St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

4 HOLE ORBITAL PLT UPPERFACE

Facility

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	40201087
Hospital Revenue Code	278
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$193.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$110.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.80
Rate for Payer: EmblemHealth Commercial	$92.00
Rate for Payer: Fidelis Medicare Advantage	$193.20
Rate for Payer: Group Health Inc Commercial	$92.00
Rate for Payer: Group Health Inc Medicare	$64.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.00
Rate for Payer: Hamaspik Choice Inc Medicare	$92.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$119.60

4 HOLE ORBITAL PLT UPPERFACE

Facility

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	40201087
Hospital Revenue Code	278
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$92.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.00
Rate for Payer: Hamaspik Choice Inc Medicare	$92.00

4 HOLE PLATE

Facility

$338.38

Service Code	HCPCS C1713
Hospital Charge Code	40005303
Hospital Revenue Code	278
Min. Negotiated Rate	$118.43
Max. Negotiated Rate	$355.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$203.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$169.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$194.57
Rate for Payer: EmblemHealth Commercial	$169.19
Rate for Payer: Fidelis Medicare Advantage	$355.30
Rate for Payer: Group Health Inc Commercial	$169.19
Rate for Payer: Group Health Inc Medicare	$118.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.19
Rate for Payer: Hamaspik Choice Inc Medicare	$169.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$219.95

4 HOLE PLATE

Facility

$338.38

Service Code	HCPCS C1713
Hospital Charge Code	40005303
Hospital Revenue Code	278
Min. Negotiated Rate	$169.19
Max. Negotiated Rate	$169.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.19
Rate for Payer: Hamaspik Choice Inc Medicare	$169.19

4 HOLE ST PLATE LONG,MAND,LOCK

Facility

$226.00

Service Code	HCPCS C1713
Hospital Charge Code	40201085
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

4 HOLE ST PLATE LONG,MAND,LOCK

Facility

$226.00

Service Code	HCPCS C1713
Hospital Charge Code	40201085
Hospital Revenue Code	278
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$237.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
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

4 HOLE STRIAGHT PLATE W/ BAR MDFC

Facility

$188.00

Service Code	HCPCS C1713
Hospital Charge Code	40201086
Hospital Revenue Code	278
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$94.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.00
Rate for Payer: Hamaspik Choice Inc Medicare	$94.00

4 HOLE STRIAGHT PLATE W/ BAR MDFC

Facility

$188.00

Service Code	HCPCS C1713
Hospital Charge Code	40201086
Hospital Revenue Code	278
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$197.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$112.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$94.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.10
Rate for Payer: EmblemHealth Commercial	$94.00
Rate for Payer: Fidelis Medicare Advantage	$197.40
Rate for Payer: Group Health Inc Commercial	$94.00
Rate for Payer: Group Health Inc Medicare	$65.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.00
Rate for Payer: Hamaspik Choice Inc Medicare	$94.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$122.20

4H ST PLATE LONG,MAND,LOCK

Facility

$271.00

Service Code	HCPCS C1713
Hospital Charge Code	40209411
Hospital Revenue Code	278
Min. Negotiated Rate	$94.85
Max. Negotiated Rate	$284.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$149.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$162.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$155.82
Rate for Payer: EmblemHealth Commercial	$135.50
Rate for Payer: Fidelis Medicare Advantage	$284.55
Rate for Payer: Group Health Inc Commercial	$135.50
Rate for Payer: Group Health Inc Medicare	$94.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.50
Rate for Payer: Hamaspik Choice Inc Medicare	$135.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$176.15

4H ST PLATE LONG,MAND,LOCK

Facility

$271.00

Service Code	HCPCS C1713
Hospital Charge Code	40209411
Hospital Revenue Code	278
Min. Negotiated Rate	$135.50
Max. Negotiated Rate	$135.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.50
Rate for Payer: Hamaspik Choice Inc Medicare	$135.50

.4MM 100X100 MESH MALLEABLE

Facility

$4,458.00

Service Code	HCPCS C1781
Hospital Charge Code	40205294
Hospital Revenue Code	278
Min. Negotiated Rate	$2,229.00
Max. Negotiated Rate	$2,229.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,229.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,229.00

.4MM 100X100 MESH MALLEABLE

Facility

$4,458.00

Service Code	HCPCS C1781
Hospital Charge Code	40205294
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$4,680.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,451.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,674.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,229.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,563.35
Rate for Payer: EmblemHealth Commercial	$2,229.00
Rate for Payer: Fidelis Medicare Advantage	$4,680.90
Rate for Payer: Group Health Inc Commercial	$2,229.00
Rate for Payer: Group Health Inc Medicare	$1,560.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,229.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,229.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,897.70

.4MM EMERGENCY SCREW

Facility

$162.00

Service Code	HCPCS C1713
Hospital Charge Code	40205299
Hospital Revenue Code	278
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$81.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.00
Rate for Payer: Hamaspik Choice Inc Medicare	$81.00

