St. Barnabas Hospital

All Charges

Charge

Type

Price

DST CEMNT TAP ASSY

Facility OP

$2,548.00

Hospital Charge Code	64907311
Hospital Revenue Code	279
Min. Negotiated Rate	$891.80
Max. Negotiated Rate	$2,038.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,401.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,274.00
Rate for Payer: Aetna Government	$1,274.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,038.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,732.64
Rate for Payer: Group Health Inc Commercial	$1,274.00
Rate for Payer: Group Health Inc Medicare	$891.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,274.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,274.00

DTAP-HEP B-IPV

Facility OP

$208.13

Service Code	HCPCS 90732
Hospital Charge Code	30300167
Hospital Revenue Code	636
Min. Negotiated Rate	$43.68
Max. Negotiated Rate	$4,368.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$114.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$125.92
Rate for Payer: Aetna Government	$125.92
Rate for Payer: Amida Care Medicaid	$43.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4,368.00
Rate for Payer: Fidelis Essential Plan Aliesa	$43.68
Rate for Payer: Fidelis Essential Plan QHP	$43.68
Rate for Payer: Fidelis Qualified Health Plan	$45.86
Rate for Payer: Group Health Inc Commercial	$104.06
Rate for Payer: Group Health Inc Medicare	$72.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.68
Rate for Payer: Hamaspik Choice Inc Medicare	$104.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43.68
Rate for Payer: Healthfirst Essential Plan	$43.68
Rate for Payer: Healthfirst QHP	$43.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43.68
Rate for Payer: SOMOS Essential	$43.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$135.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43.68

DTAP-HEP B-IPV

Facility IP

$208.13

Service Code	HCPCS 90732
Hospital Charge Code	30300167
Hospital Revenue Code	636
Min. Negotiated Rate	$104.06
Max. Negotiated Rate	$104.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.06
Rate for Payer: Hamaspik Choice Inc Medicare	$104.06

DTAP--IPV/HIP(PENTACEL)

Facility OP

$103.00

Service Code	HCPCS 90698
Hospital Charge Code	30301292
Hospital Revenue Code	636
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$105.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.11
Rate for Payer: Aetna Government	$105.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.22
Rate for Payer: Group Health Inc Commercial	$51.50
Rate for Payer: Group Health Inc Medicare	$36.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.50
Rate for Payer: Hamaspik Choice Inc Medicare	$51.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.95

DTAP--IPV/HIP(PENTACEL)

Facility IP

$103.00

Service Code	HCPCS 90698
Hospital Charge Code	30301292
Hospital Revenue Code	636
Min. Negotiated Rate	$51.50
Max. Negotiated Rate	$51.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.50
Rate for Payer: Hamaspik Choice Inc Medicare	$51.50

DTAP/IPV (KINRIX)

Facility IP

$68.76

Service Code	HCPCS 90696
Hospital Charge Code	30301293
Hospital Revenue Code	636
Min. Negotiated Rate	$34.38
Max. Negotiated Rate	$34.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38

DTAP/IPV (KINRIX)

Facility OP

$68.76

Service Code	HCPCS 90696
Hospital Charge Code	30301293
Hospital Revenue Code	636
Min. Negotiated Rate	$24.07
Max. Negotiated Rate	$56.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.24
Rate for Payer: Aetna Government	$56.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.54
Rate for Payer: Group Health Inc Commercial	$34.38
Rate for Payer: Group Health Inc Medicare	$24.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.69

DTAP IPV VACC 4-6 YR, IM

Facility OP

$68.76

Service Code	HCPCS 90696
Hospital Charge Code	41646805
Hospital Revenue Code	636
Min. Negotiated Rate	$24.07
Max. Negotiated Rate	$56.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.24
Rate for Payer: Aetna Government	$56.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.54
Rate for Payer: Group Health Inc Commercial	$34.38
Rate for Payer: Group Health Inc Medicare	$24.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.69

DTAP IPV VACC 4-6 YR, IM

Facility IP

$68.76

Service Code	HCPCS 90696
Hospital Charge Code	41656805
Hospital Revenue Code	636
Min. Negotiated Rate	$34.38
Max. Negotiated Rate	$34.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38

DTAP IPV VACC 4-6 YR, IM

Facility IP

$68.76

Service Code	HCPCS 90696
Hospital Charge Code	41646805
Hospital Revenue Code	636
Min. Negotiated Rate	$34.38
Max. Negotiated Rate	$34.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38

DTAP IPV VACC 4-6 YR, IM

Facility OP

$68.76

Service Code	HCPCS 90696
Hospital Charge Code	41656805
Hospital Revenue Code	636
Min. Negotiated Rate	$24.07
Max. Negotiated Rate	$56.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.24
Rate for Payer: Aetna Government	$56.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.54
Rate for Payer: Group Health Inc Commercial	$34.38
Rate for Payer: Group Health Inc Medicare	$24.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.69

DUAL CHAMBER PCMKR CHECK

Facility OP

$109.80

Service Code	HCPCS 93288 TC
Hospital Charge Code	30305901
Hospital Revenue Code	480
Min. Negotiated Rate	$38.43
Max. Negotiated Rate	$87.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.90
Rate for Payer: Aetna Government	$54.90
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40.63
Rate for Payer: Group Health Inc Commercial	$54.90
Rate for Payer: Group Health Inc Medicare	$38.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$54.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$45.14

