St. Barnabas Hospital

All Charges

Charge

Type

Price

CUBICIN PED 5MG/ML 500MG -PER 1MG

Facility IP

$513.00

Service Code	HCPCS J0878
Hospital Charge Code	41647078
Hospital Revenue Code	636
Min. Negotiated Rate	$256.50
Max. Negotiated Rate	$256.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$256.50
Rate for Payer: Hamaspik Choice Inc Medicare	$256.50

CUBICIN PED 5MG/ML 500MG PER 1MG

Facility IP

$513.00

Service Code	HCPCS J0878
Hospital Charge Code	41657078
Hospital Revenue Code	636
Min. Negotiated Rate	$256.50
Max. Negotiated Rate	$256.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$256.50
Rate for Payer: Hamaspik Choice Inc Medicare	$256.50

CUBICIN PED 5MG/ML 500MG PER 1MG

Facility OP

$513.00

Service Code	HCPCS J0878
Hospital Charge Code	41657078
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$333.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$282.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$256.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$294.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.07
Rate for Payer: Group Health Inc Commercial	$256.50
Rate for Payer: Group Health Inc Medicare	$179.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$256.50
Rate for Payer: Hamaspik Choice Inc Medicare	$256.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.11
Rate for Payer: SOMOS Essential	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$333.45

CUFF

Facility OP

$11,415.00

Hospital Charge Code	64903857
Hospital Revenue Code	279
Min. Negotiated Rate	$3,995.25
Max. Negotiated Rate	$9,132.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,278.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,707.50
Rate for Payer: Aetna Government	$5,707.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,132.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,762.20
Rate for Payer: Group Health Inc Commercial	$5,707.50
Rate for Payer: Group Health Inc Medicare	$3,995.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,707.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5,707.50

CUFF 4.5CM

Facility OP

$12,487.50

Service Code	HCPCS C1815
Hospital Charge Code	64903561
Hospital Revenue Code	278
Min. Negotiated Rate	$2,453.47
Max. Negotiated Rate	$13,111.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,868.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,453.47
Rate for Payer: Aetna Government	$2,453.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,180.31
Rate for Payer: Fidelis Medicare Advantage	$13,111.88
Rate for Payer: Group Health Inc Commercial	$6,243.75
Rate for Payer: Group Health Inc Medicare	$4,370.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$6,243.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,116.88

CUFF 4.5CM

Facility IP

$12,487.50

Service Code	HCPCS C1815
Hospital Charge Code	64903561
Hospital Revenue Code	278
Min. Negotiated Rate	$6,243.75
Max. Negotiated Rate	$6,243.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$6,243.75

CUFF BP 1TB/SCW CON LG ADLT WA

Facility OP

$4.47

Hospital Charge Code	64901175
Hospital Revenue Code	270
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$3.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.24
Rate for Payer: Aetna Government	$2.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.04
Rate for Payer: Group Health Inc Commercial	$2.24
Rate for Payer: Group Health Inc Medicare	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.24
Rate for Payer: Hamaspik Choice Inc Medicare	$2.24

CUFF BP AD MD DS

Facility OP

$42.90

Hospital Charge Code	64907399
Hospital Revenue Code	270
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$34.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.45
Rate for Payer: Aetna Government	$21.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.17
Rate for Payer: Group Health Inc Commercial	$21.45
Rate for Payer: Group Health Inc Medicare	$15.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.45
Rate for Payer: Hamaspik Choice Inc Medicare	$21.45

CUFF BP ADULT & BLADDER L/F

Facility OP

$23.60

Hospital Charge Code	64901748
Hospital Revenue Code	270
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$18.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.80
Rate for Payer: Aetna Government	$11.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.05
Rate for Payer: Group Health Inc Commercial	$11.80
Rate for Payer: Group Health Inc Medicare	$8.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.80
Rate for Payer: Hamaspik Choice Inc Medicare	$11.80

CUFF BP ADULT DISP ANES CRITIKON

Facility OP

$9.48

Hospital Charge Code	64902709
Hospital Revenue Code	270
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$7.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.74
Rate for Payer: Aetna Government	$4.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.45
Rate for Payer: Group Health Inc Commercial	$4.74
Rate for Payer: Group Health Inc Medicare	$3.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.74
Rate for Payer: Hamaspik Choice Inc Medicare	$4.74

CUFF B/P DURACUF INFANT 8-13CM

Facility OP

$152.83

Hospital Charge Code	64903189
Hospital Revenue Code	270
Min. Negotiated Rate	$53.49
Max. Negotiated Rate	$122.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$76.42
Rate for Payer: Aetna Government	$76.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$122.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$103.92
Rate for Payer: Group Health Inc Commercial	$76.42
Rate for Payer: Group Health Inc Medicare	$53.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.42
Rate for Payer: Hamaspik Choice Inc Medicare	$76.42

CUFF B/P INFANT & BLADDER L/F

Facility OP

$28.86

Hospital Charge Code	64901842
Hospital Revenue Code	270
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$23.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.43
Rate for Payer: Aetna Government	$14.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.62
Rate for Payer: Group Health Inc Commercial	$14.43
Rate for Payer: Group Health Inc Medicare	$10.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.43
Rate for Payer: Hamaspik Choice Inc Medicare	$14.43

