St. Barnabas Hospital

All Charges

Charge

Type

Price

3D PROFIL PLT .6MM 2X2L RECTNGL

Facility IP

$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 3X2L QUADRTE

Facility OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$203.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.02
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 IP

$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 OP

$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	$1,885.92
Rate for Payer: Aetna Government	$1,885.92
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: Cigna HMO/Network Benefit Plan/Open Access	$3,017.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,564.84
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 Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$1,885.92
Rate for Payer: Group Health Inc Medicare	$1,320.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,885.92
Rate for Payer: Hamaspik Choice Inc Medicare	$1,885.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$314.33

3MM X 100CM TEAR DROP GD

Facility OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$174.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$200.42
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 IP

$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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$152.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.83
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 IP

$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 OP

$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: 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 OP

$9.22

Hospital Charge Code	40504051
Hospital Revenue Code	260
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: 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

3X110X10MM SLFDRILLING/SLFTAPPING

Facility OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
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 IP

$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 IP

$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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$63.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.45
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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$195.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.25
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

4.0 FULLY THREADED X 48 SCREW

Facility IP

$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

4.0MMX24MM MOTIONLOC SCREW TI

Facility IP

$252.16

Service Code	HCPCS C1713
Hospital Charge Code	40007239
Hospital Revenue Code	278
Min. Negotiated Rate	$126.08
Max. Negotiated Rate	$126.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.08
Rate for Payer: Hamaspik Choice Inc Medicare	$126.08

4.0MMX24MM MOTIONLOC SCREW TI

Facility OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$126.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.99
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

4.0MMX24MM MOTIONLOC SCR TI STRL

Facility OP

$252.16

Service Code	HCPCS C1713
Hospital Charge Code	40006975
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: Cigna HMO/Network Benefit Plan/Open Access	$126.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.99
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

4.0MMX24MM MOTIONLOC SCR TI STRL

Facility IP

$252.16

Service Code	HCPCS C1713
Hospital Charge Code	40006975
Hospital Revenue Code	278
Min. Negotiated Rate	$126.08
Max. Negotiated Rate	$126.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.08
Rate for Payer: Hamaspik Choice Inc Medicare	$126.08

4.0MMX26MM MOTIONLOC SCREW TI

Facility IP

$252.16

Service Code	HCPCS C1713
Hospital Charge Code	40007240
Hospital Revenue Code	278
Min. Negotiated Rate	$126.08
Max. Negotiated Rate	$126.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.08
Rate for Payer: Hamaspik Choice Inc Medicare	$126.08

4.0MMX26MM MOTIONLOC SCREW TI

Facility OP

$252.16

Service Code	HCPCS C1713
Hospital Charge Code	40007240
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: Cigna HMO/Network Benefit Plan/Open Access	$126.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.99
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

4.0MMX26MM MOTIONLOC SCR TI STRL

Facility OP

$252.16

Service Code	HCPCS C1713
Hospital Charge Code	40006976
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: Cigna HMO/Network Benefit Plan/Open Access	$126.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.99
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

4.0MMX26MM MOTIONLOC SCR TI STRL

Facility IP

$252.16

Service Code	HCPCS C1713
Hospital Charge Code	40006976
Hospital Revenue Code	278
Min. Negotiated Rate	$126.08
Max. Negotiated Rate	$126.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.08
Rate for Payer: Hamaspik Choice Inc Medicare	$126.08

4.0MMX28MM MOTIONLOC SCREW TI

Facility IP

$252.16

Service Code	HCPCS C1713
Hospital Charge Code	40007241
Hospital Revenue Code	278
Min. Negotiated Rate	$126.08
Max. Negotiated Rate	$126.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.08
Rate for Payer: Hamaspik Choice Inc Medicare	$126.08

Price Transparency.

All Charges