St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NCB_4.0 DP THD SCR L=46MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007113
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=48MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006933
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=48MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006933
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB_4.0 DP THD SCR L=48MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007114
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB_4.0 DP THD SCR L=48MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007114
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=50MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006934
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB 4.0 DP THD SCR L=50MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006934
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB_4.0 DP THD SCR L=50MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007115
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB_4.0 DP THD SCR L=50MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007115
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=55MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006935
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=55MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006935
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB_4.0 DP THD SCR L=55MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007116
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB_4.0 DP THD SCR L=55MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007116
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB 4.0 DP THD SCR L=60MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006936
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=60MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006936
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB_4.0 DP THD SCR L=60MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007117
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB_4.0 DP THD SCR L=60MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007117
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB 4.0 DP THD SCR L=65MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006937
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB 4.0 DP THD SCR L=65MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006937
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB_4.0 DP THD SCR L=65MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007118
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB_4.0 DP THD SCR L=65MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007118
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB 4.0MM DRILL BIT, L 24

Facility

$237.32

Hospital Charge Code	40006796
Hospital Revenue Code	272
Min. Negotiated Rate	$83.06
Max. Negotiated Rate	$189.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$118.66
Rate for Payer: Aetna Government	$118.66
Rate for Payer: Brighton Health Commercial	$177.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$189.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.38
Rate for Payer: Group Health Inc Commercial	$118.66
Rate for Payer: Group Health Inc Medicare	$83.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.66
Rate for Payer: Hamaspik Choice Inc Medicare	$118.66

NCB 4.0MM DRILL_BIT, L 24

Facility

$237.32

Hospital Charge Code	40006869
Hospital Revenue Code	272
Min. Negotiated Rate	$83.06
Max. Negotiated Rate	$189.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$118.66
Rate for Payer: Aetna Government	$118.66
Rate for Payer: Brighton Health Commercial	$177.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$189.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.38
Rate for Payer: Group Health Inc Commercial	$118.66
Rate for Payer: Group Health Inc Medicare	$83.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.66
Rate for Payer: Hamaspik Choice Inc Medicare	$118.66

NCB 4.0MM DRILL GUIDE, LO

Facility

$734.20

Hospital Charge Code	40006797
Hospital Revenue Code	272
Min. Negotiated Rate	$256.97
Max. Negotiated Rate	$587.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$403.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$367.10
Rate for Payer: Aetna Government	$367.10
Rate for Payer: Brighton Health Commercial	$550.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$587.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$499.26
Rate for Payer: Group Health Inc Commercial	$367.10
Rate for Payer: Group Health Inc Medicare	$256.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$367.10
Rate for Payer: Hamaspik Choice Inc Medicare	$367.10

NCB 4.3MM CANN LNG 95 DEG SCRW IN

Facility

$385.64

Hospital Charge Code	40006786
Hospital Revenue Code	272
Min. Negotiated Rate	$134.97
Max. Negotiated Rate	$308.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$212.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$192.82
Rate for Payer: Aetna Government	$192.82
Rate for Payer: Brighton Health Commercial	$289.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$308.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$262.24
Rate for Payer: Group Health Inc Commercial	$192.82
Rate for Payer: Group Health Inc Medicare	$134.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.82
Rate for Payer: Hamaspik Choice Inc Medicare	$192.82

Know your out-of-pocket cost for care.

All Charges