St. Barnabas Hospital

All Charges

Charge

Type

Price

CURVED PLATE 10H 1.6MM

Facility OP

$7,388.00

Service Code	HCPCS C1713
Hospital Charge Code	40209395
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,757.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,063.40
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	$3,694.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,248.10
Rate for Payer: Fidelis Medicare Advantage	$7,757.40
Rate for Payer: Group Health Inc Commercial	$3,694.00
Rate for Payer: Group Health Inc Medicare	$2,585.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,694.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,694.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,802.20

CURVED PLATE 10H 1.6MM

Facility IP

$7,388.00

Service Code	HCPCS C1713
Hospital Charge Code	40209395
Hospital Revenue Code	278
Min. Negotiated Rate	$3,694.00
Max. Negotiated Rate	$3,694.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,694.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,694.00

CUSHION RING

Facility OP

$49.47

Hospital Charge Code	64903166
Hospital Revenue Code	270
Min. Negotiated Rate	$17.31
Max. Negotiated Rate	$39.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.74
Rate for Payer: Aetna Government	$24.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.64
Rate for Payer: Group Health Inc Commercial	$24.74
Rate for Payer: Group Health Inc Medicare	$17.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.74
Rate for Payer: Hamaspik Choice Inc Medicare	$24.74

CUSIL SADDLE

Facility OP

$1,630.13

Hospital Charge Code	42301630
Hospital Revenue Code	361
Min. Negotiated Rate	$570.55
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$896.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$815.06
Rate for Payer: Aetna Government	$815.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$815.06
Rate for Payer: Group Health Inc Medicare	$570.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$815.06
Rate for Payer: Hamaspik Choice Inc Medicare	$815.06

CUSTOM ABUTMENT

Facility OP

$1,000.00

Service Code	HCPCS D6057
Hospital Charge Code	42303320
Hospital Revenue Code	361
Min. Negotiated Rate	$172.65
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$172.65
Rate for Payer: Aetna Government	$172.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$500.00
Rate for Payer: Group Health Inc Medicare	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00

CUSTOM CRANIAL PLATE XL 50040

Facility IP

$29,811.86

Service Code	HCPCS C1713
Hospital Charge Code	64906594
Hospital Revenue Code	278
Min. Negotiated Rate	$14,905.93
Max. Negotiated Rate	$14,905.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,905.93
Rate for Payer: Hamaspik Choice Inc Medicare	$14,905.93

CUSTOM CRANIAL PLATE XL 50040

Facility OP

$29,811.86

Service Code	HCPCS C1713
Hospital Charge Code	64906594
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$31,302.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16,396.52
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	$14,905.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$17,141.82
Rate for Payer: Fidelis Medicare Advantage	$31,302.45
Rate for Payer: Group Health Inc Commercial	$14,905.93
Rate for Payer: Group Health Inc Medicare	$10,434.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,905.93
Rate for Payer: Hamaspik Choice Inc Medicare	$14,905.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19,377.71

CUSTOM SEAL KIT

Facility OP

$1,875.00

Hospital Charge Code	64903896
Hospital Revenue Code	279
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,031.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$937.50
Rate for Payer: Aetna Government	$937.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,275.00
Rate for Payer: Group Health Inc Commercial	$937.50
Rate for Payer: Group Health Inc Medicare	$656.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$937.50
Rate for Payer: Hamaspik Choice Inc Medicare	$937.50

CUST. ULTRA. BACTERIAL REPL. FILT

Facility OP

$598.00

Hospital Charge Code	40203365
Hospital Revenue Code	272
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$478.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$328.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$299.00
Rate for Payer: Aetna Government	$299.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$478.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$406.64
Rate for Payer: Group Health Inc Commercial	$299.00
Rate for Payer: Group Health Inc Medicare	$209.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$299.00
Rate for Payer: Hamaspik Choice Inc Medicare	$299.00

