St. Barnabas Hospital

All Charges

Charge

Type

Price

BOLT LOCKING TI 4.9X42MM

Facility IP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200130
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

BOLT LOCKING TI 4.9X44MM

Facility OP

$304.00

Service Code	HCPCS C1713
Hospital Charge Code	40200131
Hospital Revenue Code	278
Min. Negotiated Rate	$106.40
Max. Negotiated Rate	$319.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$167.20
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	$152.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.80
Rate for Payer: Fidelis Medicare Advantage	$319.20
Rate for Payer: Group Health Inc Commercial	$152.00
Rate for Payer: Group Health Inc Medicare	$106.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.00
Rate for Payer: Hamaspik Choice Inc Medicare	$152.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.60

BOLT LOCKING TI 4.9X44MM

Facility IP

$304.00

Service Code	HCPCS C1713
Hospital Charge Code	40200131
Hospital Revenue Code	278
Min. Negotiated Rate	$152.00
Max. Negotiated Rate	$152.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.00
Rate for Payer: Hamaspik Choice Inc Medicare	$152.00

BOLT LOCKING TI 4.9X50MM

Facility IP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200132
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

BOLT LOCKING TI 4.9X50MM

Facility OP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200132
Hospital Revenue Code	278
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$310.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
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	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: Fidelis Medicare Advantage	$310.80
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

BONE BIOPSY OPEN DEEP

Facility OP

$7,183.50

Service Code	HCPCS 20245
Hospital Charge Code	30300356
Hospital Revenue Code	510
Min. Negotiated Rate	$233.00
Max. Negotiated Rate	$3,591.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,285.96
Rate for Payer: Aetna Government	$3,285.96
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$3,285.96
Rate for Payer: Cash Price	$3,285.96
Rate for Payer: Cash Price	$3,285.96
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,285.96
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	$3,285.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$383.99
Rate for Payer: Fidelis Essential Plan Aliesa	$2,793.07
Rate for Payer: Fidelis Essential Plan QHP	$2,924.50
Rate for Payer: Fidelis Medicare Advantage	$3,285.96
Rate for Payer: Fidelis Qualified Health Plan	$2,924.50
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	$3,591.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,285.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$426.66
Rate for Payer: Healthfirst Medicare Advantage	$2,793.07
Rate for Payer: Healthfirst QHP	$3,285.96
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$3,285.96
Rate for Payer: Senior Whole Health Medicare Advantage	$3,285.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,285.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,628.77
Rate for Payer: Wellcare Medicare	$3,121.66

BONE BLOCK

Facility IP

$8,400.00

Service Code	HCPCS C1713
Hospital Charge Code	40202292
Hospital Revenue Code	278
Min. Negotiated Rate	$4,200.00
Max. Negotiated Rate	$4,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,200.00

BONE BLOCK

Facility OP

$8,400.00

Service Code	HCPCS C1713
Hospital Charge Code	40202292
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,820.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,620.00
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	$4,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,830.00
Rate for Payer: Fidelis Medicare Advantage	$8,820.00
Rate for Payer: Group Health Inc Commercial	$4,200.00
Rate for Payer: Group Health Inc Medicare	$2,940.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,460.00

BONE BLOCK 1.2CC SYN CAN

Facility OP

$475.00

Hospital Charge Code	64904097
Hospital Revenue Code	270
Min. Negotiated Rate	$166.25
Max. Negotiated Rate	$380.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$261.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$237.50
Rate for Payer: Aetna Government	$237.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$380.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$323.00
Rate for Payer: Group Health Inc Commercial	$237.50
Rate for Payer: Group Health Inc Medicare	$166.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.50
Rate for Payer: Hamaspik Choice Inc Medicare	$237.50

BONE BLOCK 1.2CC SYN CAN

Facility IP

$380.00

Service Code	HCPCS C1713
Hospital Charge Code	40202291
Hospital Revenue Code	278
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.00
Rate for Payer: Hamaspik Choice Inc Medicare	$190.00

BONE BLOCK 1.2CC SYN CAN

Facility OP

$380.00

Service Code	HCPCS C1713
Hospital Charge Code	40202291
Hospital Revenue Code	278
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$399.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.00
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	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$218.50
Rate for Payer: Fidelis Medicare Advantage	$399.00
Rate for Payer: Group Health Inc Commercial	$190.00
Rate for Payer: Group Health Inc Medicare	$133.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.00
Rate for Payer: Hamaspik Choice Inc Medicare	$190.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$247.00

BONE BLOCK PRO OSTEON200 10X10X40

Facility OP

$1,212.50

Hospital Charge Code	64903998
Hospital Revenue Code	270
Min. Negotiated Rate	$424.38
Max. Negotiated Rate	$970.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$666.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$606.25
Rate for Payer: Aetna Government	$606.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$970.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$824.50
Rate for Payer: Group Health Inc Commercial	$606.25
Rate for Payer: Group Health Inc Medicare	$424.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$606.25
Rate for Payer: Hamaspik Choice Inc Medicare	$606.25

BONE BX

Facility OP

$4,157.25

Service Code	HCPCS 20220
Hospital Charge Code	40082785
Hospital Revenue Code	360
Min. Negotiated Rate	$93.56
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,874.89
Rate for Payer: Aetna Government	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,874.89
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	$1,874.89
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$93.56
Rate for Payer: Fidelis Essential Plan Aliesa	$1,593.66
Rate for Payer: Fidelis Essential Plan QHP	$1,668.65
Rate for Payer: Fidelis Medicare Advantage	$1,874.89
Rate for Payer: Fidelis Qualified Health Plan	$1,668.65
Rate for Payer: Group Health Inc Commercial	$1,874.89
Rate for Payer: Group Health Inc Medicare	$1,874.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,874.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$103.96
Rate for Payer: Healthfirst Medicare Advantage	$1,593.66
Rate for Payer: Healthfirst QHP	$1,874.89
Rate for Payer: Senior Whole Health Medicare Advantage	$1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,499.91
Rate for Payer: Wellcare Medicare	$1,781.15

