St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

3D PLT 6X2H, CURVED SQUARE

Facility

$656.00

Service Code	HCPCS C1713
Hospital Charge Code	40209834
Hospital Revenue Code	278
Min. Negotiated Rate	$328.00
Max. Negotiated Rate	$328.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$328.00

3D PLT 6X2H, CURVED SQUARE

Facility

$656.00

Service Code	HCPCS C1713
Hospital Charge Code	40209834
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$688.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$360.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$393.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$328.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$377.20
Rate for Payer: EmblemHealth Commercial	$328.00
Rate for Payer: Fidelis Medicare Advantage	$688.80
Rate for Payer: Group Health Inc Commercial	$328.00
Rate for Payer: Group Health Inc Medicare	$229.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$328.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$426.40

3D PLT,6X2 HOLE,CURVED SQUARE

Facility

$656.00

Service Code	HCPCS C1713
Hospital Charge Code	40201070
Hospital Revenue Code	278
Min. Negotiated Rate	$328.00
Max. Negotiated Rate	$328.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$328.00

3D PLT,6X2 HOLE,CURVED SQUARE

Facility

$656.00

Service Code	HCPCS C1713
Hospital Charge Code	40201070
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$688.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$360.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$393.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$328.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$377.20
Rate for Payer: EmblemHealth Commercial	$328.00
Rate for Payer: Fidelis Medicare Advantage	$688.80
Rate for Payer: Group Health Inc Commercial	$328.00
Rate for Payer: Group Health Inc Medicare	$229.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$328.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$426.40

3D PLTE 3X2 HOLE SQUR 6MM PROFILE

Facility

$408.00

Service Code	HCPCS C1713
Hospital Charge Code	40201067
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$428.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$244.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.60
Rate for Payer: EmblemHealth Commercial	$204.00
Rate for Payer: Fidelis Medicare Advantage	$428.40
Rate for Payer: Group Health Inc Commercial	$204.00
Rate for Payer: Group Health Inc Medicare	$142.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.00
Rate for Payer: Hamaspik Choice Inc Medicare	$204.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$265.20

3D PLTE 3X2 HOLE SQUR 6MM PROFILE

Facility

$408.00

Service Code	HCPCS C1713
Hospital Charge Code	40201067
Hospital Revenue Code	278
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$204.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.00
Rate for Payer: Hamaspik Choice Inc Medicare	$204.00

3D PROFIL PLT .6MM 2X2L RECTNGL

Facility

$365.00

Service Code	HCPCS C1713
Hospital Charge Code	40201063
Hospital Revenue Code	278
Min. Negotiated Rate	$182.50
Max. Negotiated Rate	$182.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.50
Rate for Payer: Hamaspik Choice Inc Medicare	$182.50

3D PROFIL PLT .6MM 2X2L RECTNGL

Facility

$365.00

Service Code	HCPCS C1713
Hospital Charge Code	40201063
Hospital Revenue Code	278
Min. Negotiated Rate	$127.75
Max. Negotiated Rate	$383.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$200.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$219.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$182.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$209.88
Rate for Payer: EmblemHealth Commercial	$182.50
Rate for Payer: Fidelis Medicare Advantage	$383.25
Rate for Payer: Group Health Inc Commercial	$182.50
Rate for Payer: Group Health Inc Medicare	$127.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.50
Rate for Payer: Hamaspik Choice Inc Medicare	$182.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$237.25

3D PROFIL PLT .6MM 3X2L QUADRTE

Facility

$407.00

Service Code	HCPCS C1713
Hospital Charge Code	40201204
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$427.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$223.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$244.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$203.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.02
Rate for Payer: EmblemHealth Commercial	$203.50
Rate for Payer: Fidelis Medicare Advantage	$427.35
Rate for Payer: Group Health Inc Commercial	$203.50
Rate for Payer: Group Health Inc Medicare	$142.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.50
Rate for Payer: Hamaspik Choice Inc Medicare	$203.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$264.55

3D PROFIL PLT .6MM 3X2L QUADRTE

Facility

$407.00

Service Code	HCPCS C1713
Hospital Charge Code	40201204
Hospital Revenue Code	278
Min. Negotiated Rate	$203.50
Max. Negotiated Rate	$203.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.50
Rate for Payer: Hamaspik Choice Inc Medicare	$203.50

3D RADIOTHERAPY PLAN

Facility

$3,771.83

Service Code	HCPCS 77295 TC
Hospital Charge Code	66542931
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$3,017.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,074.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,602.37
Rate for Payer: Aetna Government	$1,602.37
Rate for Payer: Affinity Essential Plan 1&2	$1,121.66
Rate for Payer: Affinity Essential Plan 3&4	$1,121.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,121.66
Rate for Payer: Brighton Health Commercial	$2,828.87
Rate for Payer: Cash Price	$1,602.37
Rate for Payer: Cash Price	$1,602.37
Rate for Payer: Cash Price	$1,602.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,602.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,017.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,564.84
Rate for Payer: Elderplan Medicare Advantage	$1,602.37
Rate for Payer: EmblemHealth Commercial	$1,602.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Medicare Advantage	$1,602.37
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$1,602.37
Rate for Payer: Group Health Inc Medicare	$1,602.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,885.92
Rate for Payer: Hamaspik Choice Inc Medicare	$1,602.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,442.13
Rate for Payer: Healthfirst Medicare Advantage	$1,602.37
Rate for Payer: Healthfirst QHP	$1,602.37
Rate for Payer: Humana Medicare	$1,634.42
Rate for Payer: Senior Whole Health Medicare Advantage	$1,602.37
Rate for Payer: United Healthcare Medicare Advantage	$1,602.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,602.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,281.90
Rate for Payer: Wellcare Medicare	$1,522.25

