St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SCROTAL SUPPORT

Facility

$75.48

Hospital Charge Code	40205715
Hospital Revenue Code	270
Min. Negotiated Rate	$26.42
Max. Negotiated Rate	$60.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.74
Rate for Payer: Aetna Government	$37.74
Rate for Payer: Brighton Health Commercial	$56.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.33
Rate for Payer: Group Health Inc Commercial	$37.74
Rate for Payer: Group Health Inc Medicare	$26.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.74
Rate for Payer: Hamaspik Choice Inc Medicare	$37.74

SCROTAL ZERO DEGRE ANG SET

Facility

$21,975.00

Service Code	HCPCS C1813
Hospital Charge Code	64903841
Hospital Revenue Code	278
Min. Negotiated Rate	$10,987.50
Max. Negotiated Rate	$10,987.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,987.50
Rate for Payer: Hamaspik Choice Inc Medicare	$10,987.50

SCROTAL ZERO DEGRE ANG SET

Facility

$21,975.00

Service Code	HCPCS C1813
Hospital Charge Code	64903841
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$23,073.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,086.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Brighton Health Commercial	$13,185.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10,987.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,635.62
Rate for Payer: EmblemHealth Commercial	$10,987.50
Rate for Payer: Fidelis Medicare Advantage	$23,073.75
Rate for Payer: Group Health Inc Commercial	$10,987.50
Rate for Payer: Group Health Inc Medicare	$7,691.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,987.50
Rate for Payer: Hamaspik Choice Inc Medicare	$10,987.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14,283.75

SC&RP, 1 TO 3 TEETH/QUAD

Facility

$354.38

Service Code	HCPCS D4241
Hospital Charge Code	42303391
Hospital Revenue Code	361
Min. Negotiated Rate	$177.19
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,763.60
Rate for Payer: Aetna Government	$1,763.60
Rate for Payer: Affinity Essential Plan 1&2	$1,234.52
Rate for Payer: Affinity Essential Plan 3&4	$1,234.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,234.52
Rate for Payer: Brighton Health Commercial	$265.78
Rate for Payer: Cash Price	$1,763.60
Rate for Payer: Cash Price	$1,763.60
Rate for Payer: Cash Price	$1,763.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,763.60
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	$1,763.60
Rate for Payer: EmblemHealth Commercial	$1,763.60
Rate for Payer: Fidelis Essential Plan Aliesa	$1,499.06
Rate for Payer: Fidelis Essential Plan QHP	$1,569.60
Rate for Payer: Fidelis Medicare Advantage	$1,763.60
Rate for Payer: Fidelis Qualified Health Plan	$1,569.60
Rate for Payer: Group Health Inc Commercial	$1,763.60
Rate for Payer: Group Health Inc Medicare	$1,763.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1,763.60
Rate for Payer: Healthfirst Medicare Advantage	$1,499.06
Rate for Payer: Healthfirst QHP	$1,763.60
Rate for Payer: Humana Medicare	$1,798.87
Rate for Payer: Senior Whole Health Medicare Advantage	$1,763.60
Rate for Payer: United Healthcare Medicare Advantage	$1,763.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,763.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,410.88
Rate for Payer: Wellcare Medicare	$1,675.42

SC&RP, 1 TO 3 TEETH/QUAD

Facility

$354.38

Service Code	HCPCS D4241
Hospital Charge Code	42303391
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,763.60

SCR STRY NON-LK 2.7MM X 22MM

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40203439
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

SCR STRY NON-LK 2.7MM X 22MM

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40203439
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$180.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: EmblemHealth Commercial	$150.00
Rate for Payer: Fidelis Medicare Advantage	$315.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$195.00

SCRUB BRUSH

Facility

$35.66

Hospital Charge Code	41809547
Hospital Revenue Code	270
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$28.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.83
Rate for Payer: Aetna Government	$17.83
Rate for Payer: Brighton Health Commercial	$26.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.25
Rate for Payer: Group Health Inc Commercial	$17.83
Rate for Payer: Group Health Inc Medicare	$12.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.83
Rate for Payer: Hamaspik Choice Inc Medicare	$17.83

SCRUB BRUSH

Facility

$35.66

Hospital Charge Code	41709547
Hospital Revenue Code	270
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$28.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.83
Rate for Payer: Aetna Government	$17.83
Rate for Payer: Brighton Health Commercial	$26.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.25
Rate for Payer: Group Health Inc Commercial	$17.83
Rate for Payer: Group Health Inc Medicare	$12.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.83
Rate for Payer: Hamaspik Choice Inc Medicare	$17.83

SCR UNIII AXS SD 1.5X5MM

Facility

$205.00

Service Code	HCPCS C1713
Hospital Charge Code	64904753
Hospital Revenue Code	278
Min. Negotiated Rate	$102.50
Max. Negotiated Rate	$102.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.50
Rate for Payer: Hamaspik Choice Inc Medicare	$102.50

