St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DRESSING, GEL, THERAHONEY

Facility

$27.48

Hospital Charge Code	40201965
Hospital Revenue Code	270
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$21.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.74
Rate for Payer: Aetna Government	$13.74
Rate for Payer: Brighton Health Commercial	$20.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.69
Rate for Payer: Group Health Inc Commercial	$13.74
Rate for Payer: Group Health Inc Medicare	$9.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.74
Rate for Payer: Hamaspik Choice Inc Medicare	$13.74

DRESSING, GLFBR, OPTICELL,AG,4X5

Facility

$19.03

Hospital Charge Code	40201968
Hospital Revenue Code	270
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$15.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.52
Rate for Payer: Aetna Government	$9.52
Rate for Payer: Brighton Health Commercial	$14.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.94
Rate for Payer: Group Health Inc Commercial	$9.52
Rate for Payer: Group Health Inc Medicare	$6.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.52
Rate for Payer: Hamaspik Choice Inc Medicare	$9.52

DRESSING GRANUFOAM VAC LG

Facility

$131.63

Hospital Charge Code	64903303
Hospital Revenue Code	270
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: Brighton Health Commercial	$98.72
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 GRANUFOAM VAC LRG

Facility

$145.17

Hospital Charge Code	64903290
Hospital Revenue Code	270
Min. Negotiated Rate	$50.81
Max. Negotiated Rate	$116.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.58
Rate for Payer: Aetna Government	$72.58
Rate for Payer: Brighton Health Commercial	$108.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$116.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.72
Rate for Payer: Group Health Inc Commercial	$72.58
Rate for Payer: Group Health Inc Medicare	$50.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.58
Rate for Payer: Hamaspik Choice Inc Medicare	$72.58

DRESSING GRANUFOAM VAC MD

Facility

$109.07

Hospital Charge Code	64903292
Hospital Revenue Code	270
Min. Negotiated Rate	$38.17
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: Brighton Health Commercial	$81.80
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	$38.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.54
Rate for Payer: Hamaspik Choice Inc Medicare	$54.54

DRESSING GRANUFOAM VAC MED

Facility

$123.09

Hospital Charge Code	64903302
Hospital Revenue Code	270
Min. Negotiated Rate	$43.08
Max. Negotiated Rate	$98.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.54
Rate for Payer: Aetna Government	$61.54
Rate for Payer: Brighton Health Commercial	$92.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$98.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.70
Rate for Payer: Group Health Inc Commercial	$61.54
Rate for Payer: Group Health Inc Medicare	$43.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.54
Rate for Payer: Hamaspik Choice Inc Medicare	$61.54

DRESSING GRANUFOAM VAC SM

Facility

$95.55

Hospital Charge Code	64903309
Hospital Revenue Code	270
Min. Negotiated Rate	$33.44
Max. Negotiated Rate	$76.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.78
Rate for Payer: Aetna Government	$47.78
Rate for Payer: Brighton Health Commercial	$71.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.97
Rate for Payer: Group Health Inc Commercial	$47.78
Rate for Payer: Group Health Inc Medicare	$33.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.78
Rate for Payer: Hamaspik Choice Inc Medicare	$47.78

DRESSING HEMOSTAT 1/2

Facility

$71.17

Hospital Charge Code	64901885
Hospital Revenue Code	270
Min. Negotiated Rate	$24.91
Max. Negotiated Rate	$56.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.58
Rate for Payer: Aetna Government	$35.58
Rate for Payer: Brighton Health Commercial	$53.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.40
Rate for Payer: Group Health Inc Commercial	$35.58
Rate for Payer: Group Health Inc Medicare	$24.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.58
Rate for Payer: Hamaspik Choice Inc Medicare	$35.58

DRESSING HEMOSTAT 2X14

Facility

$243.23

Hospital Charge Code	64901262
Hospital Revenue Code	270
Min. Negotiated Rate	$85.13
Max. Negotiated Rate	$194.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$133.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$121.62
Rate for Payer: Aetna Government	$121.62
Rate for Payer: Brighton Health Commercial	$182.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$194.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.40
Rate for Payer: Group Health Inc Commercial	$121.62
Rate for Payer: Group Health Inc Medicare	$85.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.62
Rate for Payer: Hamaspik Choice Inc Medicare	$121.62

