St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NCB-PP ADD-ON TO NCB-DF TRAY

Facility

$1,023.42

Service Code	HCPCS C1713
Hospital Charge Code	40006857
Hospital Revenue Code	278
Min. Negotiated Rate	$511.71
Max. Negotiated Rate	$511.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$511.71
Rate for Payer: Hamaspik Choice Inc Medicare	$511.71

NCB-PP ADD-ON TO NCB-DF TRAY

Facility

$1,023.42

Service Code	HCPCS C1713
Hospital Charge Code	40006857
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,074.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$562.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$614.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$511.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$588.47
Rate for Payer: EmblemHealth Commercial	$511.71
Rate for Payer: Fidelis Medicare Advantage	$1,074.59
Rate for Payer: Group Health Inc Commercial	$511.71
Rate for Payer: Group Health Inc Medicare	$358.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$511.71
Rate for Payer: Hamaspik Choice Inc Medicare	$511.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$665.22

NCB PP CONN BOLT FOR TARGET DEVIC

Facility

$637.78

Service Code	HCPCS C1713
Hospital Charge Code	40006801
Hospital Revenue Code	278
Min. Negotiated Rate	$318.89
Max. Negotiated Rate	$318.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.89
Rate for Payer: Hamaspik Choice Inc Medicare	$318.89

NCB PP CONN BOLT FOR TARGET DEVIC

Facility

$637.78

Service Code	HCPCS C1713
Hospital Charge Code	40006801
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$669.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$350.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$382.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$318.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$366.72
Rate for Payer: EmblemHealth Commercial	$318.89
Rate for Payer: Fidelis Medicare Advantage	$669.67
Rate for Payer: Group Health Inc Commercial	$318.89
Rate for Payer: Group Health Inc Medicare	$223.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.89
Rate for Payer: Hamaspik Choice Inc Medicare	$318.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$414.56

NCB PP DF PROV,LT,9/12 HOLE PLATE

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006794
Hospital Revenue Code	278
Min. Negotiated Rate	$67.49
Max. Negotiated Rate	$202.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$115.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$110.87
Rate for Payer: EmblemHealth Commercial	$96.41
Rate for Payer: Fidelis Medicare Advantage	$202.46
Rate for Payer: Group Health Inc Commercial	$96.41
Rate for Payer: Group Health Inc Medicare	$67.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.41
Rate for Payer: Hamaspik Choice Inc Medicare	$96.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$125.33

NCB PP DF PROV,LT,9/12 HOLE PLATE

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006794
Hospital Revenue Code	278
Min. Negotiated Rate	$96.41
Max. Negotiated Rate	$96.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.41
Rate for Payer: Hamaspik Choice Inc Medicare	$96.41

NCB PP DF PROV,RT,15/18 HL PLATES

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006791
Hospital Revenue Code	278
Min. Negotiated Rate	$96.41
Max. Negotiated Rate	$96.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.41
Rate for Payer: Hamaspik Choice Inc Medicare	$96.41

NCB PP DF PROV,RT,15/18 HL PLATES

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006791
Hospital Revenue Code	278
Min. Negotiated Rate	$67.49
Max. Negotiated Rate	$202.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$115.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$110.87
Rate for Payer: EmblemHealth Commercial	$96.41
Rate for Payer: Fidelis Medicare Advantage	$202.46
Rate for Payer: Group Health Inc Commercial	$96.41
Rate for Payer: Group Health Inc Medicare	$67.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.41
Rate for Payer: Hamaspik Choice Inc Medicare	$96.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$125.33

NCB PP DF PROV,RT,9/12 HOLE PLATE

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006793
Hospital Revenue Code	278
Min. Negotiated Rate	$96.41
Max. Negotiated Rate	$96.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.41
Rate for Payer: Hamaspik Choice Inc Medicare	$96.41

NCB PP DF PROV,RT,9/12 HOLE PLATE

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006793
Hospital Revenue Code	278
Min. Negotiated Rate	$67.49
Max. Negotiated Rate	$202.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$115.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$110.87
Rate for Payer: EmblemHealth Commercial	$96.41
Rate for Payer: Fidelis Medicare Advantage	$202.46
Rate for Payer: Group Health Inc Commercial	$96.41
Rate for Payer: Group Health Inc Medicare	$67.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.41
Rate for Payer: Hamaspik Choice Inc Medicare	$96.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$125.33

NCB PP DIST FEM MIS BTM COV 12 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006810
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$443.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$232.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$253.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$211.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.06
Rate for Payer: EmblemHealth Commercial	$211.36
Rate for Payer: Fidelis Medicare Advantage	$443.86
Rate for Payer: Group Health Inc Commercial	$211.36
Rate for Payer: Group Health Inc Medicare	$147.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.36
Rate for Payer: Hamaspik Choice Inc Medicare	$211.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$274.77

