St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006790
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 PF PROV,LT,9/12 HOLE PLATE

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006790
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 PF PROV RT, 15/18 HL PLATE

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006787
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 PF PROV RT, 15/18 HL PLATE

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006787
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 PF PROV,RT,9/12 HOLE PLATE

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006789
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 PF PROV,RT,9/12 HOLE PLATE

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006789
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 PROX FEM MIS BOT COV 15 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006806
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 PROX FEM MIS BOT COV 15 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006806
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 PROX FEM MIS BTM COV 12 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006805
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 PROX FEM MIS BTM COV 12 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006805
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 PROX FEM MIS BTM COV 18 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006807
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 PROX FEM MIS BTM COV 18 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006807
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 PROX FEM MIS BTM COV 21 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006808
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 PROX FEM MIS BTM COV 21 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006808
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 PROX FEM MIS BTM COV 9 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006804
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 PROX FEM MIS BTM COV 9 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006804
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 PROX FEM PLATE,L,L.245MM

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007265
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 PROX FEM PLATE,L,L.245MM

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007265
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 PROX FEM PLATE,L,L.285MM

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007266
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 PROX FEM PLATE,L,L.285MM

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007266
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 PROX FEM PLATE,L,L.324MM

Facility

$3,114.72

Service Code	HCPCS C1713
Hospital Charge Code	40007267
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 PROX FEM PLATE,L,L.324MM

Facility

$3,114.72

Service Code	HCPCS C1713
Hospital Charge Code	40007267
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 PROX FEM PLATE,L,L.363MM

Facility

$3,263.04

Service Code	HCPCS C1713
Hospital Charge Code	40007268
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 PROX FEM PLATE,L,L.363MM

Facility

$3,263.04

Service Code	HCPCS C1713
Hospital Charge Code	40007268
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 PROX FEM PLATE,L,L.401MM

Facility

$3,589.36

Service Code	HCPCS C1713
Hospital Charge Code	40007269
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

Know your out-of-pocket cost for care.

All Charges