St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PRIMARY RECON PLATE,17 HOLE

Facility

$1,394.00

Service Code	HCPCS C1713
Hospital Charge Code	40201284
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,463.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$766.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$836.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$697.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$801.55
Rate for Payer: EmblemHealth Commercial	$697.00
Rate for Payer: Fidelis Medicare Advantage	$1,463.70
Rate for Payer: Group Health Inc Commercial	$697.00
Rate for Payer: Group Health Inc Medicare	$487.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$697.00
Rate for Payer: Hamaspik Choice Inc Medicare	$697.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$906.10

PRIMARY RECON PLATE,17 HOLE

Facility

$1,394.00

Service Code	HCPCS C1713
Hospital Charge Code	40201284
Hospital Revenue Code	278
Min. Negotiated Rate	$697.00
Max. Negotiated Rate	$697.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$697.00
Rate for Payer: Hamaspik Choice Inc Medicare	$697.00

PRIMARY SECUR-FIT PLUS HIP STEM

Facility

$1,220.80

Service Code	HCPCS C1776
Hospital Charge Code	40201285
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,281.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$671.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$732.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$610.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$701.96
Rate for Payer: EmblemHealth Commercial	$610.40
Rate for Payer: Fidelis Medicare Advantage	$1,281.84
Rate for Payer: Group Health Inc Commercial	$610.40
Rate for Payer: Group Health Inc Medicare	$427.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$610.40
Rate for Payer: Hamaspik Choice Inc Medicare	$610.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$793.52

PRIMARY SECUR-FIT PLUS HIP STEM

Facility

$1,220.80

Service Code	HCPCS C1776
Hospital Charge Code	40201285
Hospital Revenue Code	278
Min. Negotiated Rate	$610.40
Max. Negotiated Rate	$610.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$610.40
Rate for Payer: Hamaspik Choice Inc Medicare	$610.40

PRIMARY TIBIAL BASEPLATE#4

Facility

$3,422.00

Service Code	HCPCS C1713
Hospital Charge Code	40201288
Hospital Revenue Code	278
Min. Negotiated Rate	$1,711.00
Max. Negotiated Rate	$1,711.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,711.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,711.00

PRIMARY TIBIAL BASEPLATE#4

Facility

$3,422.00

Service Code	HCPCS C1713
Hospital Charge Code	40201288
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,593.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,882.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,053.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,711.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,967.65
Rate for Payer: EmblemHealth Commercial	$1,711.00
Rate for Payer: Fidelis Medicare Advantage	$3,593.10
Rate for Payer: Group Health Inc Commercial	$1,711.00
Rate for Payer: Group Health Inc Medicare	$1,197.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,711.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,711.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,224.30

PRIMARY TIBIAL BASEPLTE #3

Facility

$6,660.00

Service Code	HCPCS C1713
Hospital Charge Code	40201287
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,993.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,663.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,996.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,330.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,829.50
Rate for Payer: EmblemHealth Commercial	$3,330.00
Rate for Payer: Fidelis Medicare Advantage	$6,993.00
Rate for Payer: Group Health Inc Commercial	$3,330.00
Rate for Payer: Group Health Inc Medicare	$2,331.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,330.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,330.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,329.00

PRIMARY TIBIAL BASEPLTE #3

Facility

$6,660.00

Service Code	HCPCS C1713
Hospital Charge Code	40201287
Hospital Revenue Code	278
Min. Negotiated Rate	$3,330.00
Max. Negotiated Rate	$3,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,330.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,330.00

PRIMATRIX 4X4 MESH (607-005-440)

Facility

$2,187.50

Service Code	HCPCS C1781
Hospital Charge Code	64901195
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,296.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,203.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,312.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,093.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,257.81
Rate for Payer: EmblemHealth Commercial	$1,093.75
Rate for Payer: Fidelis Medicare Advantage	$2,296.88
Rate for Payer: Group Health Inc Commercial	$1,093.75
Rate for Payer: Group Health Inc Medicare	$765.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,093.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,093.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,421.88

PRIMATRIX 4X4 MESH (607-005-440)

Facility

$2,187.50

Service Code	HCPCS C1781
Hospital Charge Code	64901195
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.75
Max. Negotiated Rate	$1,093.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,093.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,093.75

PRIMATRIX 8CMX12CM MESH

Facility

$11,732.00

Service Code	HCPCS Q4110
Hospital Charge Code	40005324
Hospital Revenue Code	636
Min. Negotiated Rate	$5,866.00
Max. Negotiated Rate	$5,866.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,866.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,866.00

PRIMATRIX 8CMX12CM MESH

Facility

$11,732.00

Service Code	HCPCS Q4110
Hospital Charge Code	40005324
Hospital Revenue Code	636
Min. Negotiated Rate	$43.43
Max. Negotiated Rate	$7,625.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,452.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.43
Rate for Payer: Aetna Government	$43.43
Rate for Payer: Brighton Health Commercial	$7,039.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,866.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,745.90
Rate for Payer: Group Health Inc Commercial	$5,866.00
Rate for Payer: Group Health Inc Medicare	$4,106.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,866.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,866.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,625.80

