St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PIN APEX 3MMX 80/50

Facility

$135.80

Service Code	HCPCS C1713
Hospital Charge Code	40205935
Hospital Revenue Code	278
Min. Negotiated Rate	$67.90
Max. Negotiated Rate	$67.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.90
Rate for Payer: Hamaspik Choice Inc Medicare	$67.90

PIN APEX 3MMX 80/50

Facility

$135.80

Service Code	HCPCS C1713
Hospital Charge Code	40205935
Hospital Revenue Code	278
Min. Negotiated Rate	$47.53
Max. Negotiated Rate	$142.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$81.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.08
Rate for Payer: EmblemHealth Commercial	$67.90
Rate for Payer: Fidelis Medicare Advantage	$142.59
Rate for Payer: Group Health Inc Commercial	$67.90
Rate for Payer: Group Health Inc Medicare	$47.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.90
Rate for Payer: Hamaspik Choice Inc Medicare	$67.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.27

PIN APEX 4 MM 150/50

Facility

$172.20

Service Code	HCPCS C1713
Hospital Charge Code	40201387
Hospital Revenue Code	278
Min. Negotiated Rate	$60.27
Max. Negotiated Rate	$180.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$103.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.02
Rate for Payer: EmblemHealth Commercial	$86.10
Rate for Payer: Fidelis Medicare Advantage	$180.81
Rate for Payer: Group Health Inc Commercial	$86.10
Rate for Payer: Group Health Inc Medicare	$60.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.10
Rate for Payer: Hamaspik Choice Inc Medicare	$86.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.93

PIN APEX 4 MM 150/50

Facility

$172.20

Service Code	HCPCS C1713
Hospital Charge Code	40201387
Hospital Revenue Code	278
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$86.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.10
Rate for Payer: Hamaspik Choice Inc Medicare	$86.10

PIN APEX 5X150

Facility

$220.00

Service Code	HCPCS C1713
Hospital Charge Code	40200758
Hospital Revenue Code	278
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$110.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00

PIN APEX 5X150

Facility

$220.00

Service Code	HCPCS C1713
Hospital Charge Code	40200758
Hospital Revenue Code	278
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$132.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.50
Rate for Payer: EmblemHealth Commercial	$110.00
Rate for Payer: Fidelis Medicare Advantage	$231.00
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$143.00

PIN APEX 5X180

Facility

$1,399.72

Service Code	HCPCS C1713
Hospital Charge Code	64906715
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,469.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$769.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$839.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$699.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$804.84
Rate for Payer: EmblemHealth Commercial	$699.86
Rate for Payer: Fidelis Medicare Advantage	$1,469.71
Rate for Payer: Group Health Inc Commercial	$699.86
Rate for Payer: Group Health Inc Medicare	$489.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$699.86
Rate for Payer: Hamaspik Choice Inc Medicare	$699.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$909.82

PIN APEX 5X180

Facility

$1,399.72

Service Code	HCPCS C1713
Hospital Charge Code	64906715
Hospital Revenue Code	278
Min. Negotiated Rate	$699.86
Max. Negotiated Rate	$699.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$699.86
Rate for Payer: Hamaspik Choice Inc Medicare	$699.86

PIN APEX HALF 2/D 4 X 090

Facility

$172.20

Service Code	HCPCS C1713
Hospital Charge Code	40201392
Hospital Revenue Code	278
Min. Negotiated Rate	$60.27
Max. Negotiated Rate	$180.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$103.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.02
Rate for Payer: EmblemHealth Commercial	$86.10
Rate for Payer: Fidelis Medicare Advantage	$180.81
Rate for Payer: Group Health Inc Commercial	$86.10
Rate for Payer: Group Health Inc Medicare	$60.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.10
Rate for Payer: Hamaspik Choice Inc Medicare	$86.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.93

PIN APEX HALF 2/D 4 X 090

Facility

$172.20

Service Code	HCPCS C1713
Hospital Charge Code	40201392
Hospital Revenue Code	278
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$86.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.10
Rate for Payer: Hamaspik Choice Inc Medicare	$86.10

PIN APEX HALF 5X150 40TH S/D

Facility

$254.80

Service Code	HCPCS C1713
Hospital Charge Code	40200759
Hospital Revenue Code	278
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$127.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.40
Rate for Payer: Hamaspik Choice Inc Medicare	$127.40

PIN APEX HALF 5X150 40TH S/D

Facility

$254.80

Service Code	HCPCS C1713
Hospital Charge Code	40200759
Hospital Revenue Code	278
Min. Negotiated Rate	$89.18
Max. Negotiated Rate	$267.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$140.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$152.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$127.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.51
Rate for Payer: EmblemHealth Commercial	$127.40
Rate for Payer: Fidelis Medicare Advantage	$267.54
Rate for Payer: Group Health Inc Commercial	$127.40
Rate for Payer: Group Health Inc Medicare	$89.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.40
Rate for Payer: Hamaspik Choice Inc Medicare	$127.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$165.62

PIN APEX HALF 6X180 50CT THRD

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	40201388
Hospital Revenue Code	278
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$262.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$150.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$143.75
Rate for Payer: EmblemHealth Commercial	$125.00
Rate for Payer: Fidelis Medicare Advantage	$262.50
Rate for Payer: Group Health Inc Commercial	$125.00
Rate for Payer: Group Health Inc Medicare	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$162.50

