St. Barnabas Hospital

All Charges

Charge

Type

Price

DRESSING TRAY

Facility OP

$3.00

Hospital Charge Code	40201230
Hospital Revenue Code	270
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

DRESSING VAC GRANUFOAM

Facility OP

$150.88

Hospital Charge Code	40201957
Hospital Revenue Code	272
Min. Negotiated Rate	$52.81
Max. Negotiated Rate	$120.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.44
Rate for Payer: Aetna Government	$75.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.60
Rate for Payer: Group Health Inc Commercial	$75.44
Rate for Payer: Group Health Inc Medicare	$52.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.44
Rate for Payer: Hamaspik Choice Inc Medicare	$75.44

DRESSING VAC GRANUFOAM LRG

Facility OP

$130.93

Hospital Charge Code	64901129
Hospital Revenue Code	270
Min. Negotiated Rate	$45.83
Max. Negotiated Rate	$104.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.46
Rate for Payer: Aetna Government	$65.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.03
Rate for Payer: Group Health Inc Commercial	$65.46
Rate for Payer: Group Health Inc Medicare	$45.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.46
Rate for Payer: Hamaspik Choice Inc Medicare	$65.46

DRESSING VAC GRANUFOAM LRG

Facility OP

$131.63

Hospital Charge Code	40201958
Hospital Revenue Code	272
Min. Negotiated Rate	$46.07
Max. Negotiated Rate	$105.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.82
Rate for Payer: Aetna Government	$65.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$105.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.51
Rate for Payer: Group Health Inc Commercial	$65.82
Rate for Payer: Group Health Inc Medicare	$46.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.82
Rate for Payer: Hamaspik Choice Inc Medicare	$65.82

DRESSING VAC GRANUFOAM MED

Facility OP

$108.48

Hospital Charge Code	64901128
Hospital Revenue Code	270
Min. Negotiated Rate	$37.97
Max. Negotiated Rate	$86.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.24
Rate for Payer: Aetna Government	$54.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.77
Rate for Payer: Group Health Inc Commercial	$54.24
Rate for Payer: Group Health Inc Medicare	$37.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.24
Rate for Payer: Hamaspik Choice Inc Medicare	$54.24

DRESSING VAC GRANUFOAM MED

Facility OP

$109.08

Hospital Charge Code	40201959
Hospital Revenue Code	272
Min. Negotiated Rate	$38.18
Max. Negotiated Rate	$87.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.54
Rate for Payer: Aetna Government	$54.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.17
Rate for Payer: Group Health Inc Commercial	$54.54
Rate for Payer: Group Health Inc Medicare	$38.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.54
Rate for Payer: Hamaspik Choice Inc Medicare	$54.54

DRESSING VAC GRANUFOAM SM

Facility OP

$86.03

Hospital Charge Code	64901127
Hospital Revenue Code	270
Min. Negotiated Rate	$30.11
Max. Negotiated Rate	$68.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.02
Rate for Payer: Aetna Government	$43.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.50
Rate for Payer: Group Health Inc Commercial	$43.02
Rate for Payer: Group Health Inc Medicare	$30.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.02
Rate for Payer: Hamaspik Choice Inc Medicare	$43.02

DRESSING VAC GRANUFOAM SM

Facility OP

$86.50

Hospital Charge Code	40201960
Hospital Revenue Code	272
Min. Negotiated Rate	$30.28
Max. Negotiated Rate	$69.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.25
Rate for Payer: Aetna Government	$43.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$69.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.82
Rate for Payer: Group Health Inc Commercial	$43.25
Rate for Payer: Group Health Inc Medicare	$30.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.25
Rate for Payer: Hamaspik Choice Inc Medicare	$43.25

DRESSING VAC GRANUFOM SIL SM

Facility OP

$692.78

Hospital Charge Code	64903317
Hospital Revenue Code	270
Min. Negotiated Rate	$242.47
Max. Negotiated Rate	$554.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$381.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$346.39
Rate for Payer: Aetna Government	$346.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$554.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$471.09
Rate for Payer: Group Health Inc Commercial	$346.39
Rate for Payer: Group Health Inc Medicare	$242.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$346.39
Rate for Payer: Hamaspik Choice Inc Medicare	$346.39

DRESSING WND FLOWABLE MATRIX

Facility OP

$6,500.00

Service Code	HCPCS Q4114
Hospital Charge Code	64907439
Hospital Revenue Code	278
Min. Negotiated Rate	$1,487.83
Max. Negotiated Rate	$6,825.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,575.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,487.83
Rate for Payer: Aetna Government	$1,487.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,737.50
Rate for Payer: Fidelis Medicare Advantage	$6,825.00
Rate for Payer: Group Health Inc Commercial	$3,250.00
Rate for Payer: Group Health Inc Medicare	$2,275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,250.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,530.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,225.00

DRESSING WND FLOWABLE MATRIX

Facility IP

$6,500.00

Service Code	HCPCS Q4114
Hospital Charge Code	64907439
Hospital Revenue Code	278
Min. Negotiated Rate	$3,250.00
Max. Negotiated Rate	$3,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,250.00

DRESSIN WOUND HYDRO BLUE 4X5

Facility OP

$14.95

Hospital Charge Code	64903596
Hospital Revenue Code	270
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$11.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.48
Rate for Payer: Aetna Government	$7.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.17
Rate for Payer: Group Health Inc Commercial	$7.48
Rate for Payer: Group Health Inc Medicare	$5.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.48
Rate for Payer: Hamaspik Choice Inc Medicare	$7.48

