St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NCB-PH PLATE TRAY

Facility

$1,223.64

Hospital Charge Code	40006829
Hospital Revenue Code	272
Min. Negotiated Rate	$428.27
Max. Negotiated Rate	$978.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$673.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$611.82
Rate for Payer: Aetna Government	$611.82
Rate for Payer: Brighton Health Commercial	$917.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$978.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$832.08
Rate for Payer: Group Health Inc Commercial	$611.82
Rate for Payer: Group Health Inc Medicare	$428.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$611.82
Rate for Payer: Hamaspik Choice Inc Medicare	$611.82

NCB-PH PLATE W 4 LOCK HOLES

Facility

$2,773.60

Service Code	HCPCS C1713
Hospital Charge Code	40006996
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,912.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,525.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,664.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,386.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,594.82
Rate for Payer: EmblemHealth Commercial	$1,386.80
Rate for Payer: Fidelis Medicare Advantage	$2,912.28
Rate for Payer: Group Health Inc Commercial	$1,386.80
Rate for Payer: Group Health Inc Medicare	$970.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,386.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1,386.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,802.84

NCB-PH PLATE W 4 LOCK HOLES

Facility

$2,773.60

Service Code	HCPCS C1713
Hospital Charge Code	40006996
Hospital Revenue Code	278
Min. Negotiated Rate	$1,386.80
Max. Negotiated Rate	$1,386.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,386.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1,386.80

NCB-PH PLATE W 5 LOCK HOLES

Facility

$2,818.08

Service Code	HCPCS C1713
Hospital Charge Code	40006997
Hospital Revenue Code	278
Min. Negotiated Rate	$1,409.04
Max. Negotiated Rate	$1,409.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,409.04
Rate for Payer: Hamaspik Choice Inc Medicare	$1,409.04

NCB-PH PLATE W 5 LOCK HOLES

Facility

$2,818.08

Service Code	HCPCS C1713
Hospital Charge Code	40006997
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,958.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,549.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,690.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,409.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,620.40
Rate for Payer: EmblemHealth Commercial	$1,409.04
Rate for Payer: Fidelis Medicare Advantage	$2,958.98
Rate for Payer: Group Health Inc Commercial	$1,409.04
Rate for Payer: Group Health Inc Medicare	$986.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,409.04
Rate for Payer: Hamaspik Choice Inc Medicare	$1,409.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,831.75

NCB-PH PLATE W 7 LOCK HOLES

Facility

$3,381.70

Service Code	HCPCS C1713
Hospital Charge Code	40006998
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,550.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,859.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,029.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,690.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,944.48
Rate for Payer: EmblemHealth Commercial	$1,690.85
Rate for Payer: Fidelis Medicare Advantage	$3,550.78
Rate for Payer: Group Health Inc Commercial	$1,690.85
Rate for Payer: Group Health Inc Medicare	$1,183.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,690.85
Rate for Payer: Hamaspik Choice Inc Medicare	$1,690.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,198.10

NCB-PH PLATE W 7 LOCK HOLES

Facility

$3,381.70

Service Code	HCPCS C1713
Hospital Charge Code	40006998
Hospital Revenue Code	278
Min. Negotiated Rate	$1,690.85
Max. Negotiated Rate	$1,690.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,690.85
Rate for Payer: Hamaspik Choice Inc Medicare	$1,690.85

NCB-PH/PT CANNULATED DEPTH GAUGE

Facility

$407.88

Hospital Charge Code	40006757
Hospital Revenue Code	272
Min. Negotiated Rate	$142.76
Max. Negotiated Rate	$326.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$203.94
Rate for Payer: Aetna Government	$203.94
Rate for Payer: Brighton Health Commercial	$305.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$326.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$277.36
Rate for Payer: Group Health Inc Commercial	$203.94
Rate for Payer: Group Health Inc Medicare	$142.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.94
Rate for Payer: Hamaspik Choice Inc Medicare	$203.94

