St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

2x3 Bioclusive Dressing

Facility

$9.22

Hospital Charge Code	40200005
Hospital Revenue Code	270
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$7.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.61
Rate for Payer: Aetna Government	$4.61
Rate for Payer: Brighton Health Commercial	$6.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.27
Rate for Payer: Group Health Inc Commercial	$4.61
Rate for Payer: Group Health Inc Medicare	$3.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.61
Rate for Payer: Hamaspik Choice Inc Medicare	$4.61

2X6 H 3D PLATE MDFC MALLEABLE

Facility

$774.00

Service Code	HCPCS C1713
Hospital Charge Code	40200590
Hospital Revenue Code	278
Min. Negotiated Rate	$387.00
Max. Negotiated Rate	$387.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$387.00
Rate for Payer: Hamaspik Choice Inc Medicare	$387.00

2X6 H 3D PLATE MDFC MALLEABLE

Facility

$774.00

Service Code	HCPCS C1713
Hospital Charge Code	40200590
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$812.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$425.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$464.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$387.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$445.05
Rate for Payer: EmblemHealth Commercial	$387.00
Rate for Payer: Fidelis Medicare Advantage	$812.70
Rate for Payer: Group Health Inc Commercial	$387.00
Rate for Payer: Group Health Inc Medicare	$270.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$387.00
Rate for Payer: Hamaspik Choice Inc Medicare	$387.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$503.10

2X6 H 3D PLT, MDFACE LOCK

Facility

$688.00

Service Code	HCPCS C1713
Hospital Charge Code	40202322
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$722.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$378.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$412.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$344.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$395.60
Rate for Payer: EmblemHealth Commercial	$344.00
Rate for Payer: Fidelis Medicare Advantage	$722.40
Rate for Payer: Group Health Inc Commercial	$344.00
Rate for Payer: Group Health Inc Medicare	$240.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$344.00
Rate for Payer: Hamaspik Choice Inc Medicare	$344.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$447.20

2X6 H 3D PLT, MDFACE LOCK

Facility

$688.00

Service Code	HCPCS C1713
Hospital Charge Code	40202322
Hospital Revenue Code	278
Min. Negotiated Rate	$344.00
Max. Negotiated Rate	$344.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$344.00
Rate for Payer: Hamaspik Choice Inc Medicare	$344.00

2X6H 3D PLT,MDFACE,LOCK

Facility

$988.00

Service Code	HCPCS C1781
Hospital Charge Code	40209817
Hospital Revenue Code	278
Min. Negotiated Rate	$494.00
Max. Negotiated Rate	$494.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$494.00
Rate for Payer: Hamaspik Choice Inc Medicare	$494.00

2X6H 3D PLT,MDFACE,LOCK

Facility

$988.00

Service Code	HCPCS C1781
Hospital Charge Code	40209817
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,037.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$543.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$592.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$494.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$568.10
Rate for Payer: EmblemHealth Commercial	$494.00
Rate for Payer: Fidelis Medicare Advantage	$1,037.40
Rate for Payer: Group Health Inc Commercial	$494.00
Rate for Payer: Group Health Inc Medicare	$345.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$494.00
Rate for Payer: Hamaspik Choice Inc Medicare	$494.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$642.20

2X6H 3D PLT MIDFACE

Facility

$822.00

Service Code	HCPCS C1781
Hospital Charge Code	40209818
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$863.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$452.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$493.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$411.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$472.65
Rate for Payer: EmblemHealth Commercial	$411.00
Rate for Payer: Fidelis Medicare Advantage	$863.10
Rate for Payer: Group Health Inc Commercial	$411.00
Rate for Payer: Group Health Inc Medicare	$287.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.00
Rate for Payer: Hamaspik Choice Inc Medicare	$411.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$534.30

2X6H 3D PLT MIDFACE

Facility

$822.00

Service Code	HCPCS C1781
Hospital Charge Code	40209818
Hospital Revenue Code	278
Min. Negotiated Rate	$411.00
Max. Negotiated Rate	$411.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.00
Rate for Payer: Hamaspik Choice Inc Medicare	$411.00

300CC TISSUE EXPANDER

Facility

$2,700.00

Service Code	HCPCS C1789
Hospital Charge Code	40009272
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,835.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,620.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,552.50
Rate for Payer: EmblemHealth Commercial	$1,350.00
Rate for Payer: Fidelis Medicare Advantage	$2,835.00
Rate for Payer: Group Health Inc Commercial	$1,350.00
Rate for Payer: Group Health Inc Medicare	$945.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,755.00

300CC TISSUE EXPANDER

Facility

$2,700.00

Service Code	HCPCS C1789
Hospital Charge Code	40009272
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$1,350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,350.00

300CC TISSUE EXPANDER 133MX-11-T

Facility

$2,700.00

Service Code	HCPCS C1789
Hospital Charge Code	40005327
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,835.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,620.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,552.50
Rate for Payer: EmblemHealth Commercial	$1,350.00
Rate for Payer: Fidelis Medicare Advantage	$2,835.00
Rate for Payer: Group Health Inc Commercial	$1,350.00
Rate for Payer: Group Health Inc Medicare	$945.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,755.00

300CC TISSUE EXPANDER 133MX-11-T

Facility

$2,700.00

Service Code	HCPCS C1789
Hospital Charge Code	40005327
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$1,350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,350.00

30 HOLE STRGHT PLATE,75MM PROFILE

Facility

$1,182.00

Service Code	HCPCS C1713
Hospital Charge Code	40201062
Hospital Revenue Code	278
Min. Negotiated Rate	$591.00
Max. Negotiated Rate	$591.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$591.00
Rate for Payer: Hamaspik Choice Inc Medicare	$591.00

