St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OSSEOUS SURGERY INC FLAP ENTRY/CL

Facility

$1,118.41

Service Code	HCPCS D4260
Hospital Charge Code	42300870
Hospital Revenue Code	361
Min. Negotiated Rate	$559.20
Max. Negotiated Rate	$6,907.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$615.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,772.21
Rate for Payer: Aetna Government	$6,772.21
Rate for Payer: Affinity Essential Plan 1&2	$4,740.55
Rate for Payer: Affinity Essential Plan 3&4	$4,740.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,740.55
Rate for Payer: Brighton Health Commercial	$838.81
Rate for Payer: Cash Price	$6,772.21
Rate for Payer: Cash Price	$6,772.21
Rate for Payer: Cash Price	$6,772.21
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,772.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$6,772.21
Rate for Payer: EmblemHealth Commercial	$6,772.21
Rate for Payer: Fidelis Essential Plan Aliesa	$5,756.38
Rate for Payer: Fidelis Essential Plan QHP	$6,027.27
Rate for Payer: Fidelis Medicare Advantage	$6,772.21
Rate for Payer: Fidelis Qualified Health Plan	$6,027.27
Rate for Payer: Group Health Inc Commercial	$6,772.21
Rate for Payer: Group Health Inc Medicare	$6,772.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$559.20
Rate for Payer: Hamaspik Choice Inc Medicare	$6,772.21
Rate for Payer: Healthfirst Medicare Advantage	$5,756.38
Rate for Payer: Healthfirst QHP	$6,772.21
Rate for Payer: Humana Medicare	$6,907.65
Rate for Payer: Senior Whole Health Medicare Advantage	$6,772.21
Rate for Payer: United Healthcare Medicare Advantage	$6,772.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,772.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,417.77
Rate for Payer: Wellcare Medicare	$6,433.60

Ostectomy, calcaneus;

Facility

$3,818.01

Service Code	CPT 28118
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$3,818.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

Ostectomy, calcaneus; for spur, with or without plantar fascial release

Facility

$3,818.01

Service Code	CPT 28119
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$3,818.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

Ostectomy, complete excision; fifth metatarsal head

Facility

$3,818.01

Service Code	CPT 28113
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$3,818.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head

Facility

$3,818.01

Service Code	CPT 28288
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$3,818.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

OSTEOAMP GRANULES 10.0CC (2-4MM)

Facility

$3,603.26

Service Code	HCPCS C1713
Hospital Charge Code	40005192
Hospital Revenue Code	278
Min. Negotiated Rate	$1,801.63
Max. Negotiated Rate	$1,801.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,801.63
Rate for Payer: Hamaspik Choice Inc Medicare	$1,801.63

OSTEOAMP GRANULES 10.0CC (2-4MM)

Facility

$3,603.26

Service Code	HCPCS C1713
Hospital Charge Code	40005192
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,783.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,981.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,161.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,801.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,071.87
Rate for Payer: EmblemHealth Commercial	$1,801.63
Rate for Payer: Fidelis Medicare Advantage	$3,783.42
Rate for Payer: Group Health Inc Commercial	$1,801.63
Rate for Payer: Group Health Inc Medicare	$1,261.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,801.63
Rate for Payer: Hamaspik Choice Inc Medicare	$1,801.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,342.12

OSTEOAMP GRANULES 1.0CC (2-4MM)

Facility

$857.58

Service Code	HCPCS C1713
Hospital Charge Code	40005189
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$900.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$471.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$514.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$428.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$493.11
Rate for Payer: EmblemHealth Commercial	$428.79
Rate for Payer: Fidelis Medicare Advantage	$900.46
Rate for Payer: Group Health Inc Commercial	$428.79
Rate for Payer: Group Health Inc Medicare	$300.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$428.79
Rate for Payer: Hamaspik Choice Inc Medicare	$428.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$557.43

OSTEOAMP GRANULES 1.0CC (2-4MM)