NCB-PH SCREW RACK

Facility

$563.62

Hospital Charge Code	40006830
Hospital Revenue Code	272
Min. Negotiated Rate	$197.27
Max. Negotiated Rate	$450.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$281.81
Rate for Payer: Aetna Government	$281.81
Rate for Payer: Brighton Health Commercial	$422.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$450.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$383.26
Rate for Payer: Group Health Inc Commercial	$281.81
Rate for Payer: Group Health Inc Medicare	$197.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.81
Rate for Payer: Hamaspik Choice Inc Medicare	$281.81

NCB-PH SMALL DEPTH GAU

Facility

$667.44

Hospital Charge Code	40006756
Hospital Revenue Code	272
Min. Negotiated Rate	$233.60
Max. Negotiated Rate	$533.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$333.72
Rate for Payer: Aetna Government	$333.72
Rate for Payer: Brighton Health Commercial	$500.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$533.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$453.86
Rate for Payer: Group Health Inc Commercial	$333.72
Rate for Payer: Group Health Inc Medicare	$233.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$333.72
Rate for Payer: Hamaspik Choice Inc Medicare	$333.72

NCB-PH SOFT TISS SLEEVE 10/8.0MM

Facility

$400.48

Hospital Charge Code	40006738
Hospital Revenue Code	272
Min. Negotiated Rate	$140.17
Max. Negotiated Rate	$320.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$200.24
Rate for Payer: Aetna Government	$200.24
Rate for Payer: Brighton Health Commercial	$300.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.33
Rate for Payer: Group Health Inc Commercial	$200.24
Rate for Payer: Group Health Inc Medicare	$140.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24

NCB-PH TARGETING GUIDE

Facility

$1,705.68

Hospital Charge Code	40006734
Hospital Revenue Code	272
Min. Negotiated Rate	$596.99
Max. Negotiated Rate	$1,364.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$938.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$852.84
Rate for Payer: Aetna Government	$852.84
Rate for Payer: Brighton Health Commercial	$1,279.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,364.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,159.86
Rate for Payer: Group Health Inc Commercial	$852.84
Rate for Payer: Group Health Inc Medicare	$596.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$852.84
Rate for Payer: Hamaspik Choice Inc Medicare	$852.84

NCB-PH TARGETING MOD FOR DEVICE

Facility

$3,900.82

Hospital Charge Code	40006752
Hospital Revenue Code	272
Min. Negotiated Rate	$1,365.29
Max. Negotiated Rate	$3,120.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,950.41
Rate for Payer: Aetna Government	$1,950.41
Rate for Payer: Brighton Health Commercial	$2,925.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,120.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,652.56
Rate for Payer: Group Health Inc Commercial	$1,950.41
Rate for Payer: Group Health Inc Medicare	$1,365.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.41
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.41

NCB-PH TIS PRO SLEEVE FOR0024.202

Facility

$459.80

Hospital Charge Code	40006753
Hospital Revenue Code	272
Min. Negotiated Rate	$160.93
Max. Negotiated Rate	$367.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$252.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$229.90
Rate for Payer: Aetna Government	$229.90
Rate for Payer: Brighton Health Commercial	$344.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$367.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$312.66
Rate for Payer: Group Health Inc Commercial	$229.90
Rate for Payer: Group Health Inc Medicare	$160.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.90
Rate for Payer: Hamaspik Choice Inc Medicare	$229.90

NCB-PH TIS PROTEC SLE FO00024.220

Facility

$533.96

Hospital Charge Code	40006760
Hospital Revenue Code	272
Min. Negotiated Rate	$186.89
Max. Negotiated Rate	$427.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$293.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$266.98
Rate for Payer: Aetna Government	$266.98
Rate for Payer: Brighton Health Commercial	$400.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$427.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$363.09
Rate for Payer: Group Health Inc Commercial	$266.98
Rate for Payer: Group Health Inc Medicare	$186.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$266.98
Rate for Payer: Hamaspik Choice Inc Medicare	$266.98

NCB-PH TROCAR 1.6MM

Facility

$400.48

Hospital Charge Code	40006741
Hospital Revenue Code	272
Min. Negotiated Rate	$140.17
Max. Negotiated Rate	$320.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$200.24
Rate for Payer: Aetna Government	$200.24
Rate for Payer: Brighton Health Commercial	$300.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.33
Rate for Payer: Group Health Inc Commercial	$200.24
Rate for Payer: Group Health Inc Medicare	$140.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24