30 HOLE STRGHT PLATE,75MM PROFILE

Facility

$1,182.00

Service Code	HCPCS C1713
Hospital Charge Code	40201062
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,241.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$650.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$709.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$591.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$679.65
Rate for Payer: EmblemHealth Commercial	$591.00
Rate for Payer: Fidelis Medicare Advantage	$1,241.10
Rate for Payer: Group Health Inc Commercial	$591.00
Rate for Payer: Group Health Inc Medicare	$413.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$591.00
Rate for Payer: Hamaspik Choice Inc Medicare	$591.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$768.30

3.0MM NCB DRLL 4.0MM NCB DP TD SC

Facility

$326.32

Hospital Charge Code	40006765
Hospital Revenue Code	272
Min. Negotiated Rate	$114.21
Max. Negotiated Rate	$261.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$163.16
Rate for Payer: Aetna Government	$163.16
Rate for Payer: Brighton Health Commercial	$244.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$261.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$221.90
Rate for Payer: Group Health Inc Commercial	$163.16
Rate for Payer: Group Health Inc Medicare	$114.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.16
Rate for Payer: Hamaspik Choice Inc Medicare	$163.16

3.0MM PIN BY 355MM STERIL

Facility

$27.36

Service Code	HCPCS C1713
Hospital Charge Code	40006467
Hospital Revenue Code	278
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$13.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.68
Rate for Payer: Hamaspik Choice Inc Medicare	$13.68

3.0MM PIN BY 355MM STERIL

Facility

$27.36

Service Code	HCPCS C1713
Hospital Charge Code	40006467
Hospital Revenue Code	278
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$16.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.73
Rate for Payer: EmblemHealth Commercial	$13.68
Rate for Payer: Fidelis Medicare Advantage	$28.73
Rate for Payer: Group Health Inc Commercial	$13.68
Rate for Payer: Group Health Inc Medicare	$9.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.68
Rate for Payer: Hamaspik Choice Inc Medicare	$13.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.78

3.0MM THREAD GUIDE PIN

Facility

$194.40

Service Code	HCPCS C1713
Hospital Charge Code	40006466
Hospital Revenue Code	278
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$97.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.20
Rate for Payer: Hamaspik Choice Inc Medicare	$97.20

3.0MM THREAD GUIDE PIN

Facility

$194.40

Service Code	HCPCS C1713
Hospital Charge Code	40006466
Hospital Revenue Code	278
Min. Negotiated Rate	$68.04
Max. Negotiated Rate	$204.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$116.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$97.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$111.78
Rate for Payer: EmblemHealth Commercial	$97.20
Rate for Payer: Fidelis Medicare Advantage	$204.12
Rate for Payer: Group Health Inc Commercial	$97.20
Rate for Payer: Group Health Inc Medicare	$68.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.20
Rate for Payer: Hamaspik Choice Inc Medicare	$97.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$126.36

3.1 LONG DRILL

Facility

$824.00

Hospital Charge Code	40005310
Hospital Revenue Code	272
Min. Negotiated Rate	$288.40
Max. Negotiated Rate	$659.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$453.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$412.00
Rate for Payer: Aetna Government	$412.00
Rate for Payer: Brighton Health Commercial	$618.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$659.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$560.32
Rate for Payer: Group Health Inc Commercial	$412.00
Rate for Payer: Group Health Inc Medicare	$288.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$412.00
Rate for Payer: Hamaspik Choice Inc Medicare	$412.00

3.2MM CLAIBRATED DRILL BIT

Facility

$416.00

Hospital Charge Code	40203560
Hospital Revenue Code	272
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$332.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$228.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$208.00
Rate for Payer: Aetna Government	$208.00
Rate for Payer: Brighton Health Commercial	$312.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$332.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$282.88
Rate for Payer: Group Health Inc Commercial	$208.00
Rate for Payer: Group Health Inc Medicare	$145.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$208.00
Rate for Payer: Hamaspik Choice Inc Medicare	$208.00

3.2MM SHORT BIT

Facility

$406.00

Hospital Charge Code	40203561
Hospital Revenue Code	272
Min. Negotiated Rate	$142.10
Max. Negotiated Rate	$324.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$223.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$203.00
Rate for Payer: Aetna Government	$203.00
Rate for Payer: Brighton Health Commercial	$304.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$324.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$276.08
Rate for Payer: Group Health Inc Commercial	$203.00
Rate for Payer: Group Health Inc Medicare	$142.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00

3.3MM DRILL BIT NCB PP TRGT DEVIC

Facility

$200.24

Hospital Charge Code	40006802
Hospital Revenue Code	272
Min. Negotiated Rate	$70.08
Max. Negotiated Rate	$160.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$100.12
Rate for Payer: Aetna Government	$100.12
Rate for Payer: Brighton Health Commercial	$150.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.16
Rate for Payer: Group Health Inc Commercial	$100.12
Rate for Payer: Group Health Inc Medicare	$70.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.12
Rate for Payer: Hamaspik Choice Inc Medicare	$100.12

3.3MM FREE HAND DRILL 152.5MM

Facility

$187.20

Service Code	HCPCS C1713
Hospital Charge Code	40006473
Hospital Revenue Code	278
Min. Negotiated Rate	$65.52
Max. Negotiated Rate	$196.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$102.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$112.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$93.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$107.64
Rate for Payer: EmblemHealth Commercial	$93.60
Rate for Payer: Fidelis Medicare Advantage	$196.56
Rate for Payer: Group Health Inc Commercial	$93.60
Rate for Payer: Group Health Inc Medicare	$65.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.60
Rate for Payer: Hamaspik Choice Inc Medicare	$93.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$121.68

Know your out-of-pocket cost for care.

All Charges