St. Barnabas Hospital

All Charges

Charge

Type

Price

ACYCLOVIR 40 MG/ML SUSP

Facility IP

$0.25

Service Code	HCPCS J8499
Hospital Charge Code	41651595
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13

ACYCLOVIR 40 MG/ML SUSP

Facility IP

$0.25

Service Code	HCPCS J8499
Hospital Charge Code	41641595
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13

ACYCLOVIR 500 MG/10 ML INJ

Facility OP

$0.08

Hospital Charge Code	41653579
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

ACYCLOVIR 500 MG/10 ML INJ

Facility OP

$0.08

Hospital Charge Code	41643579
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

ACYCLOVIR 5 MG/ML INJ PEDIATRIC

Facility OP

$1.00

Hospital Charge Code	41654573
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

ACYCLOVIR 5 MG/ML INJ PEDIATRIC

Facility OP

$1.00

Hospital Charge Code	41644573
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

ACYCLOVIR 5MG/ML NS

Facility IP

$5.64

Service Code	HCPCS J0133
Hospital Charge Code	41640328
Hospital Revenue Code	636
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$2.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.82
Rate for Payer: Hamaspik Choice Inc Medicare	$2.82

ACYCLOVIR 5MG/ML NS

Facility OP

$5.64

Service Code	HCPCS J0133
Hospital Charge Code	41650328
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$3.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.04
Rate for Payer: Group Health Inc Commercial	$2.82
Rate for Payer: Group Health Inc Medicare	$1.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.82
Rate for Payer: Hamaspik Choice Inc Medicare	$2.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.06
Rate for Payer: SOMOS Essential	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.67

ACYCLOVIR 5MG/ML NS

Facility IP

$5.64

Service Code	HCPCS J0133
Hospital Charge Code	41650328
Hospital Revenue Code	636
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$2.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.82
Rate for Payer: Hamaspik Choice Inc Medicare	$2.82

ACYCLOVIR 5MG/ML NS

Facility OP

$5.64

Service Code	HCPCS J0133
Hospital Charge Code	41640328
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$3.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.04
Rate for Payer: Group Health Inc Commercial	$2.82
Rate for Payer: Group Health Inc Medicare	$1.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.82
Rate for Payer: Hamaspik Choice Inc Medicare	$2.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.06
Rate for Payer: SOMOS Essential	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.67

ACYCLOVIR 800 MG TAB

Facility IP

$0.29

Service Code	HCPCS J8499
Hospital Charge Code	41643578
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15

ACYCLOVIR 800 MG TAB

Facility IP

$0.29

Service Code	HCPCS J8499
Hospital Charge Code	41653578
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15

ACYCLOVIR 800 MG TAB

Facility OP

$0.29

Service Code	HCPCS J8499
Hospital Charge Code	41643578
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

ACYCLOVIR 800 MG TAB

Facility OP

$0.29

Service Code	HCPCS J8499
Hospital Charge Code	41653578
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

ADAMTS13 ACTIVITY REFLEX PANEL

Facility OP

$420.00

Hospital Charge Code	40629846
Hospital Revenue Code	305
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$336.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$210.00
Rate for Payer: Aetna Government	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$336.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$285.60
Rate for Payer: Group Health Inc Commercial	$210.00
Rate for Payer: Group Health Inc Medicare	$147.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00

ADAPTA PACEMAKER

Facility OP

$8,016.00

Service Code	HCPCS C1786
Hospital Charge Code	66574083
Hospital Revenue Code	275
Min. Negotiated Rate	$1,116.69
Max. Negotiated Rate	$8,416.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,408.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,116.69
Rate for Payer: Aetna Government	$1,116.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,008.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,609.20
Rate for Payer: Fidelis Medicare Advantage	$8,416.80
Rate for Payer: Group Health Inc Commercial	$4,008.00
Rate for Payer: Group Health Inc Medicare	$2,805.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,008.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,008.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,210.40