CUFF B/P NEONATAL SIZE 0 DISP

Facility OP

$110.00

Hospital Charge Code	64903017
Hospital Revenue Code	270
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$88.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.00
Rate for Payer: Aetna Government	$55.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$88.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.80
Rate for Payer: Group Health Inc Commercial	$55.00
Rate for Payer: Group Health Inc Medicare	$38.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.00
Rate for Payer: Hamaspik Choice Inc Medicare	$55.00

CUFF B/P NEONATAL SIZE 3

Facility OP

$4.20

Hospital Charge Code	64902464
Hospital Revenue Code	270
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.10
Rate for Payer: Aetna Government	$2.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.86
Rate for Payer: Group Health Inc Commercial	$2.10
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2.10

CUFF B/P NEONATAL SIZE 4

Facility OP

$3.83

Hospital Charge Code	64902466
Hospital Revenue Code	270
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$3.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.92
Rate for Payer: Aetna Government	$1.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.60
Rate for Payer: Group Health Inc Commercial	$1.92
Rate for Payer: Group Health Inc Medicare	$1.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.92
Rate for Payer: Hamaspik Choice Inc Medicare	$1.92

CUFF B/P NEONATAL SIZE 5

Facility OP

$4.38

Hospital Charge Code	64902468
Hospital Revenue Code	270
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$3.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.19
Rate for Payer: Aetna Government	$2.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.98
Rate for Payer: Group Health Inc Commercial	$2.19
Rate for Payer: Group Health Inc Medicare	$1.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.19
Rate for Payer: Hamaspik Choice Inc Medicare	$2.19

CUFF BP OBESE

Facility OP

$51.63

Hospital Charge Code	64901848
Hospital Revenue Code	270
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$41.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.82
Rate for Payer: Aetna Government	$25.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.11
Rate for Payer: Group Health Inc Commercial	$25.82
Rate for Payer: Group Health Inc Medicare	$18.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.82
Rate for Payer: Hamaspik Choice Inc Medicare	$25.82

CUFF B/P PEDS & BLADDER L/F

Facility OP

$33.14

Hospital Charge Code	64901750
Hospital Revenue Code	270
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$26.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.57
Rate for Payer: Aetna Government	$16.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.54
Rate for Payer: Group Health Inc Commercial	$16.57
Rate for Payer: Group Health Inc Medicare	$11.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.57
Rate for Payer: Hamaspik Choice Inc Medicare	$16.57

CUFF BP THIGH

Facility OP

$84.07

Hospital Charge Code	64901844
Hospital Revenue Code	270
Min. Negotiated Rate	$29.42
Max. Negotiated Rate	$67.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.04
Rate for Payer: Aetna Government	$42.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.17
Rate for Payer: Group Health Inc Commercial	$42.04
Rate for Payer: Group Health Inc Medicare	$29.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.04
Rate for Payer: Hamaspik Choice Inc Medicare	$42.04

CUFF,BP,VNYL,NEO 3,DISP 2 TB,M

Facility OP

$3.58

Hospital Charge Code	64901673
Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$2.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.79
Rate for Payer: Aetna Government	$1.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.43
Rate for Payer: Group Health Inc Commercial	$1.79
Rate for Payer: Group Health Inc Medicare	$1.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.79
Rate for Payer: Hamaspik Choice Inc Medicare	$1.79

CUFF,BP,VNYL,NEO4,DISP 2 TB,M

Facility OP

$3.58

Hospital Charge Code	64901676
Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$2.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.79
Rate for Payer: Aetna Government	$1.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.43
Rate for Payer: Group Health Inc Commercial	$1.79
Rate for Payer: Group Health Inc Medicare	$1.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.79
Rate for Payer: Hamaspik Choice Inc Medicare	$1.79

CUFF, IZ, AMS 800 4.5CM

Facility IP

$13,862.50

Service Code	HCPCS C1815
Hospital Charge Code	64905123
Hospital Revenue Code	278
Min. Negotiated Rate	$6,931.25
Max. Negotiated Rate	$6,931.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,931.25
Rate for Payer: Hamaspik Choice Inc Medicare	$6,931.25

CUFF, IZ, AMS 800 4.5CM

Facility OP

$13,862.50

Service Code	HCPCS C1815
Hospital Charge Code	64905123
Hospital Revenue Code	278
Min. Negotiated Rate	$2,453.47
Max. Negotiated Rate	$14,555.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,624.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,453.47
Rate for Payer: Aetna Government	$2,453.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,931.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,970.94
Rate for Payer: Fidelis Medicare Advantage	$14,555.62
Rate for Payer: Group Health Inc Commercial	$6,931.25
Rate for Payer: Group Health Inc Medicare	$4,851.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,931.25
Rate for Payer: Hamaspik Choice Inc Medicare	$6,931.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9,010.62

CUFF NIBP SM ADLT WEL-ALYN 2-TB

Facility OP

$21.88

Hospital Charge Code	64902830
Hospital Revenue Code	270
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$17.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.94
Rate for Payer: Aetna Government	$10.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.88
Rate for Payer: Group Health Inc Commercial	$10.94
Rate for Payer: Group Health Inc Medicare	$7.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.94
Rate for Payer: Hamaspik Choice Inc Medicare	$10.94

CUFF PORT OVAL ACCESS

Facility OP

$4.68

Hospital Charge Code	64902470
Hospital Revenue Code	270
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$3.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.34
Rate for Payer: Aetna Government	$2.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.18
Rate for Payer: Group Health Inc Commercial	$2.34
Rate for Payer: Group Health Inc Medicare	$1.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.34
Rate for Payer: Hamaspik Choice Inc Medicare	$2.34

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