St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PIN RETENTION/TOOTH, IN ADDITION

Facility

$72.50

Service Code	HCPCS D2951
Hospital Charge Code	42300650
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

PIN RETENTION/TOOTH, IN ADDITION

Facility

$72.50

Service Code	HCPCS D2951
Hospital Charge Code	42300650
Hospital Revenue Code	361
Min. Negotiated Rate	$36.25
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$54.38
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

PINS DIA 4MM X 20MM SD/ST

Facility

$164.00

Service Code	HCPCS C1713
Hospital Charge Code	40201399
Hospital Revenue Code	278
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$82.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00

PINS DIA 4MM X 20MM SD/ST

Facility

$164.00

Service Code	HCPCS C1713
Hospital Charge Code	40201399
Hospital Revenue Code	278
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$172.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$98.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$94.30
Rate for Payer: EmblemHealth Commercial	$82.00
Rate for Payer: Fidelis Medicare Advantage	$172.20
Rate for Payer: Group Health Inc Commercial	$82.00
Rate for Payer: Group Health Inc Medicare	$57.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$106.60

PINS DIA 5MM X 150MM BLUNT

Facility

$164.00

Service Code	HCPCS C1713
Hospital Charge Code	40201400
Hospital Revenue Code	278
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$82.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00

PINS DIA 5MM X 150MM BLUNT

Facility

$164.00

Service Code	HCPCS C1713
Hospital Charge Code	40201400
Hospital Revenue Code	278
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$172.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$98.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$94.30
Rate for Payer: EmblemHealth Commercial	$82.00
Rate for Payer: Fidelis Medicare Advantage	$172.20
Rate for Payer: Group Health Inc Commercial	$82.00
Rate for Payer: Group Health Inc Medicare	$57.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$106.60

PINS DIA 5MM X 200MM BLUNT

Facility

$164.00

Service Code	HCPCS C1713
Hospital Charge Code	40201401
Hospital Revenue Code	278
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$82.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00

PINS DIA 5MM X 200MM BLUNT

Facility

$164.00

Service Code	HCPCS C1713
Hospital Charge Code	40201401
Hospital Revenue Code	278
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$172.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$98.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$94.30
Rate for Payer: EmblemHealth Commercial	$82.00
Rate for Payer: Fidelis Medicare Advantage	$172.20
Rate for Payer: Group Health Inc Commercial	$82.00
Rate for Payer: Group Health Inc Medicare	$57.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$106.60

PINS DIA 5MM X 200 MM SD/ST

Facility

$242.00

Service Code	HCPCS C1713
Hospital Charge Code	40201402
Hospital Revenue Code	278
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$254.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$133.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$145.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$121.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$139.15
Rate for Payer: EmblemHealth Commercial	$121.00
Rate for Payer: Fidelis Medicare Advantage	$254.10
Rate for Payer: Group Health Inc Commercial	$121.00
Rate for Payer: Group Health Inc Medicare	$84.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.00
Rate for Payer: Hamaspik Choice Inc Medicare	$121.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$157.30

PINS DIA 5MM X 200 MM SD/ST

Facility

$242.00

Service Code	HCPCS C1713
Hospital Charge Code	40201402
Hospital Revenue Code	278
Min. Negotiated Rate	$121.00
Max. Negotiated Rate	$121.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.00
Rate for Payer: Hamaspik Choice Inc Medicare	$121.00

PIN S- DRL HYB ORTHO

Facility

$317.93

Service Code	HCPCS C1713
Hospital Charge Code	64907120
Hospital Revenue Code	278
Min. Negotiated Rate	$111.28
Max. Negotiated Rate	$333.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$174.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$190.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$158.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.81
Rate for Payer: EmblemHealth Commercial	$158.96
Rate for Payer: Fidelis Medicare Advantage	$333.83
Rate for Payer: Group Health Inc Commercial	$158.96
Rate for Payer: Group Health Inc Medicare	$111.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.96
Rate for Payer: Hamaspik Choice Inc Medicare	$158.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$206.65

PIN S- DRL HYB ORTHO

Facility

$317.93

Service Code	HCPCS C1713
Hospital Charge Code	64907120
Hospital Revenue Code	278
Min. Negotiated Rate	$158.96
Max. Negotiated Rate	$158.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.96
Rate for Payer: Hamaspik Choice Inc Medicare	$158.96

PIN SELF DRILLING

Facility

$274.00

Service Code	HCPCS C1713
Hospital Charge Code	40209885
Hospital Revenue Code	278
Min. Negotiated Rate	$137.00
Max. Negotiated Rate	$137.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00

