St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SP ABSCESS DRAIN RETROPERI

Facility

$4,157.25

Service Code	HCPCS 49406 TC
Hospital Charge Code	41542785
Hospital Revenue Code	361
Min. Negotiated Rate	$1,455.04
Max. Negotiated Rate	$3,117.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,286.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,078.62
Rate for Payer: Aetna Government	$2,078.62
Rate for Payer: Brighton Health Commercial	$3,117.94
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$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: Group Health Inc Commercial	$2,078.62
Rate for Payer: Group Health Inc Medicare	$1,455.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,078.62

SP ABSCESS DRAIN SUB/DIAPH

Facility

$4,157.25

Service Code	HCPCS 49405 TC
Hospital Charge Code	41542786
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,874.89

SP ABSCESS DRAIN SUB/DIAPH

Facility

$4,157.25

Service Code	HCPCS 49405 TC
Hospital Charge Code	41542786
Hospital Revenue Code	361
Min. Negotiated Rate	$1,455.04
Max. Negotiated Rate	$3,117.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,286.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,078.62
Rate for Payer: Aetna Government	$2,078.62
Rate for Payer: Brighton Health Commercial	$3,117.94
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$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: Group Health Inc Commercial	$2,078.62
Rate for Payer: Group Health Inc Medicare	$1,455.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,078.62

SPACE MAINTAINER-FIXED-UNILATERAL

Facility

$290.00

Service Code	HCPCS D1510
Hospital Charge Code	42300295
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

SPACE MAINTAINER-FIXED-UNILATERAL

Facility

$290.00

Service Code	HCPCS D1510
Hospital Charge Code	42300295
Hospital Revenue Code	361
Min. Negotiated Rate	$145.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$159.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Brighton Health Commercial	$217.50
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

SPACE MAINTAINER-REMOVABLE-UNILAT

Facility

$508.88

Service Code	HCPCS D1520
Hospital Charge Code	42300305
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

SPACE MAINTAINER-REMOVABLE-UNILAT

Facility

$508.88

Service Code	HCPCS D1520
Hospital Charge Code	42300305
Hospital Revenue Code	361
Min. Negotiated Rate	$254.44
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$279.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Brighton Health Commercial	$381.66
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$254.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

SPACE MAINT FIXED BILAT MANDIBULA

Facility

$435.00

Service Code	HCPCS D1517
Hospital Charge Code	42300737
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

SPACE MAINT FIXED BILAT MANDIBULA

Facility

$435.00

Service Code	HCPCS D1517
Hospital Charge Code	42300737
Hospital Revenue Code	361
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Brighton Health Commercial	$326.25
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

SPACE MAINT-FIXED BILAT MAXILLARY

Facility

$435.00

Service Code	HCPCS D1516
Hospital Charge Code	42300736
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

SPACE MAINT-FIXED BILAT MAXILLARY

Facility

$435.00

Service Code	HCPCS D1516
Hospital Charge Code	42300736
Hospital Revenue Code	361
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Brighton Health Commercial	$326.25
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

SPACER, 15X13MM 6MM HEIGHT

Facility

$5,812.50

Service Code	HCPCS C1713
Hospital Charge Code	64904761
Hospital Revenue Code	278
Min. Negotiated Rate	$2,906.25
Max. Negotiated Rate	$2,906.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,906.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,906.25

SPACER, 15X13MM 6MM HEIGHT

Facility

$5,812.50

Service Code	HCPCS C1713
Hospital Charge Code	64904761
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,103.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,196.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,487.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,906.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,342.19
Rate for Payer: EmblemHealth Commercial	$2,906.25
Rate for Payer: Fidelis Medicare Advantage	$6,103.12
Rate for Payer: Group Health Inc Commercial	$2,906.25
Rate for Payer: Group Health Inc Medicare	$2,034.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,906.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,906.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,778.12

SPACER, 15X13X8MM 5EGREE SCDF

Facility

$5,812.50

Service Code	HCPCS C1713
Hospital Charge Code	64905521
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,103.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,196.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,487.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,906.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,342.19
Rate for Payer: EmblemHealth Commercial	$2,906.25
Rate for Payer: Fidelis Medicare Advantage	$6,103.12
Rate for Payer: Group Health Inc Commercial	$2,906.25
Rate for Payer: Group Health Inc Medicare	$2,034.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,906.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,906.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,778.12