DRESSNG VAC GRANUFOM SIL

Facility OP

$151.19

Hospital Charge Code	64901130
Hospital Revenue Code	270
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$120.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.60
Rate for Payer: Aetna Government	$75.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.81
Rate for Payer: Group Health Inc Commercial	$75.60
Rate for Payer: Group Health Inc Medicare	$52.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.60
Rate for Payer: Hamaspik Choice Inc Medicare	$75.60

DRESSNG VAC GRANUFOM SIL MED

Facility OP

$851.85

Hospital Charge Code	64903321
Hospital Revenue Code	270
Min. Negotiated Rate	$298.15
Max. Negotiated Rate	$681.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$468.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$425.92
Rate for Payer: Aetna Government	$425.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$681.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$579.26
Rate for Payer: Group Health Inc Commercial	$425.92
Rate for Payer: Group Health Inc Medicare	$298.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$425.92
Rate for Payer: Hamaspik Choice Inc Medicare	$425.92

DRESS PROFOR MULTI LYR COMPRES

Facility OP

$21.65

Hospital Charge Code	64903417
Hospital Revenue Code	270
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$17.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.82
Rate for Payer: Aetna Government	$10.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.72
Rate for Payer: Group Health Inc Commercial	$10.82
Rate for Payer: Group Health Inc Medicare	$7.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.82
Rate for Payer: Hamaspik Choice Inc Medicare	$10.82

DRILL 1.35X50M 6M STOP-6013506

Facility OP

$101.47

Service Code	HCPCS C1713
Hospital Charge Code	64906523
Hospital Revenue Code	278
Min. Negotiated Rate	$35.51
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.81
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	$50.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.35
Rate for Payer: Fidelis Medicare Advantage	$106.54
Rate for Payer: Group Health Inc Commercial	$50.74
Rate for Payer: Group Health Inc Medicare	$35.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.74
Rate for Payer: Hamaspik Choice Inc Medicare	$50.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.96

DRILL 1.35X50M 6M STOP-6013506

Facility IP

$101.47

Service Code	HCPCS C1713
Hospital Charge Code	64906523
Hospital Revenue Code	278
Min. Negotiated Rate	$50.74
Max. Negotiated Rate	$50.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.74
Rate for Payer: Hamaspik Choice Inc Medicare	$50.74

DRILL 1.6

Facility IP

$785.00

Service Code	HCPCS C1713
Hospital Charge Code	64906955
Hospital Revenue Code	278
Min. Negotiated Rate	$392.50
Max. Negotiated Rate	$392.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.50
Rate for Payer: Hamaspik Choice Inc Medicare	$392.50

DRILL 1.6

Facility OP

$785.00

Service Code	HCPCS C1713
Hospital Charge Code	64906955
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$824.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$431.75
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	$392.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$451.38
Rate for Payer: Fidelis Medicare Advantage	$824.25
Rate for Payer: Group Health Inc Commercial	$392.50
Rate for Payer: Group Health Inc Medicare	$274.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.50
Rate for Payer: Hamaspik Choice Inc Medicare	$392.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$510.25

DRILL 1.9

Facility IP

$589.35

Service Code	HCPCS C1713
Hospital Charge Code	64907448
Hospital Revenue Code	278
Min. Negotiated Rate	$294.68
Max. Negotiated Rate	$294.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$294.68
Rate for Payer: Hamaspik Choice Inc Medicare	$294.68

DRILL 1.9

Facility OP

$589.35

Service Code	HCPCS C1713
Hospital Charge Code	64907448
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$618.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$324.14
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	$294.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$338.88
Rate for Payer: Fidelis Medicare Advantage	$618.82
Rate for Payer: Group Health Inc Commercial	$294.68
Rate for Payer: Group Health Inc Medicare	$206.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$294.68
Rate for Payer: Hamaspik Choice Inc Medicare	$294.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$383.08

DRILL 1.9MM

Facility OP

$356.00

Hospital Charge Code	40202133
Hospital Revenue Code	270
Min. Negotiated Rate	$124.60
Max. Negotiated Rate	$284.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$195.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$178.00
Rate for Payer: Aetna Government	$178.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$284.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$242.08
Rate for Payer: Group Health Inc Commercial	$178.00
Rate for Payer: Group Health Inc Medicare	$124.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.00
Rate for Payer: Hamaspik Choice Inc Medicare	$178.00

DRILL 1X54MM 12MM STP STRY END

Facility OP

$193.04

Service Code	HCPCS C1713
Hospital Charge Code	64906641
Hospital Revenue Code	278
Min. Negotiated Rate	$67.56
Max. Negotiated Rate	$202.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.17
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	$96.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$111.00
Rate for Payer: Fidelis Medicare Advantage	$202.69
Rate for Payer: Group Health Inc Commercial	$96.52
Rate for Payer: Group Health Inc Medicare	$67.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.52
Rate for Payer: Hamaspik Choice Inc Medicare	$96.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$125.48

DRILL 1X54MM 12MM STP STRY END

Facility IP

$193.04

Service Code	HCPCS C1713
Hospital Charge Code	64906641
Hospital Revenue Code	278
Min. Negotiated Rate	$96.52
Max. Negotiated Rate	$96.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.52
Rate for Payer: Hamaspik Choice Inc Medicare	$96.52

DRILL 2.0 ORTHO

Facility OP

$785.00

Service Code	HCPCS C1713
Hospital Charge Code	64907014
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$824.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$431.75
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	$392.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$451.38
Rate for Payer: Fidelis Medicare Advantage	$824.25
Rate for Payer: Group Health Inc Commercial	$392.50
Rate for Payer: Group Health Inc Medicare	$274.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.50
Rate for Payer: Hamaspik Choice Inc Medicare	$392.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$510.25

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