St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$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 PROX FEM PLATE,R,L.245MM

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007260
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,R,L.245MM

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007260
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,R,L.285MM

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007261
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,R,L.285MM

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007261
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,R,L.324MM

Facility

$3,114.72

Service Code	HCPCS C1713
Hospital Charge Code	40007262
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,R,L.324MM

Facility

$3,114.72

Service Code	HCPCS C1713
Hospital Charge Code	40007262
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,R,L.363MM

Facility

$3,263.04

Service Code	HCPCS C1713
Hospital Charge Code	40007263
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,R,L.363MM

Facility

$3,263.04

Service Code	HCPCS C1713
Hospital Charge Code	40007263
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,R,L.401MM

Facility

$3,589.36

Service Code	HCPCS C1713
Hospital Charge Code	40007264
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 PROX FEM PLATE,R,L.401MM

Facility

$3,589.36

Service Code	HCPCS C1713
Hospital Charge Code	40007264
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 PROX FEM PLT F L.401MM STR

Facility

$3,589.36

Service Code	HCPCS C1713
Hospital Charge Code	40007004
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 PROX FEM PLT F L.401MM STR

Facility

$3,589.36

Service Code	HCPCS C1713
Hospital Charge Code	40007004
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 PROX FEM PLT L L.245MM STR

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007006
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 PLT L L.245MM STR

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007006
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 PLT L L.285MM STR

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007007
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 PLT L L.285MM STR

Facility

$2,936.74

Service Code	HCPCS C1713
Hospital Charge Code	40007007
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 PLT L L.324MM STR

Facility

$3,114.72

Service Code	HCPCS C1713
Hospital Charge Code	40007008
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 PLT L L.324MM STR

Facility

$3,114.72

Service Code	HCPCS C1713
Hospital Charge Code	40007008
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 PLT L L.363 STR

Facility

$3,263.04

Service Code	HCPCS C1713
Hospital Charge Code	40007009
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 PLT L L.363 STR

Facility

$3,263.04

Service Code	HCPCS C1713
Hospital Charge Code	40007009
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 PLT L L.401MM STR

Facility

$3,589.36

Service Code	HCPCS C1713
Hospital Charge Code	40007010
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 PROX FEM PLT L L.401MM STR

Facility

$3,589.36

Service Code	HCPCS C1713
Hospital Charge Code	40007010
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 PROX FEM PLT R L.245MM STR

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007000
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 PLT R L.245MM STR

Facility

$2,788.42

Service Code	HCPCS C1713
Hospital Charge Code	40007000
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

Know your out-of-pocket cost for care.

All Charges