St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

JOINT RESECT TOES W IMPLANT

Facility

$18,117.83

Service Code	HCPCS 28291
Hospital Charge Code	40029958
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,273.12

JOINT TOE 21.5MM CC

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64905096
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,250.00

JOINT TOE 21.5MM CC

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64905096
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,725.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,475.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,700.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,587.50
Rate for Payer: EmblemHealth Commercial	$2,250.00
Rate for Payer: Fidelis Medicare Advantage	$4,725.00
Rate for Payer: Group Health Inc Commercial	$2,250.00
Rate for Payer: Group Health Inc Medicare	$1,575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,925.00

JOINT, TOE NON-POR COATED C 33.6

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64905229
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,150.00
Rate for Payer: EmblemHealth Commercial	$1,000.00
Rate for Payer: Fidelis Medicare Advantage	$2,100.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,300.00

JOINT, TOE NON-POR COATED C 33.6

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64905229
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

JOINT UNIVERSAL FOR TWO TUBES

Facility

$1,136.00

Hospital Charge Code	40200196
Hospital Revenue Code	270
Min. Negotiated Rate	$397.60
Max. Negotiated Rate	$908.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$624.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$568.00
Rate for Payer: Aetna Government	$568.00
Rate for Payer: Brighton Health Commercial	$852.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$908.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$772.48
Rate for Payer: Group Health Inc Commercial	$568.00
Rate for Payer: Group Health Inc Medicare	$397.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$568.00
Rate for Payer: Hamaspik Choice Inc Medicare	$568.00

JONES SUSPENSION

Facility

$18,117.83

Service Code	HCPCS 28760
Hospital Charge Code	40082670
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$13,588.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,273.12
Rate for Payer: Aetna Government	$8,273.12
Rate for Payer: Affinity Essential Plan 1&2	$5,791.18
Rate for Payer: Affinity Essential Plan 3&4	$5,791.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$5,791.18
Rate for Payer: Brighton Health Commercial	$13,588.37
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,273.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$8,273.12
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$7,032.15
Rate for Payer: Fidelis Essential Plan QHP	$7,363.08
Rate for Payer: Fidelis Medicare Advantage	$8,273.12
Rate for Payer: Fidelis Qualified Health Plan	$7,363.08
Rate for Payer: Group Health Inc Commercial	$8,273.12
Rate for Payer: Group Health Inc Medicare	$8,273.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,058.92
Rate for Payer: Hamaspik Choice Inc Medicare	$8,273.12
Rate for Payer: Healthfirst Medicare Advantage	$7,032.15
Rate for Payer: Healthfirst QHP	$8,273.12
Rate for Payer: Humana Medicare	$8,438.58
Rate for Payer: Senior Whole Health Medicare Advantage	$8,273.12
Rate for Payer: United Healthcare Commercial	$2,546.00
Rate for Payer: United Healthcare Medicare Advantage	$8,273.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,273.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,618.50
Rate for Payer: Wellcare Medicare	$7,859.46

JONES SUSPENSION

Facility

$18,117.83

Service Code	HCPCS 28760
Hospital Charge Code	40082670
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,273.12

JOSEPH RASP 6 1/2

Facility

$195.93

Hospital Charge Code	64903622
Hospital Revenue Code	270
Min. Negotiated Rate	$68.58
Max. Negotiated Rate	$156.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$107.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$97.96
Rate for Payer: Aetna Government	$97.96
Rate for Payer: Brighton Health Commercial	$146.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$156.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$133.23
Rate for Payer: Group Health Inc Commercial	$97.96
Rate for Payer: Group Health Inc Medicare	$68.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.96
Rate for Payer: Hamaspik Choice Inc Medicare	$97.96

JOYSTICK SCREW HOLES T8

Facility

$1,715.35

Service Code	HCPCS C1713
Hospital Charge Code	64907537
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,801.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$943.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,029.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$857.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$986.33
Rate for Payer: EmblemHealth Commercial	$857.68
Rate for Payer: Fidelis Medicare Advantage	$1,801.12
Rate for Payer: Group Health Inc Commercial	$857.68
Rate for Payer: Group Health Inc Medicare	$600.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$857.68
Rate for Payer: Hamaspik Choice Inc Medicare	$857.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,114.98

