St. Barnabas Hospital

All Charges

Charge

Type

Price

TIBIA PSN STM 5 DEG SZ G L

Facility OP

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905662
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,750.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,875.00
Rate for Payer: Fidelis Medicare Advantage	$5,250.00
Rate for Payer: Group Health Inc Commercial	$2,500.00
Rate for Payer: Group Health Inc Medicare	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,250.00

TIBIA PSN STM 5 DEG SZ G L

Facility IP

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905662
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00

TIBIA PSN TEM 5 DEG SZ C L

Facility IP

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40204655
Hospital Revenue Code	278
Min. Negotiated Rate	$2,200.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00

TIBIA PSN TEM 5 DEG SZ C L

Facility OP

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40204655
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,620.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,420.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,530.00
Rate for Payer: Fidelis Medicare Advantage	$4,620.00
Rate for Payer: Group Health Inc Commercial	$2,200.00
Rate for Payer: Group Health Inc Medicare	$1,540.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,860.00

TIBIA RIGHT SIZE 4

Facility OP

$3,935.25

Service Code	HCPCS C1713
Hospital Charge Code	64902660
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,132.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,164.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,967.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,262.77
Rate for Payer: Fidelis Medicare Advantage	$4,132.01
Rate for Payer: Group Health Inc Commercial	$1,967.62
Rate for Payer: Group Health Inc Medicare	$1,377.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,967.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,967.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,557.91

TIBIA RIGHT SIZE 4

Facility IP

$3,935.25

Service Code	HCPCS C1713
Hospital Charge Code	64902660
Hospital Revenue Code	278
Min. Negotiated Rate	$1,967.62
Max. Negotiated Rate	$1,967.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,967.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,967.62

TIB INS HRHK

Facility IP

$3,864.38

Service Code	HCPCS C1776
Hospital Charge Code	64907260
Hospital Revenue Code	278
Min. Negotiated Rate	$1,932.19
Max. Negotiated Rate	$1,932.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,932.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1,932.19

TIB INS HRHK

Facility OP

$3,864.38

Service Code	HCPCS C1776
Hospital Charge Code	64907260
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,057.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,125.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,932.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,222.02
Rate for Payer: Fidelis Medicare Advantage	$4,057.60
Rate for Payer: Group Health Inc Commercial	$1,932.19
Rate for Payer: Group Health Inc Medicare	$1,352.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,932.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1,932.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,511.85

TIB PROX

Facility IP

$24,300.00

Service Code	HCPCS C1776
Hospital Charge Code	64907301
Hospital Revenue Code	278
Min. Negotiated Rate	$12,150.00
Max. Negotiated Rate	$12,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$12,150.00

TIB PROX

Facility OP

$24,300.00

Service Code	HCPCS C1776
Hospital Charge Code	64907301
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$25,515.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13,365.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12,150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,972.50
Rate for Payer: Fidelis Medicare Advantage	$25,515.00
Rate for Payer: Group Health Inc Commercial	$12,150.00
Rate for Payer: Group Health Inc Medicare	$8,505.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$12,150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15,795.00

TIB REV LEGION SZ 6 RIGHT

Facility IP

$9,677.50

Service Code	HCPCS C1776
Hospital Charge Code	64904856
Hospital Revenue Code	278
Min. Negotiated Rate	$4,838.75
Max. Negotiated Rate	$4,838.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,838.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,838.75

TIB REV LEGION SZ 6 RIGHT

Facility OP

$9,677.50

Service Code	HCPCS C1776
Hospital Charge Code	64904856
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,161.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,322.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,838.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,564.56
Rate for Payer: Fidelis Medicare Advantage	$10,161.38
Rate for Payer: Group Health Inc Commercial	$4,838.75
Rate for Payer: Group Health Inc Medicare	$3,387.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,838.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,838.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,290.38

TIB ROT HRHK COMP

Facility IP

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907257
Hospital Revenue Code	278
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,000.00

TIB ROT HRHK COMP

Facility OP

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907257
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,500.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,750.00
Rate for Payer: Fidelis Medicare Advantage	$10,500.00
Rate for Payer: Group Health Inc Commercial	$5,000.00
Rate for Payer: Group Health Inc Medicare	$3,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,500.00

TIB STEM MRS

Facility OP

$12,898.12

Service Code	HCPCS C1776
Hospital Charge Code	64907276
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$13,543.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,093.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,449.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,416.42
Rate for Payer: Fidelis Medicare Advantage	$13,543.03
Rate for Payer: Group Health Inc Commercial	$6,449.06
Rate for Payer: Group Health Inc Medicare	$4,514.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,449.06
Rate for Payer: Hamaspik Choice Inc Medicare	$6,449.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,383.78

TIB STEM MRS

Facility IP

$12,898.12

Service Code	HCPCS C1776
Hospital Charge Code	64907276
Hospital Revenue Code	278
Min. Negotiated Rate	$6,449.06
Max. Negotiated Rate	$6,449.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,449.06
Rate for Payer: Hamaspik Choice Inc Medicare	$6,449.06

TIB TRI AUG

Facility IP

$3,896.25

Service Code	HCPCS C1776
Hospital Charge Code	64907218
Hospital Revenue Code	278
Min. Negotiated Rate	$1,948.12
Max. Negotiated Rate	$1,948.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,948.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,948.12

TIB TRI AUG

Facility OP

$3,896.25

Service Code	HCPCS C1776
Hospital Charge Code	64907218
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,091.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,142.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,948.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,240.34
Rate for Payer: Fidelis Medicare Advantage	$4,091.06
Rate for Payer: Group Health Inc Commercial	$1,948.12
Rate for Payer: Group Health Inc Medicare	$1,363.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,948.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,948.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,532.56

TIBULA, CEMENT 5 DEG SZ D L

Facility OP

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905519
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,750.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,875.00
Rate for Payer: Fidelis Medicare Advantage	$5,250.00
Rate for Payer: Group Health Inc Commercial	$2,500.00
Rate for Payer: Group Health Inc Medicare	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,250.00

TIBULA, CEMENT 5 DEG SZ D L

Facility IP

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905519
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00

TIBULA, CEMENT 5 DEG SZ E L

Facility IP

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905510
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00

TIBULA, CEMENT 5 DEG SZ E L

Facility OP

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905510
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,750.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,875.00
Rate for Payer: Fidelis Medicare Advantage	$5,250.00
Rate for Payer: Group Health Inc Commercial	$2,500.00
Rate for Payer: Group Health Inc Medicare	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,250.00

TIBULA CMNTD PSN STM 5 DEG SZ D L

Facility IP

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40204604
Hospital Revenue Code	278
Min. Negotiated Rate	$2,200.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00

TIBULA CMNTD PSN STM 5 DEG SZ D L

Facility OP

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40204604
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,620.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,420.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,530.00
Rate for Payer: Fidelis Medicare Advantage	$4,620.00
Rate for Payer: Group Health Inc Commercial	$2,200.00
Rate for Payer: Group Health Inc Medicare	$1,540.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,860.00

TIBULA CMNTD PSN STM 5 DEG SZ E L

Facility IP

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40204596
Hospital Revenue Code	278
Min. Negotiated Rate	$2,200.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00

Price Transparency.

All Charges