St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SCRW BONE CANCELL 6MM/1.9MM/4MM12

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64903049
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$35.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.64
Rate for Payer: EmblemHealth Commercial	$29.25
Rate for Payer: Fidelis Medicare Advantage	$61.42
Rate for Payer: Group Health Inc Commercial	$29.25
Rate for Payer: Group Health Inc Medicare	$20.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.02

SCRW BONE CANCELL 6MM/1.9MM/4MM12

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64903049
Hospital Revenue Code	278
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25

SCRW BONE CANCELL 6MM/1.9MM/4MM14

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64903198
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$35.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.64
Rate for Payer: EmblemHealth Commercial	$29.25
Rate for Payer: Fidelis Medicare Advantage	$61.42
Rate for Payer: Group Health Inc Commercial	$29.25
Rate for Payer: Group Health Inc Medicare	$20.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.02

SCRW BONE CANCELL 6MM/1.9MM/4MM14

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64903198
Hospital Revenue Code	278
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25

SCRW BONE CANCELL 6MM/1.9MM/4MM19

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64903516
Hospital Revenue Code	278
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25

SCRW BONE CANCELL 6MM/1.9MM/4MM19

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64903516
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$35.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.64
Rate for Payer: EmblemHealth Commercial	$29.25
Rate for Payer: Fidelis Medicare Advantage	$61.42
Rate for Payer: Group Health Inc Commercial	$29.25
Rate for Payer: Group Health Inc Medicare	$20.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.02

SCRW BONE CANCELL 6MM/1.9MM/4MM2

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901427
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/4MM2

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901427
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/4MM20

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64903518
Hospital Revenue Code	278
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25

SCRW BONE CANCELL 6MM/1.9MM/4MM20

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64903518
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$35.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.64
Rate for Payer: EmblemHealth Commercial	$29.25
Rate for Payer: Fidelis Medicare Advantage	$61.42
Rate for Payer: Group Health Inc Commercial	$29.25
Rate for Payer: Group Health Inc Medicare	$20.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.02

SCRW BONE CANCELL 6MM/1.9MM/4MM21

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64904195
Hospital Revenue Code	278
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25

SCRW BONE CANCELL 6MM/1.9MM/4MM21

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64904195
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$35.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.64
Rate for Payer: EmblemHealth Commercial	$29.25
Rate for Payer: Fidelis Medicare Advantage	$61.42
Rate for Payer: Group Health Inc Commercial	$29.25
Rate for Payer: Group Health Inc Medicare	$20.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.02

SCRW BONE CANCELL 6MM/1.9MM/4MM22

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64904197
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$35.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.64
Rate for Payer: EmblemHealth Commercial	$29.25
Rate for Payer: Fidelis Medicare Advantage	$61.42
Rate for Payer: Group Health Inc Commercial	$29.25
Rate for Payer: Group Health Inc Medicare	$20.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.02

SCRW BONE CANCELL 6MM/1.9MM/4MM22

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64904197
Hospital Revenue Code	278
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25

SCRW BONE CANCELL 6MM/1.9MM/4MM23

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64904199
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$35.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.64
Rate for Payer: EmblemHealth Commercial	$29.25
Rate for Payer: Fidelis Medicare Advantage	$61.42
Rate for Payer: Group Health Inc Commercial	$29.25
Rate for Payer: Group Health Inc Medicare	$20.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.02

SCRW BONE CANCELL 6MM/1.9MM/4MM23

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64904199
Hospital Revenue Code	278
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25

SCRW BONE CANCELL 6MM/1.9MM/4MM24

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64904200
Hospital Revenue Code	278
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25

SCRW BONE CANCELL 6MM/1.9MM/4MM24

Facility

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64904200
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$35.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.64
Rate for Payer: EmblemHealth Commercial	$29.25
Rate for Payer: Fidelis Medicare Advantage	$61.42
Rate for Payer: Group Health Inc Commercial	$29.25
Rate for Payer: Group Health Inc Medicare	$20.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.02

SCRW BONE CANCELL 6MM/1.9MM/4MM4

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901450
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/4MM4

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901450
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/4MM5

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901682
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/4MM5

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901682
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/4MM6

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901744
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/4MM6

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901744
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/4MM7

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901749
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

Know your out-of-pocket cost for care.

All Charges