JOYSTICK SCREW HOLES T8

Facility

$1,715.35

Service Code	HCPCS C1713
Hospital Charge Code	64907537
Hospital Revenue Code	278
Min. Negotiated Rate	$857.68
Max. Negotiated Rate	$857.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$857.68
Rate for Payer: Hamaspik Choice Inc Medicare	$857.68

K084-IGE SUNFLOWER SEED

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729311
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.22

K084-IGE SUNFLOWER SEED

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729311
Hospital Revenue Code	300
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$9.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.22
Rate for Payer: Aetna Government	$5.22
Rate for Payer: Affinity Essential Plan 1&2	$3.65
Rate for Payer: Affinity Essential Plan 3&4	$3.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.65
Rate for Payer: Brighton Health Commercial	$9.79
Rate for Payer: Cash Price	$5.22
Rate for Payer: Cash Price	$5.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.01
Rate for Payer: Elderplan Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$5.22
Rate for Payer: Fidelis Essential Plan Aliesa	$4.44
Rate for Payer: Fidelis Essential Plan QHP	$4.65
Rate for Payer: Fidelis Medicare Advantage	$5.22
Rate for Payer: Fidelis Qualified Health Plan	$4.65
Rate for Payer: Group Health Inc Commercial	$5.22
Rate for Payer: Group Health Inc Medicare	$5.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.52
Rate for Payer: Hamaspik Choice Inc Medicare	$5.22
Rate for Payer: Healthfirst Medicare Advantage	$5.22
Rate for Payer: Healthfirst QHP	$5.22
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Senior Whole Health Medicare Advantage	$5.22
Rate for Payer: United Healthcare Commercial	$6.61
Rate for Payer: United Healthcare Medicare Advantage	$5.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.18
Rate for Payer: Wellcare Medicare	$4.70

K2 HEMITOE IMPLANT SIZE 3

Facility

$3,190.74

Hospital Charge Code	40209711
Hospital Revenue Code	272
Min. Negotiated Rate	$1,116.76
Max. Negotiated Rate	$2,552.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,754.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,595.37
Rate for Payer: Aetna Government	$1,595.37
Rate for Payer: Brighton Health Commercial	$2,393.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,552.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,169.70
Rate for Payer: Group Health Inc Commercial	$1,595.37
Rate for Payer: Group Health Inc Medicare	$1,116.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,595.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1,595.37

K2 HEMITOE IMPLANT SZ 4

Facility

$1,496.00

Hospital Charge Code	40209959
Hospital Revenue Code	272
Min. Negotiated Rate	$523.60
Max. Negotiated Rate	$1,196.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$822.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$748.00
Rate for Payer: Aetna Government	$748.00
Rate for Payer: Brighton Health Commercial	$1,122.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,196.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,017.28
Rate for Payer: Group Health Inc Commercial	$748.00
Rate for Payer: Group Health Inc Medicare	$523.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$748.00
Rate for Payer: Hamaspik Choice Inc Medicare	$748.00

KAIRISON DISPOS/TUBES BOX OF 10

Facility

$2,475.50

Hospital Charge Code	40209550
Hospital Revenue Code	270
Min. Negotiated Rate	$866.42
Max. Negotiated Rate	$1,980.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,361.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,237.75
Rate for Payer: Aetna Government	$1,237.75
Rate for Payer: Brighton Health Commercial	$1,856.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,980.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,683.34
Rate for Payer: Group Health Inc Commercial	$1,237.75
Rate for Payer: Group Health Inc Medicare	$866.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,237.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,237.75

KAIRISON PNEUM PUNCH HANDLE

Facility

$10,916.00

Hospital Charge Code	40209535
Hospital Revenue Code	270
Min. Negotiated Rate	$3,820.60
Max. Negotiated Rate	$8,732.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,003.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,458.00
Rate for Payer: Aetna Government	$5,458.00
Rate for Payer: Brighton Health Commercial	$8,187.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,732.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,422.88
Rate for Payer: Group Health Inc Commercial	$5,458.00
Rate for Payer: Group Health Inc Medicare	$3,820.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,458.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,458.00