SCR UNIII AXS SD 1.5X5MM

Facility

$205.00

Service Code	HCPCS C1713
Hospital Charge Code	64904753
Hospital Revenue Code	278
Min. Negotiated Rate	$71.75
Max. Negotiated Rate	$215.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$112.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$123.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$102.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$117.88
Rate for Payer: EmblemHealth Commercial	$102.50
Rate for Payer: Fidelis Medicare Advantage	$215.25
Rate for Payer: Group Health Inc Commercial	$102.50
Rate for Payer: Group Health Inc Medicare	$71.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.50
Rate for Payer: Hamaspik Choice Inc Medicare	$102.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$133.25

SCRW 1.4X3MM C-P S-T E.R

Facility

$140.00

Service Code	HCPCS C1713
Hospital Charge Code	40201314
Hospital Revenue Code	278
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$147.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$84.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.50
Rate for Payer: EmblemHealth Commercial	$70.00
Rate for Payer: Fidelis Medicare Advantage	$147.00
Rate for Payer: Group Health Inc Commercial	$70.00
Rate for Payer: Group Health Inc Medicare	$49.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.00
Rate for Payer: Hamaspik Choice Inc Medicare	$70.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$91.00

SCRW 1.4X3MM C-P S-T E.R

Facility

$140.00

Service Code	HCPCS C1713
Hospital Charge Code	40201314
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.00
Rate for Payer: Hamaspik Choice Inc Medicare	$70.00

SCRW 1.4X5MM C-P S-T E.R

Facility

$108.00

Service Code	HCPCS C1713
Hospital Charge Code	40201315
Hospital Revenue Code	278
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.00
Rate for Payer: Hamaspik Choice Inc Medicare	$54.00

SCRW 1.4X5MM C-P S-T E.R

Facility

$108.00

Service Code	HCPCS C1713
Hospital Charge Code	40201315
Hospital Revenue Code	278
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$64.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.10
Rate for Payer: EmblemHealth Commercial	$54.00
Rate for Payer: Fidelis Medicare Advantage	$113.40
Rate for Payer: Group Health Inc Commercial	$54.00
Rate for Payer: Group Health Inc Medicare	$37.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.00
Rate for Payer: Hamaspik Choice Inc Medicare	$54.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.20

SCRW 1.5MM TIT CRANL W/STARDR SLF

Facility

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	40209365
Hospital Revenue Code	278
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00

SCRW 1.5MM TIT CRANL W/STARDR SLF

Facility

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	40209365
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$240.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.00
Rate for Payer: EmblemHealth Commercial	$200.00
Rate for Payer: Fidelis Medicare Advantage	$420.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.00

SCRW 3.5MM CORTEX S-TAP 36MM

Facility

$34.50

Service Code	HCPCS C1713
Hospital Charge Code	40200256
Hospital Revenue Code	278
Min. Negotiated Rate	$12.08
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$20.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.84
Rate for Payer: EmblemHealth Commercial	$17.25
Rate for Payer: Fidelis Medicare Advantage	$36.22
Rate for Payer: Group Health Inc Commercial	$17.25
Rate for Payer: Group Health Inc Medicare	$12.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.25
Rate for Payer: Hamaspik Choice Inc Medicare	$17.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.42

SCRW 3.5MM CORTEX S-TAP 36MM

Facility

$34.50

Service Code	HCPCS C1713
Hospital Charge Code	40200256
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$17.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.25
Rate for Payer: Hamaspik Choice Inc Medicare	$17.25

SCRW BONE CANCELL 6MM/1.9MM/4MM1

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901425
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44

SCRW BONE CANCELL 6MM/1.9MM/4MM1

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901425
Hospital Revenue Code	278
Min. Negotiated Rate	$19.91
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$34.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.71
Rate for Payer: EmblemHealth Commercial	$28.44
Rate for Payer: Fidelis Medicare Advantage	$59.72
Rate for Payer: Group Health Inc Commercial	$28.44
Rate for Payer: Group Health Inc Medicare	$19.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.97

SCRW BONE CANCELL 6MM/1.9MM/4MM10

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902300
Hospital Revenue Code	278
Min. Negotiated Rate	$19.91
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$34.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.71
Rate for Payer: EmblemHealth Commercial	$28.44
Rate for Payer: Fidelis Medicare Advantage	$59.72
Rate for Payer: Group Health Inc Commercial	$28.44
Rate for Payer: Group Health Inc Medicare	$19.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.97

SCRW BONE CANCELL 6MM/1.9MM/4MM10

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902300
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44

SCRW BONE CANCELL 6MM/1.9MM/4MM11

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902759
Hospital Revenue Code	278
Min. Negotiated Rate	$19.91
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$34.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.71
Rate for Payer: EmblemHealth Commercial	$28.44
Rate for Payer: Fidelis Medicare Advantage	$59.72
Rate for Payer: Group Health Inc Commercial	$28.44
Rate for Payer: Group Health Inc Medicare	$19.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.97

SCRW BONE CANCELL 6MM/1.9MM/4MM11

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902759
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44

Know your out-of-pocket cost for care.

All Charges