St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NCB FULL THREAD CANCEL SX4.5 L=40

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007200
Hospital Revenue Code	278
Min. Negotiated Rate	$133.49
Max. Negotiated Rate	$133.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49

NCB FULL THREAD CANCEL SX4.5 L=42

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007201
Hospital Revenue Code	278
Min. Negotiated Rate	$133.49
Max. Negotiated Rate	$133.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49

NCB FULL THREAD CANCEL SX4.5 L=42

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007201
Hospital Revenue Code	278
Min. Negotiated Rate	$93.44
Max. Negotiated Rate	$280.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$160.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.51
Rate for Payer: EmblemHealth Commercial	$133.49
Rate for Payer: Fidelis Medicare Advantage	$280.33
Rate for Payer: Group Health Inc Commercial	$133.49
Rate for Payer: Group Health Inc Medicare	$93.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$173.54

NCB FULL THREAD CANCEL SX4.5 L=44

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007202
Hospital Revenue Code	278
Min. Negotiated Rate	$93.44
Max. Negotiated Rate	$280.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$160.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.51
Rate for Payer: EmblemHealth Commercial	$133.49
Rate for Payer: Fidelis Medicare Advantage	$280.33
Rate for Payer: Group Health Inc Commercial	$133.49
Rate for Payer: Group Health Inc Medicare	$93.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$173.54

NCB FULL THREAD CANCEL SX4.5 L=44

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007202
Hospital Revenue Code	278
Min. Negotiated Rate	$133.49
Max. Negotiated Rate	$133.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49

NCB FULL THREAD CANCEL SX4.5 L=46

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007203
Hospital Revenue Code	278
Min. Negotiated Rate	$93.44
Max. Negotiated Rate	$280.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$160.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.51
Rate for Payer: EmblemHealth Commercial	$133.49
Rate for Payer: Fidelis Medicare Advantage	$280.33
Rate for Payer: Group Health Inc Commercial	$133.49
Rate for Payer: Group Health Inc Medicare	$93.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$173.54

NCB FULL THREAD CANCEL SX4.5 L=46

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007203
Hospital Revenue Code	278
Min. Negotiated Rate	$133.49
Max. Negotiated Rate	$133.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49

NCB FULL THREAD CANCEL SX4.5 L=48

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007204
Hospital Revenue Code	278
Min. Negotiated Rate	$133.49
Max. Negotiated Rate	$133.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49

NCB FULL THREAD CANCEL SX4.5 L=48

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007204
Hospital Revenue Code	278
Min. Negotiated Rate	$93.44
Max. Negotiated Rate	$280.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$160.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.51
Rate for Payer: EmblemHealth Commercial	$133.49
Rate for Payer: Fidelis Medicare Advantage	$280.33
Rate for Payer: Group Health Inc Commercial	$133.49
Rate for Payer: Group Health Inc Medicare	$93.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$173.54

NCB FULL THREAD CANCEL SX4.5 L=50

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007205
Hospital Revenue Code	278
Min. Negotiated Rate	$133.49
Max. Negotiated Rate	$133.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49

NCB FULL THREAD CANCEL SX4.5 L=50

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007205
Hospital Revenue Code	278
Min. Negotiated Rate	$93.44
Max. Negotiated Rate	$280.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$160.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.51
Rate for Payer: EmblemHealth Commercial	$133.49
Rate for Payer: Fidelis Medicare Advantage	$280.33
Rate for Payer: Group Health Inc Commercial	$133.49
Rate for Payer: Group Health Inc Medicare	$93.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$173.54

NCB FULL THREAD CANCEL SX4.5 L=55

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007206
Hospital Revenue Code	278
Min. Negotiated Rate	$93.44
Max. Negotiated Rate	$280.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$160.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.51
Rate for Payer: EmblemHealth Commercial	$133.49
Rate for Payer: Fidelis Medicare Advantage	$280.33
Rate for Payer: Group Health Inc Commercial	$133.49
Rate for Payer: Group Health Inc Medicare	$93.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$173.54

NCB FULL THREAD CANCEL SX4.5 L=55

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007206
Hospital Revenue Code	278
Min. Negotiated Rate	$133.49
Max. Negotiated Rate	$133.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49

NCB FULL THREAD CANCEL SX4.5 L=60

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007207
Hospital Revenue Code	278
Min. Negotiated Rate	$93.44
Max. Negotiated Rate	$280.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$160.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.51
Rate for Payer: EmblemHealth Commercial	$133.49
Rate for Payer: Fidelis Medicare Advantage	$280.33
Rate for Payer: Group Health Inc Commercial	$133.49
Rate for Payer: Group Health Inc Medicare	$93.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$173.54

NCB FULL THREAD CANCEL SX4.5 L=60

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007207
Hospital Revenue Code	278
Min. Negotiated Rate	$133.49
Max. Negotiated Rate	$133.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49