PIN APEX HALF 6X180 50CT THRD

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	40201388
Hospital Revenue Code	278
Min. Negotiated Rate	$125.00
Max. Negotiated Rate	$125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00

PIN APEX HALF 6X200 50 CT THRD

Facility

$187.50

Service Code	HCPCS C1713
Hospital Charge Code	40201391
Hospital Revenue Code	278
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$196.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$112.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$93.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$107.81
Rate for Payer: EmblemHealth Commercial	$93.75
Rate for Payer: Fidelis Medicare Advantage	$196.88
Rate for Payer: Group Health Inc Commercial	$93.75
Rate for Payer: Group Health Inc Medicare	$65.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.75
Rate for Payer: Hamaspik Choice Inc Medicare	$93.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$121.88

PIN APEX HALF 6X200 50 CT THRD

Facility

$187.50

Service Code	HCPCS C1713
Hospital Charge Code	40201391
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.75
Rate for Payer: Hamaspik Choice Inc Medicare	$93.75

PIN APEX HLF PIN 5X 180MM

Facility

$226.00

Service Code	HCPCS C1776
Hospital Charge Code	40205069
Hospital Revenue Code	278
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$135.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$113.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$129.95
Rate for Payer: EmblemHealth Commercial	$113.00
Rate for Payer: Fidelis Medicare Advantage	$237.30
Rate for Payer: Group Health Inc Commercial	$113.00
Rate for Payer: Group Health Inc Medicare	$79.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.00
Rate for Payer: Hamaspik Choice Inc Medicare	$113.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$146.90

PIN APEX HLF PIN 5X 180MM

Facility

$226.00

Service Code	HCPCS C1776
Hospital Charge Code	40205069
Hospital Revenue Code	278
Min. Negotiated Rate	$113.00
Max. Negotiated Rate	$113.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.00
Rate for Payer: Hamaspik Choice Inc Medicare	$113.00

PIN APEX MODE TRANSFIX 4X250

Facility

$274.40

Service Code	HCPCS C1713
Hospital Charge Code	40200760
Hospital Revenue Code	278
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$137.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.20
Rate for Payer: Hamaspik Choice Inc Medicare	$137.20

PIN APEX MODE TRANSFIX 4X250

Facility

$274.40

Service Code	HCPCS C1713
Hospital Charge Code	40200760
Hospital Revenue Code	278
Min. Negotiated Rate	$96.04
Max. Negotiated Rate	$288.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$164.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$137.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.78
Rate for Payer: EmblemHealth Commercial	$137.20
Rate for Payer: Fidelis Medicare Advantage	$288.12
Rate for Payer: Group Health Inc Commercial	$137.20
Rate for Payer: Group Health Inc Medicare	$96.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.20
Rate for Payer: Hamaspik Choice Inc Medicare	$137.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$178.36

PIN APEX MOD TRANSFIX 3X250MM

Facility

$215.60

Service Code	HCPCS C1713
Hospital Charge Code	40205082
Hospital Revenue Code	278
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$107.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.80
Rate for Payer: Hamaspik Choice Inc Medicare	$107.80

PIN APEX MOD TRANSFIX 3X250MM

Facility

$215.60

Service Code	HCPCS C1713
Hospital Charge Code	40205082
Hospital Revenue Code	278
Min. Negotiated Rate	$75.46
Max. Negotiated Rate	$226.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$118.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$129.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$107.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$123.97
Rate for Payer: EmblemHealth Commercial	$107.80
Rate for Payer: Fidelis Medicare Advantage	$226.38
Rate for Payer: Group Health Inc Commercial	$107.80
Rate for Payer: Group Health Inc Medicare	$75.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.80
Rate for Payer: Hamaspik Choice Inc Medicare	$107.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$140.14

PIN AX IJS

Facility

$800.00

Service Code	HCPCS C1713
Hospital Charge Code	64907469
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$840.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$440.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$480.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$460.00
Rate for Payer: EmblemHealth Commercial	$400.00
Rate for Payer: Fidelis Medicare Advantage	$840.00
Rate for Payer: Group Health Inc Commercial	$400.00
Rate for Payer: Group Health Inc Medicare	$280.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$520.00

PIN AX IJS

Facility

$800.00

Service Code	HCPCS C1713
Hospital Charge Code	64907469
Hospital Revenue Code	278
Min. Negotiated Rate	$400.00
Max. Negotiated Rate	$400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00

PIN CLAMP

Facility

$1,843.80

Hospital Charge Code	40200668
Hospital Revenue Code	270
Min. Negotiated Rate	$645.33
Max. Negotiated Rate	$1,475.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,014.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$921.90
Rate for Payer: Aetna Government	$921.90
Rate for Payer: Brighton Health Commercial	$1,382.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,475.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,253.78
Rate for Payer: Group Health Inc Commercial	$921.90
Rate for Payer: Group Health Inc Medicare	$645.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$921.90
Rate for Payer: Hamaspik Choice Inc Medicare	$921.90

Know your out-of-pocket cost for care.

All Charges