St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DRESSING VAC GRANUFOM SIL SM

Facility

$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: Brighton Health Commercial	$519.58
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

$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: Brighton Health Commercial	$3,900.00
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: EmblemHealth Commercial	$3,250.00
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,225.00

DRESSING WND FLOWABLE MATRIX

Facility

$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

$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: Brighton Health Commercial	$11.21
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

$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: Brighton Health Commercial	$113.39
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

$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: Brighton Health Commercial	$638.89
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

$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: Brighton Health Commercial	$16.24
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

$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: Brighton Health Commercial	$60.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.35
Rate for Payer: EmblemHealth Commercial	$50.74
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

$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

$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: Brighton Health Commercial	$471.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$392.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$451.38
Rate for Payer: EmblemHealth Commercial	$392.50
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 1.6

Facility

$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 1.9

Facility

$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: Brighton Health Commercial	$353.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$294.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$338.88
Rate for Payer: EmblemHealth Commercial	$294.68
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 1.9

Facility

$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 1.9MM

Facility

$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: Brighton Health Commercial	$267.00
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

$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 1X54MM 12MM STP STRY END

Facility

$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: Brighton Health Commercial	$115.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$111.00
Rate for Payer: EmblemHealth Commercial	$96.52
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 2.0 ORTHO

Facility

$785.00

Service Code	HCPCS C1713
Hospital Charge Code	64907014
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 2.0 ORTHO

Facility

$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: Brighton Health Commercial	$471.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$392.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$451.38
Rate for Payer: EmblemHealth Commercial	$392.50
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 2.0X62MM WL 13MM REP PIN

Facility

$135.13

Service Code	HCPCS C1713
Hospital Charge Code	64906407
Hospital Revenue Code	278
Min. Negotiated Rate	$67.56
Max. Negotiated Rate	$67.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.56
Rate for Payer: Hamaspik Choice Inc Medicare	$67.56

DRILL 2.0X62MM WL 13MM REP PIN

Facility

$287.12

Hospital Charge Code	40202134
Hospital Revenue Code	270
Min. Negotiated Rate	$100.49
Max. Negotiated Rate	$229.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.56
Rate for Payer: Aetna Government	$143.56
Rate for Payer: Brighton Health Commercial	$215.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$229.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$195.24
Rate for Payer: Group Health Inc Commercial	$143.56
Rate for Payer: Group Health Inc Medicare	$100.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.56
Rate for Payer: Hamaspik Choice Inc Medicare	$143.56

DRILL 2.0X62MM WL 13MM REP PIN

Facility

$135.13

Service Code	HCPCS C1713
Hospital Charge Code	64906407
Hospital Revenue Code	278
Min. Negotiated Rate	$47.30
Max. Negotiated Rate	$141.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$81.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.70
Rate for Payer: EmblemHealth Commercial	$67.56
Rate for Payer: Fidelis Medicare Advantage	$141.89
Rate for Payer: Group Health Inc Commercial	$67.56
Rate for Payer: Group Health Inc Medicare	$47.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.56
Rate for Payer: Hamaspik Choice Inc Medicare	$67.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.83

DRILL 2.1MM CANNUL

Facility

$930.00

Service Code	HCPCS C1713
Hospital Charge Code	64907507
Hospital Revenue Code	278
Min. Negotiated Rate	$465.00
Max. Negotiated Rate	$465.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$465.00
Rate for Payer: Hamaspik Choice Inc Medicare	$465.00

DRILL 2.1MM CANNUL

Facility

$930.00

Service Code	HCPCS C1713
Hospital Charge Code	64907507
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$976.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$511.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$558.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$465.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$534.75
Rate for Payer: EmblemHealth Commercial	$465.00
Rate for Payer: Fidelis Medicare Advantage	$976.50
Rate for Payer: Group Health Inc Commercial	$465.00
Rate for Payer: Group Health Inc Medicare	$325.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$465.00
Rate for Payer: Hamaspik Choice Inc Medicare	$465.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$604.50

DRILL 2.3- 90009

Facility

$697.00

Service Code	HCPCS C1713
Hospital Charge Code	64906727
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$731.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$383.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$418.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$348.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$400.78
Rate for Payer: EmblemHealth Commercial	$348.50
Rate for Payer: Fidelis Medicare Advantage	$731.85
Rate for Payer: Group Health Inc Commercial	$348.50
Rate for Payer: Group Health Inc Medicare	$243.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$348.50
Rate for Payer: Hamaspik Choice Inc Medicare	$348.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$453.05

DRILL 2.3- 90009

Facility

$697.00

Service Code	HCPCS C1713
Hospital Charge Code	64906727
Hospital Revenue Code	278
Min. Negotiated Rate	$348.50
Max. Negotiated Rate	$348.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$348.50
Rate for Payer: Hamaspik Choice Inc Medicare	$348.50

Know your out-of-pocket cost for care.

All Charges