CUST. ULTRA. BACTERIAL REPL. FILT

Facility OP

$598.00

Hospital Charge Code	40009348
Hospital Revenue Code	272
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$478.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$328.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$299.00
Rate for Payer: Aetna Government	$299.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$478.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$406.64
Rate for Payer: Group Health Inc Commercial	$299.00
Rate for Payer: Group Health Inc Medicare	$209.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$299.00
Rate for Payer: Hamaspik Choice Inc Medicare	$299.00

CUTDOWN FOR IV ACCESS

Facility OP

$1,101.23

Service Code	HCPCS 36425
Hospital Charge Code	40000025
Hospital Revenue Code	360
Min. Negotiated Rate	$42.98
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$460.76
Rate for Payer: Aetna Government	$460.76
Rate for Payer: Cash Price	$460.76
Rate for Payer: Cash Price	$460.76
Rate for Payer: Cash Price	$460.76
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$460.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$460.76
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42.98
Rate for Payer: Fidelis Essential Plan Aliesa	$391.65
Rate for Payer: Fidelis Essential Plan QHP	$410.08
Rate for Payer: Fidelis Medicare Advantage	$460.76
Rate for Payer: Fidelis Qualified Health Plan	$410.08
Rate for Payer: Group Health Inc Commercial	$460.76
Rate for Payer: Group Health Inc Medicare	$460.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.62
Rate for Payer: Hamaspik Choice Inc Medicare	$460.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$47.75
Rate for Payer: Healthfirst Medicare Advantage	$391.65
Rate for Payer: Healthfirst QHP	$460.76
Rate for Payer: Senior Whole Health Medicare Advantage	$460.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$460.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$368.61
Rate for Payer: Wellcare Medicare	$437.72

CUT DOWN SET

Facility OP

$53.16

Hospital Charge Code	40200930
Hospital Revenue Code	270
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$42.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.58
Rate for Payer: Aetna Government	$26.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.15
Rate for Payer: Group Health Inc Commercial	$26.58
Rate for Payer: Group Health Inc Medicare	$18.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.58
Rate for Payer: Hamaspik Choice Inc Medicare	$26.58

CUTTER 38 WIDE STAINLESS STELL RL

Facility OP

$1,791.43

Hospital Charge Code	64905299
Hospital Revenue Code	270
Min. Negotiated Rate	$627.00
Max. Negotiated Rate	$1,433.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$985.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$895.72
Rate for Payer: Aetna Government	$895.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,433.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,218.17
Rate for Payer: Group Health Inc Commercial	$895.72
Rate for Payer: Group Health Inc Medicare	$627.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$895.72
Rate for Payer: Hamaspik Choice Inc Medicare	$895.72

CUTTER 4MM AGREESIVE + FORM

Facility OP

$100.00

Hospital Charge Code	64904964
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

CUTTER 5.5MM AGRRESIVE

Facility OP

$188.25

Hospital Charge Code	64904968
Hospital Revenue Code	270
Min. Negotiated Rate	$65.89
Max. Negotiated Rate	$150.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$94.12
Rate for Payer: Aetna Government	$94.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.01
Rate for Payer: Group Health Inc Commercial	$94.12
Rate for Payer: Group Health Inc Medicare	$65.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.12
Rate for Payer: Hamaspik Choice Inc Medicare	$94.12

CUTTER, FLIP II 9.0MM

Facility OP

$812.50

Hospital Charge Code	64905555
Hospital Revenue Code	270
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$446.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$406.25
Rate for Payer: Aetna Government	$406.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$650.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$552.50
Rate for Payer: Group Health Inc Commercial	$406.25
Rate for Payer: Group Health Inc Medicare	$284.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.25
Rate for Payer: Hamaspik Choice Inc Medicare	$406.25

CUTTER, FLIP II 9.5MM

Facility OP

$812.50

Hospital Charge Code	64905866
Hospital Revenue Code	270
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$446.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$406.25
Rate for Payer: Aetna Government	$406.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$650.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$552.50
Rate for Payer: Group Health Inc Commercial	$406.25
Rate for Payer: Group Health Inc Medicare	$284.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.25
Rate for Payer: Hamaspik Choice Inc Medicare	$406.25