NCBPH TRQ SCRDV4MM,3.5MM HX,248MM

Facility

$2,491.78

Hospital Charge Code	40006709
Hospital Revenue Code	272
Min. Negotiated Rate	$872.12
Max. Negotiated Rate	$1,993.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,370.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,245.89
Rate for Payer: Aetna Government	$1,245.89
Rate for Payer: Brighton Health Commercial	$1,868.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,993.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,694.41
Rate for Payer: Group Health Inc Commercial	$1,245.89
Rate for Payer: Group Health Inc Medicare	$872.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,245.89
Rate for Payer: Hamaspik Choice Inc Medicare	$1,245.89

NCB PLATE INS W 2.0MM CANNULATION

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40006800
Hospital Revenue Code	278
Min. Negotiated Rate	$200.24
Max. Negotiated Rate	$200.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24

NCB PLATE INS W 2.0MM CANNULATION

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40006800
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$240.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.28
Rate for Payer: EmblemHealth Commercial	$200.24
Rate for Payer: Fidelis Medicare Advantage	$420.50
Rate for Payer: Group Health Inc Commercial	$200.24
Rate for Payer: Group Health Inc Medicare	$140.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.31

NCB-PP ADD-ON NCB-DF SCREW CADDY

Facility

$1,231.06

Service Code	HCPCS C1713
Hospital Charge Code	40006856
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,292.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$677.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$738.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$615.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$707.86
Rate for Payer: EmblemHealth Commercial	$615.53
Rate for Payer: Fidelis Medicare Advantage	$1,292.61
Rate for Payer: Group Health Inc Commercial	$615.53
Rate for Payer: Group Health Inc Medicare	$430.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$615.53
Rate for Payer: Hamaspik Choice Inc Medicare	$615.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$800.19

NCB-PP ADD-ON NCB-DF SCREW CADDY

Facility

$1,231.06

Service Code	HCPCS C1713
Hospital Charge Code	40006856
Hospital Revenue Code	278
Min. Negotiated Rate	$615.53
Max. Negotiated Rate	$615.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$615.53
Rate for Payer: Hamaspik Choice Inc Medicare	$615.53

NCB-PP ADD-ON TO NCB-DF BASE

Facility

$1,898.50

Service Code	HCPCS C1713
Hospital Charge Code	40006855
Hospital Revenue Code	278
Min. Negotiated Rate	$949.25
Max. Negotiated Rate	$949.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$949.25
Rate for Payer: Hamaspik Choice Inc Medicare	$949.25

NCB-PP ADD-ON TO NCB-DF BASE

Facility

$1,898.50

Service Code	HCPCS C1713
Hospital Charge Code	40006855
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,993.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,044.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,139.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$949.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,091.64
Rate for Payer: EmblemHealth Commercial	$949.25
Rate for Payer: Fidelis Medicare Advantage	$1,993.42
Rate for Payer: Group Health Inc Commercial	$949.25
Rate for Payer: Group Health Inc Medicare	$664.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$949.25
Rate for Payer: Hamaspik Choice Inc Medicare	$949.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,234.02

NCB-PP ADD-ON TO NCB-DF BASE/TRAY

Facility

$4,553.44

Service Code	HCPCS C1713
Hospital Charge Code	40006854
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,781.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,504.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,732.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,276.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,618.23
Rate for Payer: EmblemHealth Commercial	$2,276.72
Rate for Payer: Fidelis Medicare Advantage	$4,781.11
Rate for Payer: Group Health Inc Commercial	$2,276.72
Rate for Payer: Group Health Inc Medicare	$1,593.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,276.72
Rate for Payer: Hamaspik Choice Inc Medicare	$2,276.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,959.74

NCB-PP ADD-ON TO NCB-DF BASE/TRAY

Facility

$4,553.44

Service Code	HCPCS C1713
Hospital Charge Code	40006854
Hospital Revenue Code	278
Min. Negotiated Rate	$2,276.72
Max. Negotiated Rate	$2,276.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,276.72
Rate for Payer: Hamaspik Choice Inc Medicare	$2,276.72

Know your out-of-pocket cost for care.

All Charges