St. Barnabas Hospital

All Charges

Charge

Type

Price

DRILL TWST 1.5 DIA X 50MM CYL

Facility IP

$367.50

Service Code	HCPCS C1713
Hospital Charge Code	64901731
Hospital Revenue Code	278
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$183.75
Rate for Payer: Hamaspik Choice Inc Medicare	$183.75

DRIVER AO CONNECGT POLY LOCK

Facility OP

$335.00

Hospital Charge Code	64907052
Hospital Revenue Code	270
Min. Negotiated Rate	$117.25
Max. Negotiated Rate	$268.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$167.50
Rate for Payer: Aetna Government	$167.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$268.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$227.80
Rate for Payer: Group Health Inc Commercial	$167.50
Rate for Payer: Group Health Inc Medicare	$117.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.50
Rate for Payer: Hamaspik Choice Inc Medicare	$167.50

DRIVER AO SQR TIP 2.0MM

Facility IP

$268.00

Service Code	HCPCS C1713
Hospital Charge Code	64906912
Hospital Revenue Code	278
Min. Negotiated Rate	$134.00
Max. Negotiated Rate	$134.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00

DRIVER AO SQR TIP 2.0MM

Facility OP

$268.00

Service Code	HCPCS C1713
Hospital Charge Code	64906912
Hospital Revenue Code	278
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$281.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.40
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	$134.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$154.10
Rate for Payer: Fidelis Medicare Advantage	$281.40
Rate for Payer: Group Health Inc Commercial	$134.00
Rate for Payer: Group Health Inc Medicare	$93.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$174.20

DRIVER HEXALOBE

Facility OP

$487.50

Hospital Charge Code	64907396
Hospital Revenue Code	270
Min. Negotiated Rate	$170.62
Max. Negotiated Rate	$390.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$268.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$243.75
Rate for Payer: Aetna Government	$243.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$390.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$331.50
Rate for Payer: Group Health Inc Commercial	$243.75
Rate for Payer: Group Health Inc Medicare	$170.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75

DRIVER REDUCT 2.5

Facility OP

$985.00

Hospital Charge Code	64907508
Hospital Revenue Code	270
Min. Negotiated Rate	$344.75
Max. Negotiated Rate	$788.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$541.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$492.50
Rate for Payer: Aetna Government	$492.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$788.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$669.80
Rate for Payer: Group Health Inc Commercial	$492.50
Rate for Payer: Group Health Inc Medicare	$344.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$492.50
Rate for Payer: Hamaspik Choice Inc Medicare	$492.50

DRIVER UNIVERSAL T10

Facility OP

$268.00

Hospital Charge Code	64906913
Hospital Revenue Code	270
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$214.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.00
Rate for Payer: Aetna Government	$134.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$214.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.24
Rate for Payer: Group Health Inc Commercial	$134.00
Rate for Payer: Group Health Inc Medicare	$93.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00

DRIVE TARGATING

Facility OP

$407.50

Hospital Charge Code	64904054
Hospital Revenue Code	270
Min. Negotiated Rate	$142.62
Max. Negotiated Rate	$326.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$203.75
Rate for Payer: Aetna Government	$203.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$326.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$277.10
Rate for Payer: Group Health Inc Commercial	$203.75
Rate for Payer: Group Health Inc Medicare	$142.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.75
Rate for Payer: Hamaspik Choice Inc Medicare	$203.75

DRONABINOL 2.5 MG CAP

Facility IP

$7.00

Service Code	HCPCS Q0167
Hospital Charge Code	41641050
Hospital Revenue Code	636
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50

DRONABINOL 2.5 MG CAP

Facility OP

$7.00

Service Code	HCPCS Q0167
Hospital Charge Code	41641050
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$4.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.66
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.89
Rate for Payer: SOMOS Essential	$0.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