BONE BX

Facility OP

$4,157.25

Service Code	HCPCS 20220
Hospital Charge Code	30302489
Hospital Revenue Code	510
Min. Negotiated Rate	$93.56
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,874.89
Rate for Payer: Aetna Government	$1,874.89
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,874.89
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	$1,874.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$93.56
Rate for Payer: Fidelis Essential Plan Aliesa	$1,593.66
Rate for Payer: Fidelis Essential Plan QHP	$1,668.65
Rate for Payer: Fidelis Medicare Advantage	$1,874.89
Rate for Payer: Fidelis Qualified Health Plan	$1,668.65
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	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,874.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$103.96
Rate for Payer: Healthfirst Medicare Advantage	$1,593.66
Rate for Payer: Healthfirst QHP	$1,874.89
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,874.89
Rate for Payer: Senior Whole Health Medicare Advantage	$1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,499.91
Rate for Payer: Wellcare Medicare	$1,781.15

BONE CANCELLOUS CRUSHED 10CC

Facility IP

$485.00

Service Code	HCPCS C1713
Hospital Charge Code	64902410
Hospital Revenue Code	278
Min. Negotiated Rate	$242.50
Max. Negotiated Rate	$242.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.50
Rate for Payer: Hamaspik Choice Inc Medicare	$242.50

BONE CANCELLOUS CRUSHED 10CC

Facility OP

$485.00

Service Code	HCPCS C1713
Hospital Charge Code	64902410
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$509.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$266.75
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	$242.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$278.88
Rate for Payer: Fidelis Medicare Advantage	$509.25
Rate for Payer: Group Health Inc Commercial	$242.50
Rate for Payer: Group Health Inc Medicare	$169.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.50
Rate for Payer: Hamaspik Choice Inc Medicare	$242.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$315.25

BONE CANCELLOUS CRUSHED 15CC

Facility OP

$697.50

Service Code	HCPCS C1713
Hospital Charge Code	64902412
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$732.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$383.62
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	$348.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$401.06
Rate for Payer: Fidelis Medicare Advantage	$732.38
Rate for Payer: Group Health Inc Commercial	$348.75
Rate for Payer: Group Health Inc Medicare	$244.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$348.75
Rate for Payer: Hamaspik Choice Inc Medicare	$348.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$453.38

BONE CANCELLOUS CRUSHED 15CC

Facility IP

$697.50

Service Code	HCPCS C1713
Hospital Charge Code	64902412
Hospital Revenue Code	278
Min. Negotiated Rate	$348.75
Max. Negotiated Rate	$348.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$348.75
Rate for Payer: Hamaspik Choice Inc Medicare	$348.75

BONE CANCELLOUS CRUSHED 20CC

Facility IP

$758.63

Service Code	HCPCS C1713
Hospital Charge Code	64902605
Hospital Revenue Code	278
Min. Negotiated Rate	$379.32
Max. Negotiated Rate	$379.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$379.32
Rate for Payer: Hamaspik Choice Inc Medicare	$379.32

BONE CANCELLOUS CRUSHED 20CC

Facility OP

$758.63

Service Code	HCPCS C1713
Hospital Charge Code	64902605
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$796.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$417.25
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	$379.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$436.21
Rate for Payer: Fidelis Medicare Advantage	$796.56
Rate for Payer: Group Health Inc Commercial	$379.32
Rate for Payer: Group Health Inc Medicare	$265.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$379.32
Rate for Payer: Hamaspik Choice Inc Medicare	$379.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$493.11

BONE CEMENT 1

Facility IP

$816.60

Service Code	HCPCS C1713
Hospital Charge Code	40202081
Hospital Revenue Code	278
Min. Negotiated Rate	$408.30
Max. Negotiated Rate	$408.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$408.30
Rate for Payer: Hamaspik Choice Inc Medicare	$408.30

BONE CEMENT 1

Facility OP

$816.60

Service Code	HCPCS C1713
Hospital Charge Code	40202081
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$857.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$449.13
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	$408.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$469.54
Rate for Payer: Fidelis Medicare Advantage	$857.43
Rate for Payer: Group Health Inc Commercial	$408.30
Rate for Payer: Group Health Inc Medicare	$285.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$408.30
Rate for Payer: Hamaspik Choice Inc Medicare	$408.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$530.79

BONE CEMENT 2

Facility OP

$460.00

Service Code	HCPCS C1713
Hospital Charge Code	40201296
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$483.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$253.00
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	$230.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$264.50
Rate for Payer: Fidelis Medicare Advantage	$483.00
Rate for Payer: Group Health Inc Commercial	$230.00
Rate for Payer: Group Health Inc Medicare	$161.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$299.00

BONE CEMENT 2

Facility IP

$460.00

Service Code	HCPCS C1713
Hospital Charge Code	40201296
Hospital Revenue Code	278
Min. Negotiated Rate	$230.00
Max. Negotiated Rate	$230.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00

BONE CEMENT 3

Facility OP

$816.60

Service Code	HCPCS C1713
Hospital Charge Code	40201187
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$857.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$449.13
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	$408.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$469.54
Rate for Payer: Fidelis Medicare Advantage	$857.43
Rate for Payer: Group Health Inc Commercial	$408.30
Rate for Payer: Group Health Inc Medicare	$285.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$408.30
Rate for Payer: Hamaspik Choice Inc Medicare	$408.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$530.79

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All Charges