St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$134.20
Max. Negotiated Rate	$3,426.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,794.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,957.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,631.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,876.25
Rate for Payer: EmblemHealth Commercial	$1,631.52
Rate for Payer: Fidelis Medicare Advantage	$3,426.19
Rate for Payer: Group Health Inc Commercial	$1,631.52
Rate for Payer: Group Health Inc Medicare	$1,142.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,631.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1,631.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,120.98

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

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007270
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,R,L.238MM

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007270
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,R,L.278MM

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007271
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,R,L.278MM

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007271
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,R,L.317MM

Facility

$3,114.72

Service Code	HCPCS C1713
Hospital Charge Code	40007272
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,R,L.317MM

Facility

$3,114.72

Service Code	HCPCS C1713
Hospital Charge Code	40007272
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,R,L.355MM

Facility

$3,263.04

Service Code	HCPCS C1713
Hospital Charge Code	40007273
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

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

Facility

$3,263.04

Service Code	HCPCS C1713
Hospital Charge Code	40007273
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,426.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,794.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,957.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,631.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,876.25
Rate for Payer: EmblemHealth Commercial	$1,631.52
Rate for Payer: Fidelis Medicare Advantage	$3,426.19
Rate for Payer: Group Health Inc Commercial	$1,631.52
Rate for Payer: Group Health Inc Medicare	$1,142.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,631.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1,631.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,120.98

NCB PP DIST FEM PLATE,R,L.393MM

Facility

$3,589.36

Service Code	HCPCS C1713
Hospital Charge Code	40007274
Hospital Revenue Code	278
Min. Negotiated Rate	$1,794.68
Max. Negotiated Rate	$1,794.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,794.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1,794.68

NCB PP DIST FEM PLATE,R,L.393MM

Facility

$3,589.36

Service Code	HCPCS C1713
Hospital Charge Code	40007274
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,768.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,974.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,153.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,794.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,063.88
Rate for Payer: EmblemHealth Commercial	$1,794.68
Rate for Payer: Fidelis Medicare Advantage	$3,768.83
Rate for Payer: Group Health Inc Commercial	$1,794.68
Rate for Payer: Group Health Inc Medicare	$1,256.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,794.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1,794.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,333.08

NCB PP DIST FEM PLT L L.238MM STR

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007020
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 PLT L L.238MM STR

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007020
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 PLT L L.278MM STR

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007021
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 PLT L L.278MM STR

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007021
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 PLT L L.317MM STR

Facility

$3,114.72

Service Code	HCPCS C1713
Hospital Charge Code	40007022
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 PLT L L.317MM STR

Facility

$3,114.72

Service Code	HCPCS C1713
Hospital Charge Code	40007022
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 PLT L L.355MM STR

Facility

$3,263.04

Service Code	HCPCS C1713
Hospital Charge Code	40007023
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,426.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,794.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,957.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,631.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,876.25
Rate for Payer: EmblemHealth Commercial	$1,631.52
Rate for Payer: Fidelis Medicare Advantage	$3,426.19
Rate for Payer: Group Health Inc Commercial	$1,631.52
Rate for Payer: Group Health Inc Medicare	$1,142.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,631.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1,631.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,120.98

NCB PP DIST FEM PLT L L.355MM STR

Facility

$3,263.04

Service Code	HCPCS C1713
Hospital Charge Code	40007023
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

NCB PP DIST FEM PLT L L.393MM STR

Facility

$3,589.36

Service Code	HCPCS C1713
Hospital Charge Code	40007024
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,768.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,974.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,153.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,794.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,063.88
Rate for Payer: EmblemHealth Commercial	$1,794.68
Rate for Payer: Fidelis Medicare Advantage	$3,768.83
Rate for Payer: Group Health Inc Commercial	$1,794.68
Rate for Payer: Group Health Inc Medicare	$1,256.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,794.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1,794.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,333.08

NCB PP DIST FEM PLT L L.393MM STR

Facility

$3,589.36

Service Code	HCPCS C1713
Hospital Charge Code	40007024
Hospital Revenue Code	278
Min. Negotiated Rate	$1,794.68
Max. Negotiated Rate	$1,794.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,794.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1,794.68

NCB PP DIST FEM PLT R L.238MM STR

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007015
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 PLT R L.238MM STR

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007015
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 PLT R L.278MM STR

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007016
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 PLT R L.278MM STR

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007016
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

Know your out-of-pocket cost for care.

All Charges