DRONABINOL 2.5 MG CAP

Facility OP

$7.00

Service Code	HCPCS Q0167
Hospital Charge Code	41651050
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$4.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.66
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.89
Rate for Payer: SOMOS Essential	$0.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

DRONABINOL 2.5 MG CAP

Facility IP

$7.00

Service Code	HCPCS Q0167
Hospital Charge Code	41651050
Hospital Revenue Code	636
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50

DRONEDARONE 400 MG TAB

Facility OP

$8.46

Hospital Charge Code	41645293
Hospital Revenue Code	250
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$6.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.23
Rate for Payer: Aetna Government	$4.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.75
Rate for Payer: Group Health Inc Commercial	$4.23
Rate for Payer: Group Health Inc Medicare	$2.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.23
Rate for Payer: Hamaspik Choice Inc Medicare	$4.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.50

DRONEDARONE 400 MG TAB

Facility OP

$8.46

Hospital Charge Code	41655293
Hospital Revenue Code	250
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$6.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.23
Rate for Payer: Aetna Government	$4.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.75
Rate for Payer: Group Health Inc Commercial	$4.23
Rate for Payer: Group Health Inc Medicare	$2.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.23
Rate for Payer: Hamaspik Choice Inc Medicare	$4.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.50

DROTRECOGIN ALFA 20 MG INJ

Facility OP

$2,657.00

Hospital Charge Code	41642784
Hospital Revenue Code	250
Min. Negotiated Rate	$929.95
Max. Negotiated Rate	$2,125.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,461.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,328.50
Rate for Payer: Aetna Government	$1,328.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,806.76
Rate for Payer: Group Health Inc Commercial	$1,328.50
Rate for Payer: Group Health Inc Medicare	$929.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,328.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,328.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,727.05

DROTRECOGIN ALFA 20 MG INJ

Facility OP

$2,657.00

Hospital Charge Code	41652784
Hospital Revenue Code	250
Min. Negotiated Rate	$929.95
Max. Negotiated Rate	$2,125.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,461.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,328.50
Rate for Payer: Aetna Government	$1,328.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,806.76
Rate for Payer: Group Health Inc Commercial	$1,328.50
Rate for Payer: Group Health Inc Medicare	$929.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,328.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,328.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,727.05

DROTRECOGIN ALFA 5 MG INJ

Facility OP

$665.00

Hospital Charge Code	41642783
Hospital Revenue Code	250
Min. Negotiated Rate	$232.75
Max. Negotiated Rate	$532.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$365.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$332.50
Rate for Payer: Aetna Government	$332.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$532.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$452.20
Rate for Payer: Group Health Inc Commercial	$332.50
Rate for Payer: Group Health Inc Medicare	$232.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$332.50
Rate for Payer: Hamaspik Choice Inc Medicare	$332.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$432.25

DROTRECOGIN ALFA 5 MG INJ

Facility OP

$665.00

Hospital Charge Code	41652783
Hospital Revenue Code	250
Min. Negotiated Rate	$232.75
Max. Negotiated Rate	$532.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$365.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$332.50
Rate for Payer: Aetna Government	$332.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$532.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$452.20
Rate for Payer: Group Health Inc Commercial	$332.50
Rate for Payer: Group Health Inc Medicare	$232.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$332.50
Rate for Payer: Hamaspik Choice Inc Medicare	$332.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$432.25

DRUG ELUTING PERIPH STENT

Facility IP

$4,487.50

Service Code	HCPCS C1874
Hospital Charge Code	64904187
Hospital Revenue Code	278
Min. Negotiated Rate	$2,243.75
Max. Negotiated Rate	$2,243.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,243.75

DRUG ELUTING PERIPH STENT

Facility OP

$4,487.50

Service Code	HCPCS C1874
Hospital Charge Code	64904187
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,711.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,468.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,580.31
Rate for Payer: Fidelis Medicare Advantage	$4,711.88
Rate for Payer: Group Health Inc Commercial	$2,243.75
Rate for Payer: Group Health Inc Medicare	$1,570.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,243.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,916.88

