St. Barnabas Hospital

All Charges

Charge

Type

Price

DISPOSABLE SIGMOIDOSCOPE

Facility OP

$12.05

Hospital Charge Code	40201217
Hospital Revenue Code	270
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$9.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.02
Rate for Payer: Aetna Government	$6.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.19
Rate for Payer: Group Health Inc Commercial	$6.02
Rate for Payer: Group Health Inc Medicare	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.02
Rate for Payer: Hamaspik Choice Inc Medicare	$6.02

DISPOSABLES KIT T3

Facility OP

$1,782.50

Hospital Charge Code	64905871
Hospital Revenue Code	270
Min. Negotiated Rate	$623.88
Max. Negotiated Rate	$1,426.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$980.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$891.25
Rate for Payer: Aetna Government	$891.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,426.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,212.10
Rate for Payer: Group Health Inc Commercial	$891.25
Rate for Payer: Group Health Inc Medicare	$623.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$891.25
Rate for Payer: Hamaspik Choice Inc Medicare	$891.25

DISPOSABLES KIT TRANS SAW BLADE

Facility OP

$805.00

Hospital Charge Code	64905354
Hospital Revenue Code	270
Min. Negotiated Rate	$281.75
Max. Negotiated Rate	$644.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$442.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.50
Rate for Payer: Aetna Government	$402.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$644.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$547.40
Rate for Payer: Group Health Inc Commercial	$402.50
Rate for Payer: Group Health Inc Medicare	$281.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$402.50
Rate for Payer: Hamaspik Choice Inc Medicare	$402.50

DISPOSABLE SUTURE REMOVAL SET

Facility OP

$6.73

Hospital Charge Code	40201216
Hospital Revenue Code	270
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.58
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36

DISPOSABLE TOWELS

Facility OP

$9.57

Hospital Charge Code	40201218
Hospital Revenue Code	270
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$7.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.78
Rate for Payer: Aetna Government	$4.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.51
Rate for Payer: Group Health Inc Commercial	$4.78
Rate for Payer: Group Health Inc Medicare	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.78
Rate for Payer: Hamaspik Choice Inc Medicare	$4.78

Disposable Transducer

Facility OP

$97.45

Hospital Charge Code	40201219
Hospital Revenue Code	270
Min. Negotiated Rate	$34.11
Max. Negotiated Rate	$77.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.72
Rate for Payer: Aetna Government	$48.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$77.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.27
Rate for Payer: Group Health Inc Commercial	$48.72
Rate for Payer: Group Health Inc Medicare	$34.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.72
Rate for Payer: Hamaspik Choice Inc Medicare	$48.72

DISPOSABLE TUBING SET W EXT

Facility OP

$988.50

Hospital Charge Code	64906005
Hospital Revenue Code	270
Min. Negotiated Rate	$345.98
Max. Negotiated Rate	$790.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$543.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$494.25
Rate for Payer: Aetna Government	$494.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$790.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$672.18
Rate for Payer: Group Health Inc Commercial	$494.25
Rate for Payer: Group Health Inc Medicare	$345.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$494.25
Rate for Payer: Hamaspik Choice Inc Medicare	$494.25

DISPSBLE BIPLR CONNECTING CABLES

Facility OP

$430.00

Hospital Charge Code	40200849
Hospital Revenue Code	270
Min. Negotiated Rate	$150.50
Max. Negotiated Rate	$344.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$236.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$215.00
Rate for Payer: Aetna Government	$215.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$344.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$292.40
Rate for Payer: Group Health Inc Commercial	$215.00
Rate for Payer: Group Health Inc Medicare	$150.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$215.00
Rate for Payer: Hamaspik Choice Inc Medicare	$215.00

DISSECTION NEEDLES KRA05125

Facility OP

$101.93

Hospital Charge Code	64902691
Hospital Revenue Code	270
Min. Negotiated Rate	$35.68
Max. Negotiated Rate	$81.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.96
Rate for Payer: Aetna Government	$50.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.31
Rate for Payer: Group Health Inc Commercial	$50.96
Rate for Payer: Group Health Inc Medicare	$35.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.96
Rate for Payer: Hamaspik Choice Inc Medicare	$50.96