NCB FULL THREAD CANCEL SX4.5 L=65

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007208
Hospital Revenue Code	278
Min. Negotiated Rate	$93.44
Max. Negotiated Rate	$280.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$160.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.51
Rate for Payer: EmblemHealth Commercial	$133.49
Rate for Payer: Fidelis Medicare Advantage	$280.33
Rate for Payer: Group Health Inc Commercial	$133.49
Rate for Payer: Group Health Inc Medicare	$93.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$173.54

NCB FULL THREAD CANCEL SX4.5 L=65

Facility

$266.98

Service Code	HCPCS C1713
Hospital Charge Code	40007208
Hospital Revenue Code	278
Min. Negotiated Rate	$133.49
Max. Negotiated Rate	$133.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.49
Rate for Payer: Hamaspik Choice Inc Medicare	$133.49

NCB-GRAPHIC_CASE MODINSTR

Facility

$919.60

Hospital Charge Code	40006838
Hospital Revenue Code	272
Min. Negotiated Rate	$321.86
Max. Negotiated Rate	$735.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$505.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$459.80
Rate for Payer: Aetna Government	$459.80
Rate for Payer: Brighton Health Commercial	$689.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$735.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$625.33
Rate for Payer: Group Health Inc Commercial	$459.80
Rate for Payer: Group Health Inc Medicare	$321.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$459.80
Rate for Payer: Hamaspik Choice Inc Medicare	$459.80

NCB LOCKING CAP STERILE

Facility

$318.90

Service Code	HCPCS C1713
Hospital Charge Code	40006897
Hospital Revenue Code	278
Min. Negotiated Rate	$159.45
Max. Negotiated Rate	$159.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.45
Rate for Payer: Hamaspik Choice Inc Medicare	$159.45

NCB LOCKING CAP STERILE

Facility

$318.90

Service Code	HCPCS C1713
Hospital Charge Code	40006897
Hospital Revenue Code	278
Min. Negotiated Rate	$111.62
Max. Negotiated Rate	$334.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$175.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$191.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$159.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$183.37
Rate for Payer: EmblemHealth Commercial	$159.45
Rate for Payer: Fidelis Medicare Advantage	$334.84
Rate for Payer: Group Health Inc Commercial	$159.45
Rate for Payer: Group Health Inc Medicare	$111.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.45
Rate for Payer: Hamaspik Choice Inc Medicare	$159.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$207.28

NCB LOCKING SCREW CAP

Facility

$318.90

Service Code	HCPCS C1713
Hospital Charge Code	40007542
Hospital Revenue Code	278
Min. Negotiated Rate	$111.62
Max. Negotiated Rate	$334.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$175.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$191.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$159.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$183.37
Rate for Payer: EmblemHealth Commercial	$159.45
Rate for Payer: Fidelis Medicare Advantage	$334.84
Rate for Payer: Group Health Inc Commercial	$159.45
Rate for Payer: Group Health Inc Medicare	$111.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.45
Rate for Payer: Hamaspik Choice Inc Medicare	$159.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$207.28

NCB LOCKING SCREW CAP

Facility

$318.90

Service Code	HCPCS C1713
Hospital Charge Code	40007542
Hospital Revenue Code	278
Min. Negotiated Rate	$159.45
Max. Negotiated Rate	$159.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.45
Rate for Payer: Hamaspik Choice Inc Medicare	$159.45

NCB LOCKING SCREW CAP

Facility

$318.90

Service Code	HCPCS C1713
Hospital Charge Code	40204623
Hospital Revenue Code	278
Min. Negotiated Rate	$159.45
Max. Negotiated Rate	$159.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.45
Rate for Payer: Hamaspik Choice Inc Medicare	$159.45

NCB LOCKING SCREW CAP

Facility

$318.90

Service Code	HCPCS C1713
Hospital Charge Code	40204623
Hospital Revenue Code	278
Min. Negotiated Rate	$111.62
Max. Negotiated Rate	$334.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$175.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$191.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$159.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$183.37
Rate for Payer: EmblemHealth Commercial	$159.45
Rate for Payer: Fidelis Medicare Advantage	$334.84
Rate for Payer: Group Health Inc Commercial	$159.45
Rate for Payer: Group Health Inc Medicare	$111.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.45
Rate for Payer: Hamaspik Choice Inc Medicare	$159.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$207.28

NCB LOCKING SCREW CAP CLIP

Facility

$741.60

Hospital Charge Code	40006746
Hospital Revenue Code	272
Min. Negotiated Rate	$259.56
Max. Negotiated Rate	$593.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$407.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$370.80
Rate for Payer: Aetna Government	$370.80
Rate for Payer: Brighton Health Commercial	$556.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$593.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$504.29
Rate for Payer: Group Health Inc Commercial	$370.80
Rate for Payer: Group Health Inc Medicare	$259.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$370.80
Rate for Payer: Hamaspik Choice Inc Medicare	$370.80

Know your out-of-pocket cost for care.

All Charges