DRUG MANAGEMENT

Facility OP

$453.95

Service Code	HCPCS 90863
Hospital Charge Code	30300005
Hospital Revenue Code	914
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$363.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$188.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$363.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$308.69
Rate for Payer: Group Health Inc Commercial	$226.98
Rate for Payer: Group Health Inc Medicare	$158.88
Rate for Payer: Hamaspik Choice Inc Medicare	$226.98

DRUG SCREEN 10 W/CONF, SE

Facility OP

$31.50

Service Code	HCPCS 80305
Hospital Charge Code	40609156
Hospital Revenue Code	300
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$1,414.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.60
Rate for Payer: Aetna Government	$12.60
Rate for Payer: Amida Care Medicaid	$14.14
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cash Price	$12.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.42
Rate for Payer: Elderplan Medicare Advantage	$12.60
Rate for Payer: EmblemHealth Commercial	$12.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,414.00
Rate for Payer: Fidelis Essential Plan Aliesa	$14.14
Rate for Payer: Fidelis Essential Plan QHP	$14.14
Rate for Payer: Fidelis Medicare Advantage	$12.60
Rate for Payer: Fidelis Qualified Health Plan	$14.85
Rate for Payer: Group Health Inc Commercial	$12.60
Rate for Payer: Group Health Inc Medicare	$12.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.14
Rate for Payer: Hamaspik Choice Inc Medicare	$12.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14.14
Rate for Payer: Healthfirst Essential Plan	$31.82
Rate for Payer: Healthfirst Medicare Advantage	$12.60
Rate for Payer: Healthfirst QHP	$14.14
Rate for Payer: Senior Whole Health Medicare Advantage	$12.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$14.14
Rate for Payer: SOMOS Essential	$31.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.08
Rate for Payer: Wellcare Medicare	$11.34

DRUG SCREEN METH

Facility OP

$155.35

Service Code	HCPCS 80358
Hospital Charge Code	40602386
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$124.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.64
Rate for Payer: Group Health Inc Commercial	$77.68
Rate for Payer: Group Health Inc Medicare	$54.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.68
Rate for Payer: Hamaspik Choice Inc Medicare	$77.68

DRVVT SCRN W/RFL PHOS NEUT

Facility OP

$23.95

Service Code	HCPCS 85613
Hospital Charge Code	40628343
Hospital Revenue Code	305
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$15.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.58
Rate for Payer: Aetna Government	$9.58
Rate for Payer: Cash Price	$9.58
Rate for Payer: Cash Price	$9.58
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$9.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.88
Rate for Payer: Elderplan Medicare Advantage	$9.58
Rate for Payer: EmblemHealth Commercial	$9.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$8.62
Rate for Payer: Fidelis Essential Plan Aliesa	$8.14
Rate for Payer: Fidelis Essential Plan QHP	$8.53
Rate for Payer: Fidelis Medicare Advantage	$9.58
Rate for Payer: Fidelis Qualified Health Plan	$8.53
Rate for Payer: Group Health Inc Commercial	$9.58
Rate for Payer: Group Health Inc Medicare	$9.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.98
Rate for Payer: Hamaspik Choice Inc Medicare	$9.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$9.58
Rate for Payer: Healthfirst Medicare Advantage	$9.58
Rate for Payer: Healthfirst QHP	$9.58
Rate for Payer: Senior Whole Health Medicare Advantage	$9.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7.66
Rate for Payer: Wellcare Medicare	$8.62

D-STAT FLOWABLE HEMOSTAT #4000

Facility OP

$282.00

Hospital Charge Code	66576691
Hospital Revenue Code	272
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$225.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$155.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$141.00
Rate for Payer: Aetna Government	$141.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.76
Rate for Payer: Group Health Inc Commercial	$141.00
Rate for Payer: Group Health Inc Medicare	$98.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00

Price Transparency.

All Charges