DRESSING HEMOSTAT 2X3

Facility

$133.66

Hospital Charge Code	64901828
Hospital Revenue Code	270
Min. Negotiated Rate	$46.78
Max. Negotiated Rate	$106.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$73.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$66.83
Rate for Payer: Aetna Government	$66.83
Rate for Payer: Brighton Health Commercial	$100.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$106.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.89
Rate for Payer: Group Health Inc Commercial	$66.83
Rate for Payer: Group Health Inc Medicare	$46.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.83
Rate for Payer: Hamaspik Choice Inc Medicare	$66.83

DRESSING MERO GEL/SINUS STENT

Facility

$280.00

Hospital Charge Code	64903959
Hospital Revenue Code	270
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$224.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.00
Rate for Payer: Aetna Government	$140.00
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$190.40
Rate for Payer: Group Health Inc Commercial	$140.00
Rate for Payer: Group Health Inc Medicare	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.00
Rate for Payer: Hamaspik Choice Inc Medicare	$140.00

DRESSING,QUIKCLOT,HEMO3 (ZME487)

Facility

$141.28

Hospital Charge Code	64906447
Hospital Revenue Code	272
Min. Negotiated Rate	$49.45
Max. Negotiated Rate	$113.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.64
Rate for Payer: Aetna Government	$70.64
Rate for Payer: Brighton Health Commercial	$105.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$113.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$96.07
Rate for Payer: Group Health Inc Commercial	$70.64
Rate for Payer: Group Health Inc Medicare	$49.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.64
Rate for Payer: Hamaspik Choice Inc Medicare	$70.64

DRESSINGS

Facility

$1.88

Hospital Charge Code	40201229
Hospital Revenue Code	270
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.94
Rate for Payer: Aetna Government	$0.94
Rate for Payer: Brighton Health Commercial	$1.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.28
Rate for Payer: Group Health Inc Commercial	$0.94
Rate for Payer: Group Health Inc Medicare	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94
Rate for Payer: Hamaspik Choice Inc Medicare	$0.94

DRESSING SET DISPOSABLE

Facility

$21.62

Hospital Charge Code	40191240
Hospital Revenue Code	710
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$17.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.81
Rate for Payer: Aetna Government	$10.81
Rate for Payer: Brighton Health Commercial	$16.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.70
Rate for Payer: Group Health Inc Commercial	$10.81
Rate for Payer: Group Health Inc Medicare	$7.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.81
Rate for Payer: Hamaspik Choice Inc Medicare	$10.81

DRESSING SET, DISPOSABLE

Facility

$45.36

Hospital Charge Code	40201240
Hospital Revenue Code	270
Min. Negotiated Rate	$15.88
Max. Negotiated Rate	$36.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.68
Rate for Payer: Aetna Government	$22.68
Rate for Payer: Brighton Health Commercial	$34.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.84
Rate for Payer: Group Health Inc Commercial	$22.68
Rate for Payer: Group Health Inc Medicare	$15.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.68
Rate for Payer: Hamaspik Choice Inc Medicare	$22.68

DRESSING, SHEET, THERAHONEY 4X5

Facility

$21.33

Hospital Charge Code	40201966
Hospital Revenue Code	270
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$17.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.66
Rate for Payer: Aetna Government	$10.66
Rate for Payer: Brighton Health Commercial	$16.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.50
Rate for Payer: Group Health Inc Commercial	$10.66
Rate for Payer: Group Health Inc Medicare	$7.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.66
Rate for Payer: Hamaspik Choice Inc Medicare	$10.66

DRESSINGSPONGE4X3W/FABRICFACING

Facility

$0.06

Hospital Charge Code	40209479
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03

DRESSING TRAY

Facility

$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: Brighton Health Commercial	$2.25
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

$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: Brighton Health Commercial	$113.16
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

$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: Brighton Health Commercial	$98.72
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 LRG

Facility

$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: Brighton Health Commercial	$98.20
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 MED

Facility

$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: Brighton Health Commercial	$81.81
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 MED

Facility

$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: Brighton Health Commercial	$81.36
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 SM

Facility

$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: Brighton Health Commercial	$64.88
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 GRANUFOAM SM

Facility

$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: Brighton Health Commercial	$64.52
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

Know your out-of-pocket cost for care.

All Charges