DUAL CHAMBER PCMKR CHECK

Facility OP

$109.80

Service Code	HCPCS 93288 TC
Hospital Charge Code	40804102
Hospital Revenue Code	480
Min. Negotiated Rate	$38.43
Max. Negotiated Rate	$87.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.90
Rate for Payer: Aetna Government	$54.90
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40.63
Rate for Payer: Group Health Inc Commercial	$54.90
Rate for Payer: Group Health Inc Medicare	$38.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$54.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$45.14

DUAL CHAMBER RATE RESP PACEMAKER

Facility OP

$10,600.00

Service Code	HCPCS C1785
Hospital Charge Code	40009102
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$11,130.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,830.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,095.00
Rate for Payer: Fidelis Medicare Advantage	$11,130.00
Rate for Payer: Group Health Inc Commercial	$5,300.00
Rate for Payer: Group Health Inc Medicare	$3,710.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,890.00

DUAL LEADES MESH CADHODES

Facility OP

$23,285.00

Hospital Charge Code	64902999
Hospital Revenue Code	272
Min. Negotiated Rate	$8,149.75
Max. Negotiated Rate	$18,628.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,806.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11,642.50
Rate for Payer: Aetna Government	$11,642.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18,628.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$15,833.80
Rate for Payer: Group Health Inc Commercial	$11,642.50
Rate for Payer: Group Health Inc Medicare	$8,149.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,642.50
Rate for Payer: Hamaspik Choice Inc Medicare	$11,642.50

DUAL LEAD ICD W/REPROGRAM

Facility OP

$109.80

Service Code	HCPCS 93283 TC
Hospital Charge Code	30305065
Hospital Revenue Code	480
Min. Negotiated Rate	$38.43
Max. Negotiated Rate	$87.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.90
Rate for Payer: Aetna Government	$54.90
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$48.38
Rate for Payer: Group Health Inc Commercial	$54.90
Rate for Payer: Group Health Inc Medicare	$38.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$54.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53.76

DUAL LEAD PACE W/REPROGRAM

Facility OP

$109.80

Service Code	HCPCS 93280 TC
Hospital Charge Code	30305062
Hospital Revenue Code	480
Min. Negotiated Rate	$38.43
Max. Negotiated Rate	$87.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.90
Rate for Payer: Aetna Government	$54.90
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$48.02
Rate for Payer: Group Health Inc Commercial	$54.90
Rate for Payer: Group Health Inc Medicare	$38.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$54.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53.35

DULOXETINE 20 MG DR CAP

Facility OP

$9.79

Hospital Charge Code	41645093
Hospital Revenue Code	250
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$7.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.90
Rate for Payer: Aetna Government	$4.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.66
Rate for Payer: Group Health Inc Commercial	$4.90
Rate for Payer: Group Health Inc Medicare	$3.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.90
Rate for Payer: Hamaspik Choice Inc Medicare	$4.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.36

DULOXETINE 20 MG DR CAP

Facility OP

$9.79

Hospital Charge Code	41655093
Hospital Revenue Code	250
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$7.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.90
Rate for Payer: Aetna Government	$4.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.66
Rate for Payer: Group Health Inc Commercial	$4.90
Rate for Payer: Group Health Inc Medicare	$3.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.90
Rate for Payer: Hamaspik Choice Inc Medicare	$4.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.36

DULOXETINE 30 MG DR CAP

Facility OP

$10.96

Hospital Charge Code	41645094
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.48
Rate for Payer: Aetna Government	$5.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.45
Rate for Payer: Group Health Inc Commercial	$5.48
Rate for Payer: Group Health Inc Medicare	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.48
Rate for Payer: Hamaspik Choice Inc Medicare	$5.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.12

DULOXETINE 30 MG DR CAP

Facility OP

$10.96

Hospital Charge Code	41655094
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.48
Rate for Payer: Aetna Government	$5.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.45
Rate for Payer: Group Health Inc Commercial	$5.48
Rate for Payer: Group Health Inc Medicare	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.48
Rate for Payer: Hamaspik Choice Inc Medicare	$5.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.12

DULOXETINE 60 MG DR CAP

Facility OP

$10.96

Hospital Charge Code	41645095
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.48
Rate for Payer: Aetna Government	$5.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.45
Rate for Payer: Group Health Inc Commercial	$5.48
Rate for Payer: Group Health Inc Medicare	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.48
Rate for Payer: Hamaspik Choice Inc Medicare	$5.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.12

DULOXETINE 60 MG DR CAP

Facility OP

$10.96

Hospital Charge Code	41655095
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.48
Rate for Payer: Aetna Government	$5.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.45
Rate for Payer: Group Health Inc Commercial	$5.48
Rate for Payer: Group Health Inc Medicare	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.48
Rate for Payer: Hamaspik Choice Inc Medicare	$5.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.12

DUODERM 4

Facility OP

$9.92

Hospital Charge Code	40204865
Hospital Revenue Code	270
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$7.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.96
Rate for Payer: Aetna Government	$4.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.75
Rate for Payer: Group Health Inc Commercial	$4.96
Rate for Payer: Group Health Inc Medicare	$3.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.96
Rate for Payer: Hamaspik Choice Inc Medicare	$4.96

DUODERM 6

Facility OP

$32.60

Hospital Charge Code	40204870
Hospital Revenue Code	270
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$26.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.30
Rate for Payer: Aetna Government	$16.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.17
Rate for Payer: Group Health Inc Commercial	$16.30
Rate for Payer: Group Health Inc Medicare	$11.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.30
Rate for Payer: Hamaspik Choice Inc Medicare	$16.30

Price Transparency.

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