3D RADIOTHERAPY PLAN

Facility

$3,771.83

Service Code	HCPCS 77295 TC
Hospital Charge Code	66542931
Hospital Revenue Code	333
Rate for Payer: Cash Price	$1,602.37

3MM X 100CM TEAR DROP GD

Facility

$348.56

Service Code	HCPCS C1713
Hospital Charge Code	40006475
Hospital Revenue Code	278
Min. Negotiated Rate	$122.00
Max. Negotiated Rate	$365.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$191.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$209.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$174.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$200.42
Rate for Payer: EmblemHealth Commercial	$174.28
Rate for Payer: Fidelis Medicare Advantage	$365.99
Rate for Payer: Group Health Inc Commercial	$174.28
Rate for Payer: Group Health Inc Medicare	$122.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.28
Rate for Payer: Hamaspik Choice Inc Medicare	$174.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$226.56

3MM X 100CM TEAR DROP GD

Facility

$348.56

Service Code	HCPCS C1713
Hospital Charge Code	40006475
Hospital Revenue Code	278
Min. Negotiated Rate	$174.28
Max. Negotiated Rate	$174.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.28
Rate for Payer: Hamaspik Choice Inc Medicare	$174.28

3MM X 70CM TEAR DROP GD W

Facility

$304.06

Service Code	HCPCS C1713
Hospital Charge Code	40006477
Hospital Revenue Code	278
Min. Negotiated Rate	$106.42
Max. Negotiated Rate	$319.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$167.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$182.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$152.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.83
Rate for Payer: EmblemHealth Commercial	$152.03
Rate for Payer: Fidelis Medicare Advantage	$319.26
Rate for Payer: Group Health Inc Commercial	$152.03
Rate for Payer: Group Health Inc Medicare	$106.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.03
Rate for Payer: Hamaspik Choice Inc Medicare	$152.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.64

3MM X 70CM TEAR DROP GD W

Facility

$304.06

Service Code	HCPCS C1713
Hospital Charge Code	40006477
Hospital Revenue Code	278
Min. Negotiated Rate	$152.03
Max. Negotiated Rate	$152.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.03
Rate for Payer: Hamaspik Choice Inc Medicare	$152.03

3M PAIR PAWS WARMING GOWN

Facility

$20.94

Hospital Charge Code	66526864
Hospital Revenue Code	270
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$16.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.47
Rate for Payer: Aetna Government	$10.47
Rate for Payer: Brighton Health Commercial	$15.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.24
Rate for Payer: Group Health Inc Commercial	$10.47
Rate for Payer: Group Health Inc Medicare	$7.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.47
Rate for Payer: Hamaspik Choice Inc Medicare	$10.47

3, SODIUM CHLOIDE -500CC

Facility

$9.22

Hospital Charge Code	40504051
Hospital Revenue Code	260
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$76.00
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
Rate for Payer: United Healthcare Commercial	$76.00

3X110X10MM SLFDRILLING/SLFTAPPING

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	40200594
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$60.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: EmblemHealth Commercial	$50.00
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

3X110X10MM SLFDRILLING/SLFTAPPING

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	40200594
Hospital Revenue Code	278
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

3X60X10MM SELFTAPPING/SLFDRILLING

Facility

$126.00

Service Code	HCPCS C1713
Hospital Charge Code	40200595
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$63.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.00
Rate for Payer: Hamaspik Choice Inc Medicare	$63.00

3X60X10MM SELFTAPPING/SLFDRILLING

Facility

$126.00

Service Code	HCPCS C1713
Hospital Charge Code	40200595
Hospital Revenue Code	278
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$75.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.45
Rate for Payer: EmblemHealth Commercial	$63.00
Rate for Payer: Fidelis Medicare Advantage	$132.30
Rate for Payer: Group Health Inc Commercial	$63.00
Rate for Payer: Group Health Inc Medicare	$44.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.00
Rate for Payer: Hamaspik Choice Inc Medicare	$63.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.90

4.0 FULLY THREADED X 48 SCREW

Facility

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64902929
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$195.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.00
Rate for Payer: Hamaspik Choice Inc Medicare	$195.00

4.0 FULLY THREADED X 48 SCREW

Facility

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64902929
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$409.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$214.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$234.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$195.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.25
Rate for Payer: EmblemHealth Commercial	$195.00
Rate for Payer: Fidelis Medicare Advantage	$409.50
Rate for Payer: Group Health Inc Commercial	$195.00
Rate for Payer: Group Health Inc Medicare	$136.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.00
Rate for Payer: Hamaspik Choice Inc Medicare	$195.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$253.50

4.0MMX24MM MOTIONLOC SCREW TI

Facility

$252.16

Service Code	HCPCS C1713
Hospital Charge Code	40007239
Hospital Revenue Code	278
Min. Negotiated Rate	$88.26
Max. Negotiated Rate	$264.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$151.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.99
Rate for Payer: EmblemHealth Commercial	$126.08
Rate for Payer: Fidelis Medicare Advantage	$264.77
Rate for Payer: Group Health Inc Commercial	$126.08
Rate for Payer: Group Health Inc Medicare	$88.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.08
Rate for Payer: Hamaspik Choice Inc Medicare	$126.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.90

Know your out-of-pocket cost for care.

All Charges