DISSECTOR,ENDOPATH,BLUNT TIP

Facility OP

$13.54

Hospital Charge Code	64904024
Hospital Revenue Code	270
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$10.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.77
Rate for Payer: Aetna Government	$6.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.21
Rate for Payer: Group Health Inc Commercial	$6.77
Rate for Payer: Group Health Inc Medicare	$4.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.77
Rate for Payer: Hamaspik Choice Inc Medicare	$6.77

DISSECTOR ENDOPATH CURV W/UNI 5MM

Facility OP

$65.00

Hospital Charge Code	64906047
Hospital Revenue Code	270
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$52.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.50
Rate for Payer: Aetna Government	$32.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.20
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

DISSECTOR ENDO PEAUNT

Facility OP

$15.81

Hospital Charge Code	64907093
Hospital Revenue Code	270
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$12.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.90
Rate for Payer: Aetna Government	$7.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.75
Rate for Payer: Group Health Inc Commercial	$7.90
Rate for Payer: Group Health Inc Medicare	$5.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.90
Rate for Payer: Hamaspik Choice Inc Medicare	$7.90

DISSECTOR ULTRASNIC CORDLESS

Facility OP

$200.00

Hospital Charge Code	64907082
Hospital Revenue Code	270
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$160.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$100.00
Rate for Payer: Aetna Government	$100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.00
Rate for Payer: Group Health Inc Commercial	$100.00
Rate for Payer: Group Health Inc Medicare	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00

DISTAL 7 HOLE

Facility OP

$1,241.50

Service Code	HCPCS C1713
Hospital Charge Code	40004999
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,303.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$682.82
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	$620.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$713.86
Rate for Payer: Fidelis Medicare Advantage	$1,303.58
Rate for Payer: Group Health Inc Commercial	$620.75
Rate for Payer: Group Health Inc Medicare	$434.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$620.75
Rate for Payer: Hamaspik Choice Inc Medicare	$620.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$806.98

DISTAL 7 HOLE

Facility IP

$1,241.50

Service Code	HCPCS C1713
Hospital Charge Code	40004999
Hospital Revenue Code	278
Min. Negotiated Rate	$620.75
Max. Negotiated Rate	$620.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$620.75
Rate for Payer: Hamaspik Choice Inc Medicare	$620.75

DISTAL ANTEROLATERAL TIBIA 6H LFT

Facility OP

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	40200537
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,150.00
Rate for Payer: Fidelis Medicare Advantage	$2,100.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,300.00

DISTAL ANTEROLATERAL TIBIA 6H LFT

Facility IP

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	40200537
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

DISTAL ANTEROLATERAL TIBIA 6H RT

Facility IP

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	40200538
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

DISTAL ANTEROLATERAL TIBIA 6H RT

Facility OP

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	40200538
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,150.00
Rate for Payer: Fidelis Medicare Advantage	$2,100.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,300.00

DISTAL ANTEROLATERAL TIBIA 8H LFT

Facility IP

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	40209951
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00

DISTAL ANTEROLATERAL TIBIA 8H LFT

Facility OP

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	40200541
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,150.00
Rate for Payer: Fidelis Medicare Advantage	$2,100.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,300.00

DISTAL ANTEROLATERAL TIBIA 8H LFT

Facility OP

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	40209951
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,837.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$962.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$875.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,006.25
Rate for Payer: Fidelis Medicare Advantage	$1,837.50
Rate for Payer: Group Health Inc Commercial	$875.00
Rate for Payer: Group Health Inc Medicare	$612.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,137.50

DISTAL ANTEROLATERAL TIBIA 8H LFT

Facility IP

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	40200541
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

DISTAL ANTEROLATERAL TIBIA 8H RT

Facility IP

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	40200539
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

DISTAL ANTEROLATERAL TIBIA 8H RT

Facility OP

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	40200539
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,150.00
Rate for Payer: Fidelis Medicare Advantage	$2,100.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,300.00

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