CUTTER FORMULA AGG 5.5MM

Facility OP

$56.10

Hospital Charge Code	64906049
Hospital Revenue Code	270
Min. Negotiated Rate	$19.64
Max. Negotiated Rate	$44.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.05
Rate for Payer: Aetna Government	$28.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.15
Rate for Payer: Group Health Inc Commercial	$28.05
Rate for Payer: Group Health Inc Medicare	$19.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.05
Rate for Payer: Hamaspik Choice Inc Medicare	$28.05

CUTTER FORMULA TOM 5.5X12.5

Facility OP

$11.22

Hospital Charge Code	64906050
Hospital Revenue Code	270
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$8.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.61
Rate for Payer: Aetna Government	$5.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.63
Rate for Payer: Group Health Inc Commercial	$5.61
Rate for Payer: Group Health Inc Medicare	$3.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.61
Rate for Payer: Hamaspik Choice Inc Medicare	$5.61

CUTTER FORMULA TOMCAT 4MM

Facility OP

$56.10

Hospital Charge Code	64906048
Hospital Revenue Code	270
Min. Negotiated Rate	$19.64
Max. Negotiated Rate	$44.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.05
Rate for Payer: Aetna Government	$28.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.15
Rate for Payer: Group Health Inc Commercial	$28.05
Rate for Payer: Group Health Inc Medicare	$19.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.05
Rate for Payer: Hamaspik Choice Inc Medicare	$28.05

CUTTER II 7.5 FLIP

Facility OP

$1,162.50

Hospital Charge Code	64905942
Hospital Revenue Code	270
Min. Negotiated Rate	$406.88
Max. Negotiated Rate	$930.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$639.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$581.25
Rate for Payer: Aetna Government	$581.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$930.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$790.50
Rate for Payer: Group Health Inc Commercial	$581.25
Rate for Payer: Group Health Inc Medicare	$406.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$581.25
Rate for Payer: Hamaspik Choice Inc Medicare	$581.25

CUTTER LINEAR

Facility OP

$242.74

Hospital Charge Code	64902973
Hospital Revenue Code	270
Min. Negotiated Rate	$84.96
Max. Negotiated Rate	$194.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$133.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$121.37
Rate for Payer: Aetna Government	$121.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$194.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.06
Rate for Payer: Group Health Inc Commercial	$121.37
Rate for Payer: Group Health Inc Medicare	$84.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.37
Rate for Payer: Hamaspik Choice Inc Medicare	$121.37

CUTTER,LINEAR,75MM,SAFETYLOCKOUT

Facility OP

$362.25

Hospital Charge Code	64902972
Hospital Revenue Code	270
Min. Negotiated Rate	$126.79
Max. Negotiated Rate	$289.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$199.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$181.12
Rate for Payer: Aetna Government	$181.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$289.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.33
Rate for Payer: Group Health Inc Commercial	$181.12
Rate for Payer: Group Health Inc Medicare	$126.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.12
Rate for Payer: Hamaspik Choice Inc Medicare	$181.12

CUTTER LINEAR PROX 55MM RELOAD

Facility OP

$143.58

Hospital Charge Code	64904646
Hospital Revenue Code	270
Min. Negotiated Rate	$50.25
Max. Negotiated Rate	$114.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$71.79
Rate for Payer: Aetna Government	$71.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$114.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$97.63
Rate for Payer: Group Health Inc Commercial	$71.79
Rate for Payer: Group Health Inc Medicare	$50.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.79
Rate for Payer: Hamaspik Choice Inc Medicare	$71.79

CUTTER,LINEAR,RELOAD,ENDO,WHITE

Facility OP

$268.91

Hospital Charge Code	64902986
Hospital Revenue Code	270
Min. Negotiated Rate	$94.12
Max. Negotiated Rate	$215.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.46
Rate for Payer: Aetna Government	$134.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$215.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.86
Rate for Payer: Group Health Inc Commercial	$134.46
Rate for Payer: Group Health Inc Medicare	$94.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.46
Rate for Payer: Hamaspik Choice Inc Medicare	$134.46

Price Transparency.

All Charges