St. Barnabas Hospital

All Charges

Charge

Type

Price

ETHAMBUTOL 100 MG TAB

Facility OP

$2.00

Hospital Charge Code	41650643
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

ETHAMBUTOL 100 MG TAB

Facility OP

$2.00

Hospital Charge Code	41640643
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

ETHAMBUTOL 400 MG TAB

Facility OP

$1.68

Hospital Charge Code	41653501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

ETHAMBUTOL 400 MG TAB

Facility OP

$1.68

Hospital Charge Code	41643501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

ETHAMBUTOL, SERUM/PLASMA

Facility OP

$105.00

Service Code	HCPCS 80375
Hospital Charge Code	40609882
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$84.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
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	$84.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.40
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

ETHANOL URINE

Facility OP

$32.15

Service Code	HCPCS 80320
Hospital Charge Code	40609713
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$25.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.68
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	$25.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.86
Rate for Payer: Group Health Inc Commercial	$16.08
Rate for Payer: Group Health Inc Medicare	$11.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.08
Rate for Payer: Hamaspik Choice Inc Medicare	$16.08

ETHIBOND MINI QUICK ANCHOR

Facility IP

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	40200172
Hospital Revenue Code	278
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00

ETHIBOND MINI QUICK ANCHOR

Facility OP

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	40200172
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$682.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
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	$325.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$373.75
Rate for Payer: Fidelis Medicare Advantage	$682.50
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$422.50

ETHICON 0.15X50X40MM PDS FLEX PLT

Facility OP

$858.00

Service Code	HCPCS C1713
Hospital Charge Code	40205627
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$900.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$471.90
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	$429.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$493.35
Rate for Payer: Fidelis Medicare Advantage	$900.90
Rate for Payer: Group Health Inc Commercial	$429.00
Rate for Payer: Group Health Inc Medicare	$300.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$429.00
Rate for Payer: Hamaspik Choice Inc Medicare	$429.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$557.70

ETHICON 0.15X50X40MM PDS FLEX PLT

Facility IP

$858.00

Service Code	HCPCS C1713
Hospital Charge Code	40205627
Hospital Revenue Code	278
Min. Negotiated Rate	$429.00
Max. Negotiated Rate	$429.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$429.00
Rate for Payer: Hamaspik Choice Inc Medicare	$429.00

ETHICON E FLEX 35 VASC STAPLER

Facility OP

$2,112.00

Hospital Charge Code	40008272
Hospital Revenue Code	272
Min. Negotiated Rate	$739.20
Max. Negotiated Rate	$1,689.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,161.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,056.00
Rate for Payer: Aetna Government	$1,056.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,689.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,436.16
Rate for Payer: Group Health Inc Commercial	$1,056.00
Rate for Payer: Group Health Inc Medicare	$739.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,056.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,056.00

ETHICON MESH KNIT VICRYL 12X12

Facility IP

$2,400.00

Service Code	HCPCS C1781
Hospital Charge Code	40209931
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00

ETHICON MESH KNIT VICRYL 12X12

Facility OP

$2,400.00

Service Code	HCPCS C1781
Hospital Charge Code	40209931
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,320.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,380.00
Rate for Payer: Fidelis Medicare Advantage	$2,520.00
Rate for Payer: Group Health Inc Commercial	$1,200.00
Rate for Payer: Group Health Inc Medicare	$840.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,560.00

ETHICON MESH PROLENE 12X12

Facility OP

$471.80

Service Code	HCPCS C1781
Hospital Charge Code	40209932
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$495.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$259.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$271.28
Rate for Payer: Fidelis Medicare Advantage	$495.39
Rate for Payer: Group Health Inc Commercial	$235.90
Rate for Payer: Group Health Inc Medicare	$165.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.90
Rate for Payer: Hamaspik Choice Inc Medicare	$235.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$306.67

ETHICON MESH PROLENE 12X12

Facility IP

$471.80

Service Code	HCPCS C1781
Hospital Charge Code	40209932
Hospital Revenue Code	278
Min. Negotiated Rate	$235.90
Max. Negotiated Rate	$235.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.90
Rate for Payer: Hamaspik Choice Inc Medicare	$235.90

