Code	64902320
Hospital Revenue Code	270
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.99
Rate for Payer: Aetna Government	$0.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.35
Rate for Payer: Group Health Inc Commercial	$0.99
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.99
Rate for Payer: Hamaspik Choice Inc Medicare	$0.99

COVER,PROBE,FOR SURE TEMP

Facility OP

$0.04

Hospital Charge Code	64901093
Hospital Revenue Code	270
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02

COVER PROBE IVAC

Facility OP

$8.75

Hospital Charge Code	64902013
Hospital Revenue Code	270
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$7.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.38
Rate for Payer: Aetna Government	$4.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.95
Rate for Payer: Group Health Inc Commercial	$4.38
Rate for Payer: Group Health Inc Medicare	$3.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.38
Rate for Payer: Hamaspik Choice Inc Medicare	$4.38

COVER PROBE LARGE

Facility OP

$1.23

Hospital Charge Code	64903324
Hospital Revenue Code	270
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.62
Rate for Payer: Aetna Government	$0.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.84
Rate for Payer: Group Health Inc Commercial	$0.62
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62

COVER PROBE TEMP SUN FISH W/PERF

Facility OP

$1.83

Hospital Charge Code	64902786
Hospital Revenue Code	270
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$1.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.92
Rate for Payer: Aetna Government	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.24
Rate for Payer: Group Health Inc Commercial	$0.92
Rate for Payer: Group Health Inc Medicare	$0.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.92
Rate for Payer: Hamaspik Choice Inc Medicare	$0.92

COVERS, CLEAN PROBE

Facility OP

$2.73

Hospital Charge Code	64903824
Hospital Revenue Code	270
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.36
Rate for Payer: Aetna Government	$1.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.86
Rate for Payer: Group Health Inc Commercial	$1.36
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1.36

COVERS,LIGHT HANDLE,FLEXI PRPLE

Facility OP

$53.06

Hospital Charge Code	64901312
Hospital Revenue Code	270
Min. Negotiated Rate	$18.57
Max. Negotiated Rate	$42.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.53
Rate for Payer: Aetna Government	$26.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.08
Rate for Payer: Group Health Inc Commercial	$26.53
Rate for Payer: Group Health Inc Medicare	$18.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.53
Rate for Payer: Hamaspik Choice Inc Medicare	$26.53

COVERS MINI-ALPHA MOP

Facility OP

$6.03

Hospital Charge Code	64902608
Hospital Revenue Code	270
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$4.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.02
Rate for Payer: Aetna Government	$3.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.10
Rate for Payer: Group Health Inc Commercial	$3.02
Rate for Payer: Group Health Inc Medicare	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.02
Rate for Payer: Hamaspik Choice Inc Medicare	$3.02

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