SPACER, 15X13X8MM 5EGREE SCDF

Facility

$5,812.50

Service Code	HCPCS C1713
Hospital Charge Code	64905521
Hospital Revenue Code	278
Min. Negotiated Rate	$2,906.25
Max. Negotiated Rate	$2,906.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,906.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,906.25

SPACER AUS 5MM X 14 X 16

Facility

$5,842.34

Hospital Charge Code	64906764
Hospital Revenue Code	279
Min. Negotiated Rate	$2,044.82
Max. Negotiated Rate	$4,673.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,213.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,921.17
Rate for Payer: Aetna Government	$2,921.17
Rate for Payer: Brighton Health Commercial	$4,381.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,673.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,972.79
Rate for Payer: Group Health Inc Commercial	$2,921.17
Rate for Payer: Group Health Inc Medicare	$2,044.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,921.17
Rate for Payer: Hamaspik Choice Inc Medicare	$2,921.17

SPACER AVS AS 4X12X14X4 DEG

Facility

$2,921.17

Service Code	HCPCS C1776
Hospital Charge Code	64906238
Hospital Revenue Code	278
Min. Negotiated Rate	$1,460.58
Max. Negotiated Rate	$1,460.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,460.58
Rate for Payer: Hamaspik Choice Inc Medicare	$1,460.58

SPACER AVS AS 4X12X14X4 DEG

Facility

$2,921.17

Service Code	HCPCS C1776
Hospital Charge Code	64906238
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,067.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,606.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,752.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,460.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,679.67
Rate for Payer: EmblemHealth Commercial	$1,460.58
Rate for Payer: Fidelis Medicare Advantage	$3,067.23
Rate for Payer: Group Health Inc Commercial	$1,460.58
Rate for Payer: Group Health Inc Medicare	$1,022.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,460.58
Rate for Payer: Hamaspik Choice Inc Medicare	$1,460.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,898.76

SPACER DISTAL ACCOLADE

Facility

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907278
Hospital Revenue Code	278
Min. Negotiated Rate	$203.88
Max. Negotiated Rate	$203.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88

SPACER DISTAL ACCOLADE

Facility

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907278
Hospital Revenue Code	278
Min. Negotiated Rate	$142.71
Max. Negotiated Rate	$428.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$244.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$203.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.46
Rate for Payer: EmblemHealth Commercial	$203.88
Rate for Payer: Fidelis Medicare Advantage	$428.14
Rate for Payer: Group Health Inc Commercial	$203.88
Rate for Payer: Group Health Inc Medicare	$142.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$265.04

SPACER DISTAL CEMENT (1067-0011)

Facility

$180.00

Service Code	HCPCS C1776
Hospital Charge Code	64906471
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$108.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$103.50
Rate for Payer: EmblemHealth Commercial	$90.00
Rate for Payer: Fidelis Medicare Advantage	$189.00
Rate for Payer: Group Health Inc Commercial	$90.00
Rate for Payer: Group Health Inc Medicare	$63.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.00
Rate for Payer: Hamaspik Choice Inc Medicare	$90.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.00

SPACER DISTAL CEMENT (1067-0011)

Facility

$180.00

Service Code	HCPCS C1776
Hospital Charge Code	64906471
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.00
Rate for Payer: Hamaspik Choice Inc Medicare	$90.00

SPACER DISTAL OSTEONICS UNIV

Facility

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907279
Hospital Revenue Code	278
Min. Negotiated Rate	$203.88
Max. Negotiated Rate	$203.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88

SPACER DISTAL OSTEONICS UNIV

Facility

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907279
Hospital Revenue Code	278
Min. Negotiated Rate	$142.71
Max. Negotiated Rate	$428.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$244.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$203.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.46
Rate for Payer: EmblemHealth Commercial	$203.88
Rate for Payer: Fidelis Medicare Advantage	$428.14
Rate for Payer: Group Health Inc Commercial	$203.88
Rate for Payer: Group Health Inc Medicare	$142.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$265.04

SPACER OMNIFIT CEMENT 12MM

Facility

$180.00

Service Code	HCPCS C1776
Hospital Charge Code	64906267
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$108.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$103.50
Rate for Payer: EmblemHealth Commercial	$90.00
Rate for Payer: Fidelis Medicare Advantage	$189.00
Rate for Payer: Group Health Inc Commercial	$90.00
Rate for Payer: Group Health Inc Medicare	$63.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.00
Rate for Payer: Hamaspik Choice Inc Medicare	$90.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.00

Know your out-of-pocket cost for care.

All Charges