ADAPTER AIRWAY ADULT

Facility OP

$5.44

Hospital Charge Code	64903892
Hospital Revenue Code	270
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$4.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.72
Rate for Payer: Aetna Government	$2.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.70
Rate for Payer: Group Health Inc Commercial	$2.72
Rate for Payer: Group Health Inc Medicare	$1.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.72
Rate for Payer: Hamaspik Choice Inc Medicare	$2.72

ADAPTER,AIRWAY,DASH,CAPNO

Facility OP

$201.65

Hospital Charge Code	64903683
Hospital Revenue Code	270
Min. Negotiated Rate	$70.58
Max. Negotiated Rate	$161.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$100.82
Rate for Payer: Aetna Government	$100.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$161.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$137.12
Rate for Payer: Group Health Inc Commercial	$100.82
Rate for Payer: Group Health Inc Medicare	$70.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.82
Rate for Payer: Hamaspik Choice Inc Medicare	$100.82

ADAPTER ATS TOURNIQUET

Facility OP

$12.75

Hospital Charge Code	64904549
Hospital Revenue Code	270
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$10.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.38
Rate for Payer: Aetna Government	$6.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.67
Rate for Payer: Group Health Inc Commercial	$6.38
Rate for Payer: Group Health Inc Medicare	$4.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.38
Rate for Payer: Hamaspik Choice Inc Medicare	$6.38

ADAPTER CO2 AIRWAY ENDTIDAL

Facility OP

$41.45

Hospital Charge Code	64901077
Hospital Revenue Code	270
Min. Negotiated Rate	$14.51
Max. Negotiated Rate	$33.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.72
Rate for Payer: Aetna Government	$20.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.19
Rate for Payer: Group Health Inc Commercial	$20.72
Rate for Payer: Group Health Inc Medicare	$14.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.72
Rate for Payer: Hamaspik Choice Inc Medicare	$20.72

ADAPTER EXTERNAL FIXATION S

Facility OP

$1,125.00

Hospital Charge Code	64905271
Hospital Revenue Code	270
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$900.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$618.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$562.50
Rate for Payer: Aetna Government	$562.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$765.00
Rate for Payer: Group Health Inc Commercial	$562.50
Rate for Payer: Group Health Inc Medicare	$393.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$562.50

ADAPTER FITTING SEVO

Facility OP

$142.62

Hospital Charge Code	64906827
Hospital Revenue Code	270
Min. Negotiated Rate	$49.92
Max. Negotiated Rate	$114.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$71.31
Rate for Payer: Aetna Government	$71.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$114.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$96.98
Rate for Payer: Group Health Inc Commercial	$71.31
Rate for Payer: Group Health Inc Medicare	$49.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.31
Rate for Payer: Hamaspik Choice Inc Medicare	$71.31

ADAPTER FOR HYSTEROSCOPE TELESCOP

Facility OP

$590.00

Hospital Charge Code	40200268
Hospital Revenue Code	270
Min. Negotiated Rate	$206.50
Max. Negotiated Rate	$472.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$324.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$295.00
Rate for Payer: Aetna Government	$295.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$472.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$401.20
Rate for Payer: Group Health Inc Commercial	$295.00
Rate for Payer: Group Health Inc Medicare	$206.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$295.00

ADAPTER FOR VACURETTE 14MM

Facility OP

$26.25

Hospital Charge Code	64904664
Hospital Revenue Code	270
Min. Negotiated Rate	$9.19
Max. Negotiated Rate	$21.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.12
Rate for Payer: Aetna Government	$13.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.85
Rate for Payer: Group Health Inc Commercial	$13.12
Rate for Payer: Group Health Inc Medicare	$9.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.12
Rate for Payer: Hamaspik Choice Inc Medicare	$13.12

ADAPTER LUER-LOCK PLUG R-2000

Facility OP

$2.20

Hospital Charge Code	40209456
Hospital Revenue Code	270
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$1.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.10
Rate for Payer: Aetna Government	$1.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.50
Rate for Payer: Group Health Inc Commercial	$1.10
Rate for Payer: Group Health Inc Medicare	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1.10

Price Transparency.

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