Facility

$857.58

Service Code	HCPCS C1713
Hospital Charge Code	40005189
Hospital Revenue Code	278
Min. Negotiated Rate	$428.79
Max. Negotiated Rate	$428.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$428.79
Rate for Payer: Hamaspik Choice Inc Medicare	$428.79

OSTEOAMP GRANULES 15.0CC (2-4MM)

Facility

$4,879.84

Service Code	HCPCS C1713
Hospital Charge Code	40005193
Hospital Revenue Code	278
Min. Negotiated Rate	$2,439.92
Max. Negotiated Rate	$2,439.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,439.92
Rate for Payer: Hamaspik Choice Inc Medicare	$2,439.92

OSTEOAMP GRANULES 15.0CC (2-4MM)

Facility

$4,879.84

Service Code	HCPCS C1713
Hospital Charge Code	40005193
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,123.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,683.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,927.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,439.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,805.91
Rate for Payer: EmblemHealth Commercial	$2,439.92
Rate for Payer: Fidelis Medicare Advantage	$5,123.83
Rate for Payer: Group Health Inc Commercial	$2,439.92
Rate for Payer: Group Health Inc Medicare	$1,707.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,439.92
Rate for Payer: Hamaspik Choice Inc Medicare	$2,439.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,171.90

OSTEOAMP GRANULES 2.5CC (2-4MM)

Facility

$1,369.24

Service Code	HCPCS C1713
Hospital Charge Code	40005190
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,437.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$753.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$821.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$684.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$787.31
Rate for Payer: EmblemHealth Commercial	$684.62
Rate for Payer: Fidelis Medicare Advantage	$1,437.70
Rate for Payer: Group Health Inc Commercial	$684.62
Rate for Payer: Group Health Inc Medicare	$479.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$684.62
Rate for Payer: Hamaspik Choice Inc Medicare	$684.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$890.01

OSTEOAMP GRANULES 2.5CC (2-4MM)

Facility

$1,369.24

Service Code	HCPCS C1713
Hospital Charge Code	40005190
Hospital Revenue Code	278
Min. Negotiated Rate	$684.62
Max. Negotiated Rate	$684.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$684.62
Rate for Payer: Hamaspik Choice Inc Medicare	$684.62

OSTEOAMP GRANULES (<2MM) 10.0CC

Facility

$3,603.26

Service Code	HCPCS C1713
Hospital Charge Code	40005186
Hospital Revenue Code	278
Min. Negotiated Rate	$1,801.63
Max. Negotiated Rate	$1,801.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,801.63
Rate for Payer: Hamaspik Choice Inc Medicare	$1,801.63

OSTEOAMP GRANULES (<2MM) 10.0CC

Facility

$3,603.26

Service Code	HCPCS C1713
Hospital Charge Code	40005186
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,783.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,981.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,161.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,801.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,071.87
Rate for Payer: EmblemHealth Commercial	$1,801.63
Rate for Payer: Fidelis Medicare Advantage	$3,783.42
Rate for Payer: Group Health Inc Commercial	$1,801.63
Rate for Payer: Group Health Inc Medicare	$1,261.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,801.63
Rate for Payer: Hamaspik Choice Inc Medicare	$1,801.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,342.12

OSTEOAMP GRANULES (<2MM) 1.0CC

Facility

$857.58

Service Code	HCPCS C1713
Hospital Charge Code	40005183
Hospital Revenue Code	278
Min. Negotiated Rate	$428.79
Max. Negotiated Rate	$428.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$428.79
Rate for Payer: Hamaspik Choice Inc Medicare	$428.79