ETHICON MESH PROLENE 3X6

Facility OP

$166.00

Service Code	HCPCS C1781
Hospital Charge Code	40209974
Hospital Revenue Code	278
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$174.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$83.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.45
Rate for Payer: Fidelis Medicare Advantage	$174.30
Rate for Payer: Group Health Inc Commercial	$83.00
Rate for Payer: Group Health Inc Medicare	$58.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.00
Rate for Payer: Hamaspik Choice Inc Medicare	$83.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$107.90

ETHICON MESH PROLENE 3X6

Facility IP

$166.00

Service Code	HCPCS C1781
Hospital Charge Code	40209974
Hospital Revenue Code	278
Min. Negotiated Rate	$83.00
Max. Negotiated Rate	$83.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.00
Rate for Payer: Hamaspik Choice Inc Medicare	$83.00

ETHICON MESH PROLENE 6X6

Facility OP

$1,247.00

Service Code	HCPCS C1781
Hospital Charge Code	40209967
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,309.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$685.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$623.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$717.02
Rate for Payer: Fidelis Medicare Advantage	$1,309.35
Rate for Payer: Group Health Inc Commercial	$623.50
Rate for Payer: Group Health Inc Medicare	$436.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$623.50
Rate for Payer: Hamaspik Choice Inc Medicare	$623.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$810.55

ETHICON MESH PROLENE 6X6

Facility IP

$1,247.00

Service Code	HCPCS C1781
Hospital Charge Code	40209967
Hospital Revenue Code	278
Min. Negotiated Rate	$623.50
Max. Negotiated Rate	$623.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$623.50
Rate for Payer: Hamaspik Choice Inc Medicare	$623.50

ETHICON SKIN STAPLER WIDE

Facility OP

$54.00

Hospital Charge Code	40008301
Hospital Revenue Code	270
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$43.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.00
Rate for Payer: Aetna Government	$27.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.72
Rate for Payer: Group Health Inc Commercial	$27.00
Rate for Payer: Group Health Inc Medicare	$18.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.00
Rate for Payer: Hamaspik Choice Inc Medicare	$27.00

ETHI ECHELON ENDO 60MM STAPLER

Facility OP

$2,264.72

Hospital Charge Code	40004202
Hospital Revenue Code	272
Min. Negotiated Rate	$792.65
Max. Negotiated Rate	$1,811.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,245.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,132.36
Rate for Payer: Aetna Government	$1,132.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,811.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,540.01
Rate for Payer: Group Health Inc Commercial	$1,132.36
Rate for Payer: Group Health Inc Medicare	$792.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,132.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1,132.36

ETHI MESH PRO 12X12 IN

Facility OP

$277.00

Service Code	HCPCS C1781
Hospital Charge Code	40008309
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$290.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$138.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.28
Rate for Payer: Fidelis Medicare Advantage	$290.85
Rate for Payer: Group Health Inc Commercial	$138.50
Rate for Payer: Group Health Inc Medicare	$96.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.50
Rate for Payer: Hamaspik Choice Inc Medicare	$138.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.05

ETHI MESH PRO 12X12 IN

Facility IP

$277.00

Service Code	HCPCS C1781
Hospital Charge Code	40008309
Hospital Revenue Code	278
Min. Negotiated Rate	$138.50
Max. Negotiated Rate	$138.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.50
Rate for Payer: Hamaspik Choice Inc Medicare	$138.50

ETHI MESH PRO 6X6 IN

Facility OP

$736.60

Service Code	HCPCS C1781
Hospital Charge Code	40008310
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$773.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$405.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$368.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$423.54
Rate for Payer: Fidelis Medicare Advantage	$773.43
Rate for Payer: Group Health Inc Commercial	$368.30
Rate for Payer: Group Health Inc Medicare	$257.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.30
Rate for Payer: Hamaspik Choice Inc Medicare	$368.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$478.79

ETHI MESH PRO 6X6 IN

Facility IP

$736.60

Service Code	HCPCS C1781
Hospital Charge Code	40008310
Hospital Revenue Code	278
Min. Negotiated Rate	$368.30
Max. Negotiated Rate	$368.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.30
Rate for Payer: Hamaspik Choice Inc Medicare	$368.30

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