.4MM EMERGENCY SCREW

Facility

$162.00

Service Code	HCPCS C1713
Hospital Charge Code	40205299
Hospital Revenue Code	278
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$170.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$97.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.15
Rate for Payer: EmblemHealth Commercial	$81.00
Rate for Payer: Fidelis Medicare Advantage	$170.10
Rate for Payer: Group Health Inc Commercial	$81.00
Rate for Payer: Group Health Inc Medicare	$56.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.00
Rate for Payer: Hamaspik Choice Inc Medicare	$81.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.30

4-NO PRIVATE

Facility

$4,209.70

Hospital Charge Code	30000027
Hospital Revenue Code	126
Min. Negotiated Rate	$933.00
Max. Negotiated Rate	$1,043.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$933.00
Rate for Payer: Optum Commercial/Medicare	$1,043.00
Rate for Payer: Optum Medicaid	$1,043.00

4 SINGLE STINGING INSECT VENOMS

Facility

$183.15

Service Code	HCPCS 95148
Hospital Charge Code	30304067
Hospital Revenue Code	510
Min. Negotiated Rate	$57.02
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$81.46
Rate for Payer: Aetna Government	$81.46
Rate for Payer: Affinity Essential Plan 1&2	$57.02
Rate for Payer: Affinity Essential Plan 3&4	$57.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$57.02
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$81.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Elderplan Medicare Advantage	$81.46
Rate for Payer: Fidelis Essential Plan Aliesa	$69.24
Rate for Payer: Fidelis Essential Plan QHP	$72.50
Rate for Payer: Fidelis Medicare Advantage	$81.46
Rate for Payer: Fidelis Qualified Health Plan	$72.50
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.58
Rate for Payer: Hamaspik Choice Inc Medicare	$81.46
Rate for Payer: Healthfirst Medicare Advantage	$69.24
Rate for Payer: Healthfirst QHP	$81.46
Rate for Payer: Humana Medicare	$83.09
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$81.46
Rate for Payer: Senior Whole Health Medicare Advantage	$81.46
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$81.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$65.17
Rate for Payer: Wellcare Medicare	$77.39

4 SINGLE STINGING INSECT VENOMS

Facility

$183.15

Service Code	HCPCS 95148
Hospital Charge Code	30304067
Hospital Revenue Code	510
Rate for Payer: Cash Price	$81.46

4-SO PRIVATE

Facility

$4,209.70

Hospital Charge Code	30000025
Hospital Revenue Code	126
Min. Negotiated Rate	$933.00
Max. Negotiated Rate	$1,043.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$933.00
Rate for Payer: Optum Commercial/Medicare	$1,043.00
Rate for Payer: Optum Medicaid	$1,043.00

4-TYPE SOL SET PRESS. PUMP

Facility

$9.57

Hospital Charge Code	40509819
Hospital Revenue Code	260
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.78
Rate for Payer: Aetna Government	$4.78
Rate for Payer: Brighton Health Commercial	$7.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.51
Rate for Payer: Group Health Inc Commercial	$4.78
Rate for Payer: Group Health Inc Medicare	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.78
Rate for Payer: Hamaspik Choice Inc Medicare	$4.78
Rate for Payer: United Healthcare Commercial	$76.00

4-TYPE TUR ADM. SET

Facility

$15.95

Hospital Charge Code	40509821
Hospital Revenue Code	260
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.98
Rate for Payer: Aetna Government	$7.98
Rate for Payer: Brighton Health Commercial	$11.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.85
Rate for Payer: Group Health Inc Commercial	$7.98
Rate for Payer: Group Health Inc Medicare	$5.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.98
Rate for Payer: Hamaspik Choice Inc Medicare	$7.98
Rate for Payer: United Healthcare Commercial	$76.00

4x5 Bioclusive Dressing

Facility

$6.73

Hospital Charge Code	40200006
Hospital Revenue Code	270
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Brighton Health Commercial	$5.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.58
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36

500CC TISSUE EXPANDER

Facility

$2,700.00

Service Code	HCPCS C1789
Hospital Charge Code	40009271
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$1,350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,350.00

500CC TISSUE EXPANDER

Facility

$2,700.00

Service Code	HCPCS C1789
Hospital Charge Code	40009271
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,835.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,620.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,552.50
Rate for Payer: EmblemHealth Commercial	$1,350.00
Rate for Payer: Fidelis Medicare Advantage	$2,835.00
Rate for Payer: Group Health Inc Commercial	$1,350.00
Rate for Payer: Group Health Inc Medicare	$945.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,755.00

500CC TISSUE EXPANDER 133MX-13-T

Facility

$3,375.00

Service Code	HCPCS C1789
Hospital Charge Code	40005326
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$3,543.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,856.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$2,025.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,940.62
Rate for Payer: EmblemHealth Commercial	$1,687.50
Rate for Payer: Fidelis Medicare Advantage	$3,543.75
Rate for Payer: Group Health Inc Commercial	$1,687.50
Rate for Payer: Group Health Inc Medicare	$1,181.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,193.75

500CC TISSUE EXPANDER 133MX-13-T

Facility

$3,375.00

Service Code	HCPCS C1789
Hospital Charge Code	40005326
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,687.50

Know your out-of-pocket cost for care.

All Charges