PIN SELF DRILLING

Facility

$274.00

Service Code	HCPCS C1713
Hospital Charge Code	40209885
Hospital Revenue Code	278
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$287.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$164.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$137.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.55
Rate for Payer: EmblemHealth Commercial	$137.00
Rate for Payer: Fidelis Medicare Advantage	$287.70
Rate for Payer: Group Health Inc Commercial	$137.00
Rate for Payer: Group Health Inc Medicare	$95.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$178.10

PIN SET MODULAR GLENOID

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64907352
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,050.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$600.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$575.00
Rate for Payer: EmblemHealth Commercial	$500.00
Rate for Payer: Fidelis Medicare Advantage	$1,050.00
Rate for Payer: Group Health Inc Commercial	$500.00
Rate for Payer: Group Health Inc Medicare	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$650.00

PIN SET MODULAR GLENOID

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64907352
Hospital Revenue Code	278
Min. Negotiated Rate	$500.00
Max. Negotiated Rate	$500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00

PIN SKULL ADULT (MAYFIELD)

Facility

$34.17

Hospital Charge Code	64904258
Hospital Revenue Code	270
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$27.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.08
Rate for Payer: Aetna Government	$17.08
Rate for Payer: Brighton Health Commercial	$25.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.24
Rate for Payer: Group Health Inc Commercial	$17.08
Rate for Payer: Group Health Inc Medicare	$11.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.08
Rate for Payer: Hamaspik Choice Inc Medicare	$17.08

PINS/RODS 100-299

Facility

$347.21

Service Code	HCPCS C1713
Hospital Charge Code	40203083
Hospital Revenue Code	278
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$173.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.60
Rate for Payer: Hamaspik Choice Inc Medicare	$173.60

PINS/RODS 100-299

Facility

$347.21

Service Code	HCPCS C1713
Hospital Charge Code	40203083
Hospital Revenue Code	278
Min. Negotiated Rate	$121.52
Max. Negotiated Rate	$364.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$190.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$208.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$173.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$199.65
Rate for Payer: EmblemHealth Commercial	$173.60
Rate for Payer: Fidelis Medicare Advantage	$364.57
Rate for Payer: Group Health Inc Commercial	$173.60
Rate for Payer: Group Health Inc Medicare	$121.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.60
Rate for Payer: Hamaspik Choice Inc Medicare	$173.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$225.69

PINS/RODS 300-499

Facility

$700.94

Service Code	HCPCS C1713
Hospital Charge Code	40203084
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$735.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$420.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$403.04
Rate for Payer: EmblemHealth Commercial	$350.47
Rate for Payer: Fidelis Medicare Advantage	$735.99
Rate for Payer: Group Health Inc Commercial	$350.47
Rate for Payer: Group Health Inc Medicare	$245.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.47
Rate for Payer: Hamaspik Choice Inc Medicare	$350.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$455.61

PINS/RODS 300-499

Facility

$700.94

Service Code	HCPCS C1713
Hospital Charge Code	40203084
Hospital Revenue Code	278
Min. Negotiated Rate	$350.47
Max. Negotiated Rate	$350.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.47
Rate for Payer: Hamaspik Choice Inc Medicare	$350.47

PINS/RODS 500-999

Facility

$1,231.69

Service Code	HCPCS C1713
Hospital Charge Code	40203085
Hospital Revenue Code	278
Min. Negotiated Rate	$615.84
Max. Negotiated Rate	$615.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$615.84
Rate for Payer: Hamaspik Choice Inc Medicare	$615.84

PINS/RODS 500-999

Facility

$1,231.69

Service Code	HCPCS C1713
Hospital Charge Code	40203085
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,293.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$677.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$739.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$615.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$708.22
Rate for Payer: EmblemHealth Commercial	$615.84
Rate for Payer: Fidelis Medicare Advantage	$1,293.27
Rate for Payer: Group Health Inc Commercial	$615.84
Rate for Payer: Group Health Inc Medicare	$431.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$615.84
Rate for Payer: Hamaspik Choice Inc Medicare	$615.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$800.60

PIN STEIN 5/6MM

Facility

$224.00

Service Code	HCPCS C1776
Hospital Charge Code	40208090
Hospital Revenue Code	278
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$134.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.80
Rate for Payer: EmblemHealth Commercial	$112.00
Rate for Payer: Fidelis Medicare Advantage	$235.20
Rate for Payer: Group Health Inc Commercial	$112.00
Rate for Payer: Group Health Inc Medicare	$78.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.00
Rate for Payer: Hamaspik Choice Inc Medicare	$112.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$145.60

PIN STEIN 5/6MM

Facility

$224.00

Service Code	HCPCS C1776
Hospital Charge Code	40208090
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.00
Rate for Payer: Hamaspik Choice Inc Medicare	$112.00

Know your out-of-pocket cost for care.

All Charges