St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PEG LOCKING T8 2.0MM / L24MM

Facility

$563.13

Service Code	HCPCS C1713
Hospital Charge Code	64905781
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$591.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$337.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$281.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$323.80
Rate for Payer: EmblemHealth Commercial	$281.56
Rate for Payer: Fidelis Medicare Advantage	$591.29
Rate for Payer: Group Health Inc Commercial	$281.56
Rate for Payer: Group Health Inc Medicare	$197.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.56
Rate for Payer: Hamaspik Choice Inc Medicare	$281.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$366.03

PEG LOCK SMOOTH 2.0 SPLS-TS

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	64906934
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$138.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: EmblemHealth Commercial	$115.00
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

PEG LOCK SMOOTH 2.0 SPLS-TS

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	64906934
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

PEG LOCK THRD 2.3 X 22MM

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64906961
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

PEG LOCK THRD 2.3 X 22MM

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64906961
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$299.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$142.50
Rate for Payer: Fidelis Medicare Advantage	$299.25
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.25

PEGLOTICASE 8 MG/ML IV SOLN [107664]

Facility

$34,357.92

Service Code	HCPCS J2507
Hospital Charge Code	75987008010
Hospital Revenue Code	278
Min. Negotiated Rate	$2,696.86
Max. Negotiated Rate	$22,332.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18,896.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,371.08
Rate for Payer: Aetna Government	$3,371.08
Rate for Payer: Brighton Health Commercial	$20,614.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,371.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17,178.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$19,755.80
Rate for Payer: Elderplan Medicare Advantage	$3,371.08
Rate for Payer: EmblemHealth Commercial	$17,178.96
Rate for Payer: Fidelis Medicare Advantage	$3,371.08
Rate for Payer: Group Health Inc Commercial	$3,371.08
Rate for Payer: Group Health Inc Medicare	$3,371.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,178.96
Rate for Payer: Hamaspik Choice Inc Medicare	$17,178.96
Rate for Payer: Healthfirst Medicare Advantage	$2,865.41
Rate for Payer: Healthfirst QHP	$3,371.08
Rate for Payer: Humana Medicare	$3,438.50
Rate for Payer: Senior Whole Health Medicare Advantage	$3,371.08
Rate for Payer: United Healthcare Medicare Advantage	$3,371.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22,332.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,696.86

PEGLOTICASE 8 MG/ML IV SOLN [107664]

Facility

$34,357.92

Service Code	HCPCS J2507
Hospital Charge Code	75987008010
Hospital Revenue Code	278
Min. Negotiated Rate	$17,178.96
Max. Negotiated Rate	$17,178.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,178.96
Rate for Payer: Hamaspik Choice Inc Medicare	$17,178.96

PEG NONLOCK THRD 2.7

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64907033
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$299.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$142.50
Rate for Payer: Fidelis Medicare Advantage	$299.25
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.25

PEG NONLOCK THRD 2.7

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64907033
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

PEGS THREAD LCK 2.7 26MM

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64907535
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$299.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$142.50
Rate for Payer: Fidelis Medicare Advantage	$299.25
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.25

PEGS THREAD LCK 2.7 26MM

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64907535
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

PEG THRDED LOCK 2.3 X 24MM

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64906996
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

PEG THRDED LOCK 2.3 X 24MM

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64906996
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$299.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$142.50
Rate for Payer: Fidelis Medicare Advantage	$299.25
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.25

PEG THRD LOCK 2.3 X 20MM

Facility

$228.00

Service Code	HCPCS C1713
Hospital Charge Code	64906906
Hospital Revenue Code	278
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$114.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.00
Rate for Payer: Hamaspik Choice Inc Medicare	$114.00

PEG THRD LOCK 2.3 X 20MM

Facility

$228.00

Service Code	HCPCS C1713
Hospital Charge Code	64906906
Hospital Revenue Code	278
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$239.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$136.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$114.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.10
Rate for Payer: EmblemHealth Commercial	$114.00
Rate for Payer: Fidelis Medicare Advantage	$239.40
Rate for Payer: Group Health Inc Commercial	$114.00
Rate for Payer: Group Health Inc Medicare	$79.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.00
Rate for Payer: Hamaspik Choice Inc Medicare	$114.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.20

PEG THRD LOCKING 2.3

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64907053
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

PEG THRD LOCKING 2.3

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64907053
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$299.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$142.50
Rate for Payer: Fidelis Medicare Advantage	$299.25
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.25

PEG THRD NONLOCK 2.3

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64907061
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$299.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$142.50
Rate for Payer: Fidelis Medicare Advantage	$299.25
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.25

PEG THRD NONLOCK 2.3

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64907061
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

PEG THREAD NL 2.7 X 22MM

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64906965
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$299.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$142.50
Rate for Payer: Fidelis Medicare Advantage	$299.25
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.25

PEG THREAD NL 2.7 X 22MM

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64906965
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

PELLETS OSTEOSET BONE FILLER

Facility

$1,310.00

Service Code	HCPCS C1713
Hospital Charge Code	40200246
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,375.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$720.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$786.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$655.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$753.25
Rate for Payer: EmblemHealth Commercial	$655.00
Rate for Payer: Fidelis Medicare Advantage	$1,375.50
Rate for Payer: Group Health Inc Commercial	$655.00
Rate for Payer: Group Health Inc Medicare	$458.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$655.00
Rate for Payer: Hamaspik Choice Inc Medicare	$655.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$851.50

PELLETS OSTEOSET BONE FILLER

Facility

$1,310.00

Service Code	HCPCS C1713
Hospital Charge Code	40200246
Hospital Revenue Code	278
Min. Negotiated Rate	$655.00
Max. Negotiated Rate	$655.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$655.00
Rate for Payer: Hamaspik Choice Inc Medicare	$655.00

PELLETS OSTEOSET BONE FILLER

Facility

$1,637.50

Service Code	HCPCS C1713
Hospital Charge Code	64901102
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,719.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$900.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$982.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$818.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$941.56
Rate for Payer: EmblemHealth Commercial	$818.75
Rate for Payer: Fidelis Medicare Advantage	$1,719.38
Rate for Payer: Group Health Inc Commercial	$818.75
Rate for Payer: Group Health Inc Medicare	$573.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$818.75
Rate for Payer: Hamaspik Choice Inc Medicare	$818.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,064.38

PELLETS OSTEOSET BONE FILLER

Facility

$1,637.50

Service Code	HCPCS C1713
Hospital Charge Code	64901102
Hospital Revenue Code	278
Min. Negotiated Rate	$818.75
Max. Negotiated Rate	$818.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$818.75
Rate for Payer: Hamaspik Choice Inc Medicare	$818.75

Know your out-of-pocket cost for care.

All Charges