KAIRISON SHAFT DET.UP 235MM 2MM

Facility

$2,196.50

Hospital Charge Code	40209540
Hospital Revenue Code	270
Min. Negotiated Rate	$768.78
Max. Negotiated Rate	$1,757.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,208.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,098.25
Rate for Payer: Aetna Government	$1,098.25
Rate for Payer: Brighton Health Commercial	$1,647.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,757.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,493.62
Rate for Payer: Group Health Inc Commercial	$1,098.25
Rate for Payer: Group Health Inc Medicare	$768.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,098.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,098.25

KAIRISON SHAFT DET.UP 235MM 3MM

Facility

$2,196.50

Hospital Charge Code	40209541
Hospital Revenue Code	270
Min. Negotiated Rate	$768.78
Max. Negotiated Rate	$1,757.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,208.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,098.25
Rate for Payer: Aetna Government	$1,098.25
Rate for Payer: Brighton Health Commercial	$1,647.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,757.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,493.62
Rate for Payer: Group Health Inc Commercial	$1,098.25
Rate for Payer: Group Health Inc Medicare	$768.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,098.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,098.25

KAIRISON SHAFT DET.UP 235MM 4MM

Facility

$2,196.50

Hospital Charge Code	40209543
Hospital Revenue Code	270
Min. Negotiated Rate	$768.78
Max. Negotiated Rate	$1,757.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,208.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,098.25
Rate for Payer: Aetna Government	$1,098.25
Rate for Payer: Brighton Health Commercial	$1,647.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,757.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,493.62
Rate for Payer: Group Health Inc Commercial	$1,098.25
Rate for Payer: Group Health Inc Medicare	$768.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,098.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,098.25

KAIRISON SHAFT DET.UP 235MM 5MM

Facility

$2,196.50

Hospital Charge Code	40209542
Hospital Revenue Code	270
Min. Negotiated Rate	$768.78
Max. Negotiated Rate	$1,757.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,208.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,098.25
Rate for Payer: Aetna Government	$1,098.25
Rate for Payer: Brighton Health Commercial	$1,647.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,757.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,493.62
Rate for Payer: Group Health Inc Commercial	$1,098.25
Rate for Payer: Group Health Inc Medicare	$768.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,098.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,098.25

KAIRISON SHAFT DET.UP 235MM 6MM

Facility

$2,196.50

Hospital Charge Code	40209544
Hospital Revenue Code	270
Min. Negotiated Rate	$768.78
Max. Negotiated Rate	$1,757.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,208.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,098.25
Rate for Payer: Aetna Government	$1,098.25
Rate for Payer: Brighton Health Commercial	$1,647.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,757.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,493.62
Rate for Payer: Group Health Inc Commercial	$1,098.25
Rate for Payer: Group Health Inc Medicare	$768.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,098.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,098.25

KAIRISON WIRE BASKET

Facility

$1,084.00

Hospital Charge Code	40209545
Hospital Revenue Code	270
Min. Negotiated Rate	$379.40
Max. Negotiated Rate	$867.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$596.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$542.00
Rate for Payer: Aetna Government	$542.00
Rate for Payer: Brighton Health Commercial	$813.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$867.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$737.12
Rate for Payer: Group Health Inc Commercial	$542.00
Rate for Payer: Group Health Inc Medicare	$379.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$542.00
Rate for Payer: Hamaspik Choice Inc Medicare	$542.00

KANAMYCIN 1000 MG/3 ML INJ

Facility

$37.00

Service Code	HCPCS J1840
Hospital Charge Code	41652990
Hospital Revenue Code	636
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$18.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.50
Rate for Payer: Hamaspik Choice Inc Medicare	$18.50

KANAMYCIN 1000 MG/3 ML INJ

Facility

$37.00

Service Code	HCPCS J1840
Hospital Charge Code	41642990
Hospital Revenue Code	636
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$24.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.22
Rate for Payer: Aetna Government	$6.22
Rate for Payer: Brighton Health Commercial	$22.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.28
Rate for Payer: Group Health Inc Commercial	$18.50
Rate for Payer: Group Health Inc Medicare	$12.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.50
Rate for Payer: Hamaspik Choice Inc Medicare	$18.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.05

Know your out-of-pocket cost for care.

All Charges