OSTEOAMP GRANULES (<2MM) 1.0CC

Facility

$857.58

Service Code	HCPCS C1713
Hospital Charge Code	40005183
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$900.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$471.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$514.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$428.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$493.11
Rate for Payer: EmblemHealth Commercial	$428.79
Rate for Payer: Fidelis Medicare Advantage	$900.46
Rate for Payer: Group Health Inc Commercial	$428.79
Rate for Payer: Group Health Inc Medicare	$300.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$428.79
Rate for Payer: Hamaspik Choice Inc Medicare	$428.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$557.43

OSTEOAMP GRANULES (<2MM) 15.0CC

Facility

$4,879.84

Service Code	HCPCS C1713
Hospital Charge Code	40005187
Hospital Revenue Code	278
Min. Negotiated Rate	$2,439.92
Max. Negotiated Rate	$2,439.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,439.92
Rate for Payer: Hamaspik Choice Inc Medicare	$2,439.92

OSTEOAMP GRANULES (<2MM) 15.0CC

Facility

$4,879.84

Service Code	HCPCS C1713
Hospital Charge Code	40005187
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,123.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,683.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,927.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,439.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,805.91
Rate for Payer: EmblemHealth Commercial	$2,439.92
Rate for Payer: Fidelis Medicare Advantage	$5,123.83
Rate for Payer: Group Health Inc Commercial	$2,439.92
Rate for Payer: Group Health Inc Medicare	$1,707.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,439.92
Rate for Payer: Hamaspik Choice Inc Medicare	$2,439.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,171.90

OSTEOAMP GRANULES (2MM) 20.0CC

Facility

$10,186.00

Service Code	HCPCS C1713
Hospital Charge Code	40005188
Hospital Revenue Code	278
Min. Negotiated Rate	$5,093.00
Max. Negotiated Rate	$5,093.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,093.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,093.00

OSTEOAMP GRANULES (2MM) 20.0CC

Facility

$10,186.00

Service Code	HCPCS C1713
Hospital Charge Code	40005188
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$10,695.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,602.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$6,111.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,093.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,856.95
Rate for Payer: EmblemHealth Commercial	$5,093.00
Rate for Payer: Fidelis Medicare Advantage	$10,695.30
Rate for Payer: Group Health Inc Commercial	$5,093.00
Rate for Payer: Group Health Inc Medicare	$3,565.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,093.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,093.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,620.90

OSTEOAMP GRANULES (<2MM) 2.5CC

Facility

$1,369.24

Service Code	HCPCS C1713
Hospital Charge Code	40005184
Hospital Revenue Code	278
Min. Negotiated Rate	$684.62
Max. Negotiated Rate	$684.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$684.62
Rate for Payer: Hamaspik Choice Inc Medicare	$684.62

OSTEOAMP GRANULES (<2MM) 2.5CC

Facility

$1,369.24

Service Code	HCPCS C1713
Hospital Charge Code	40005184
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,437.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$753.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$821.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$684.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$787.31
Rate for Payer: EmblemHealth Commercial	$684.62
Rate for Payer: Fidelis Medicare Advantage	$1,437.70
Rate for Payer: Group Health Inc Commercial	$684.62
Rate for Payer: Group Health Inc Medicare	$479.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$684.62
Rate for Payer: Hamaspik Choice Inc Medicare	$684.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$890.01

OSTEOAMP GRANULES (<2MM) 5.0CC

Facility

$2,161.96

Service Code	HCPCS C1713
Hospital Charge Code	40005185
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,270.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,189.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,297.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,080.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,243.13
Rate for Payer: EmblemHealth Commercial	$1,080.98
Rate for Payer: Fidelis Medicare Advantage	$2,270.06
Rate for Payer: Group Health Inc Commercial	$1,080.98
Rate for Payer: Group Health Inc Medicare	$756.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,080.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1,080.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,405.27

OSTEOAMP GRANULES (<2MM) 5.0CC

Facility

$2,161.96

Service Code	HCPCS C1713
Hospital Charge Code	40005185
Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.98
Max. Negotiated Rate	$1,080.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,080.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1,080.98

Know your out-of-pocket cost for care.

All Charges