PRIMATRIX PER SQ CM

Facility

$114.54

Service Code	HCPCS Q4110
Hospital Charge Code	40203403
Hospital Revenue Code	636
Min. Negotiated Rate	$57.27
Max. Negotiated Rate	$57.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.27
Rate for Payer: Hamaspik Choice Inc Medicare	$57.27

PRIMATRIX PER SQ CM

Facility

$114.54

Service Code	HCPCS Q4110
Hospital Charge Code	40203403
Hospital Revenue Code	636
Min. Negotiated Rate	$40.09
Max. Negotiated Rate	$74.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.43
Rate for Payer: Aetna Government	$43.43
Rate for Payer: Brighton Health Commercial	$68.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.86
Rate for Payer: Group Health Inc Commercial	$57.27
Rate for Payer: Group Health Inc Medicare	$40.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.27
Rate for Payer: Hamaspik Choice Inc Medicare	$57.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.45

PRIMATRIX, PER SQ CM

Facility

$114.54

Service Code	HCPCS Q4110
Hospital Charge Code	40203404
Hospital Revenue Code	636
Min. Negotiated Rate	$40.09
Max. Negotiated Rate	$74.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.43
Rate for Payer: Aetna Government	$43.43
Rate for Payer: Brighton Health Commercial	$68.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.86
Rate for Payer: Group Health Inc Commercial	$57.27
Rate for Payer: Group Health Inc Medicare	$40.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.27
Rate for Payer: Hamaspik Choice Inc Medicare	$57.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.45

PRIMATRIX, PER SQ CM

Facility

$114.54

Service Code	HCPCS Q4110
Hospital Charge Code	40203404
Hospital Revenue Code	636
Min. Negotiated Rate	$57.27
Max. Negotiated Rate	$57.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.27
Rate for Payer: Hamaspik Choice Inc Medicare	$57.27

PRIMATRIX, PER SQ CM

Facility

$69.38

Service Code	HCPCS Q4110
Hospital Charge Code	42500215
Hospital Revenue Code	636
Min. Negotiated Rate	$24.28
Max. Negotiated Rate	$45.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.43
Rate for Payer: Aetna Government	$43.43
Rate for Payer: Brighton Health Commercial	$41.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.89
Rate for Payer: Group Health Inc Commercial	$34.69
Rate for Payer: Group Health Inc Medicare	$24.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.69
Rate for Payer: Hamaspik Choice Inc Medicare	$34.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.10

PRIMATRIX, PER SQ CM

Facility

$69.38

Service Code	HCPCS Q4110
Hospital Charge Code	42500215
Hospital Revenue Code	636
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.69
Rate for Payer: Hamaspik Choice Inc Medicare	$34.69

PR IMBRICATION DIAPHRAGM EVENTRATION

Professional

Both

$3,994.06

Service Code	HCPCS 39545
Min. Negotiated Rate	$2,995.54
Max. Negotiated Rate	$2,995.54
Rate for Payer: Cash Price	$1,066.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,995.54
Rate for Payer: SOMOS Essential	$2,995.54

PRIM CLOSURE-SINUS PERFORATION

Facility

$500.00

Service Code	HCPCS D7261
Hospital Charge Code	42303445
Hospital Revenue Code	361
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
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	$375.00
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	$250.00
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

PRIM CLOSURE-SINUS PERFORATION

Facility

$500.00

Service Code	HCPCS D7261
Hospital Charge Code	42303445
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

PR IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ

Professional

Both

$558.92

Service Code	HCPCS 10030
Min. Negotiated Rate	$419.19
Max. Negotiated Rate	$419.19
Rate for Payer: Cash Price	$151.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$419.19
Rate for Payer: SOMOS Essential	$419.19

PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ

Professional

Both

$791.84

Service Code	HCPCS 49406
Min. Negotiated Rate	$593.88
Max. Negotiated Rate	$593.88
Rate for Payer: Cash Price	$214.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$593.88
Rate for Payer: SOMOS Essential	$593.88

PR IMG RETINA DETCJ/MNTR DS POC AUTON A/R UNI/BI

Professional

Both

$195.37

Service Code	HCPCS 92229
Min. Negotiated Rate	$146.53
Max. Negotiated Rate	$146.53
Rate for Payer: Cash Price	$48.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.53
Rate for Payer: SOMOS Essential	$146.53

PR IMG RETINA DETCJ/MNTR DS REM CLIN STAFF UNI/BI

Professional

Both

$73.19

Service Code	HCPCS 92227
Min. Negotiated Rate	$54.89
Max. Negotiated Rate	$54.89
Rate for Payer: Cash Price	$21.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$54.89
Rate for Payer: SOMOS Essential	$54.89

Know your out-of-pocket cost for care.

All Charges