NCB PP DIST FEM MIS BTM COV 12 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006810
Hospital Revenue Code	278
Min. Negotiated Rate	$211.36
Max. Negotiated Rate	$211.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.36
Rate for Payer: Hamaspik Choice Inc Medicare	$211.36

NCB PP DIST FEM MIS BTM COV 15 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006811
Hospital Revenue Code	278
Min. Negotiated Rate	$211.36
Max. Negotiated Rate	$211.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.36
Rate for Payer: Hamaspik Choice Inc Medicare	$211.36

NCB PP DIST FEM MIS BTM COV 15 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006811
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$443.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$232.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$253.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$211.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.06
Rate for Payer: EmblemHealth Commercial	$211.36
Rate for Payer: Fidelis Medicare Advantage	$443.86
Rate for Payer: Group Health Inc Commercial	$211.36
Rate for Payer: Group Health Inc Medicare	$147.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.36
Rate for Payer: Hamaspik Choice Inc Medicare	$211.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$274.77

NCB PP DIST FEM MIS BTM COV 21 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006813
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$443.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$232.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$253.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$211.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.06
Rate for Payer: EmblemHealth Commercial	$211.36
Rate for Payer: Fidelis Medicare Advantage	$443.86
Rate for Payer: Group Health Inc Commercial	$211.36
Rate for Payer: Group Health Inc Medicare	$147.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.36
Rate for Payer: Hamaspik Choice Inc Medicare	$211.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$274.77

NCB PP DIST FEM MIS BTM COV 21 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006813
Hospital Revenue Code	278
Min. Negotiated Rate	$211.36
Max. Negotiated Rate	$211.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.36
Rate for Payer: Hamaspik Choice Inc Medicare	$211.36

NCB PP DIST FEM MIS BTM COV 9 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006809
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$443.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$232.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$253.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$211.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.06
Rate for Payer: EmblemHealth Commercial	$211.36
Rate for Payer: Fidelis Medicare Advantage	$443.86
Rate for Payer: Group Health Inc Commercial	$211.36
Rate for Payer: Group Health Inc Medicare	$147.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.36
Rate for Payer: Hamaspik Choice Inc Medicare	$211.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$274.77

NCB PP DIST FEM MIS BTM COV 9 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006809
Hospital Revenue Code	278
Min. Negotiated Rate	$211.36
Max. Negotiated Rate	$211.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.36
Rate for Payer: Hamaspik Choice Inc Medicare	$211.36

NCB PP DIST FEM PLATE,L,L.238MM

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007275
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,927.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,533.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,673.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,394.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,603.34
Rate for Payer: EmblemHealth Commercial	$1,394.21
Rate for Payer: Fidelis Medicare Advantage	$2,927.84
Rate for Payer: Group Health Inc Commercial	$1,394.21
Rate for Payer: Group Health Inc Medicare	$975.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,394.21
Rate for Payer: Hamaspik Choice Inc Medicare	$1,394.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,812.47

NCB PP DIST FEM PLATE,L,L.238MM

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007275
Hospital Revenue Code	278
Min. Negotiated Rate	$1,394.21
Max. Negotiated Rate	$1,394.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,394.21
Rate for Payer: Hamaspik Choice Inc Medicare	$1,394.21

NCB PP DIST FEM PLATE,L,L.278MM

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007276
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,083.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,615.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,762.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,468.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,688.63
Rate for Payer: EmblemHealth Commercial	$1,468.37
Rate for Payer: Fidelis Medicare Advantage	$3,083.58
Rate for Payer: Group Health Inc Commercial	$1,468.37
Rate for Payer: Group Health Inc Medicare	$1,027.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,468.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1,468.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,908.88

NCB PP DIST FEM PLATE,L,L.278MM

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007276
Hospital Revenue Code	278
Min. Negotiated Rate	$1,468.37
Max. Negotiated Rate	$1,468.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,468.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1,468.37

NCB PP DIST FEM PLATE,L,L.317MM

Facility

$3,114.72

Service Code	HCPCS C1713
Hospital Charge Code	40007277
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.36
Max. Negotiated Rate	$1,557.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,557.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1,557.36

NCB PP DIST FEM PLATE,L,L.317MM

Facility

$3,114.72

Service Code	HCPCS C1713
Hospital Charge Code	40007277
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,270.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,713.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,868.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,557.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,790.96
Rate for Payer: EmblemHealth Commercial	$1,557.36
Rate for Payer: Fidelis Medicare Advantage	$3,270.46
Rate for Payer: Group Health Inc Commercial	$1,557.36
Rate for Payer: Group Health Inc Medicare	$1,090.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,557.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1,557.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,024.57

NCB PP DIST FEM PLATE,L,L.355MM

Facility

$3,263.04

Service Code	HCPCS C1713
Hospital Charge Code	40007278
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.52
Max. Negotiated Rate	$1,631.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,631.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1,631.52

Know your out-of-pocket cost for care.

All Charges