St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SP LIMITED REN/MESE/POR ABD

Facility

$339.45

Service Code	HCPCS 93976 TC
Hospital Charge Code	41201173
Hospital Revenue Code	920
Rate for Payer: Cash Price	$127.14

SP LIMITED REN/MESE/POR ABD

Facility

$339.45

Service Code	HCPCS 93976 TC
Hospital Charge Code	41201173
Hospital Revenue Code	920
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

SP LIMITED UE ARTERIAL

Facility

$339.45

Service Code	HCPCS 93931 TC
Hospital Charge Code	41201169
Hospital Revenue Code	920
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

SP LIMITED UE ARTERIAL

Facility

$339.45

Service Code	HCPCS 93931 TC
Hospital Charge Code	41201169
Hospital Revenue Code	920
Rate for Payer: Cash Price	$127.14

SPLINT 1000-2000

Facility

$1,500.00

Hospital Charge Code	40203016
Hospital Revenue Code	270
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$750.00
Rate for Payer: Aetna Government	$750.00
Rate for Payer: Brighton Health Commercial	$1,125.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,020.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

SPLINT 100-499

Facility

$300.00

Hospital Charge Code	40203014
Hospital Revenue Code	270
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$150.00
Rate for Payer: Aetna Government	$150.00
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.00
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

SPLINT 500-1000

Facility

$750.00

Hospital Charge Code	40203015
Hospital Revenue Code	270
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$600.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$412.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$375.00
Rate for Payer: Aetna Government	$375.00
Rate for Payer: Brighton Health Commercial	$562.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$510.00
Rate for Payer: Group Health Inc Commercial	$375.00
Rate for Payer: Group Health Inc Medicare	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00

SPLINT APPLICATION LONG

Facility

$405.08

Service Code	HCPCS 29505
Hospital Charge Code	40023230
Hospital Revenue Code	360
Min. Negotiated Rate	$145.78
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$182.22
Rate for Payer: Aetna Government	$182.22
Rate for Payer: Brighton Health Commercial	$303.81
Rate for Payer: Cash Price	$182.22
Rate for Payer: Cash Price	$182.22
Rate for Payer: Cash Price	$182.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$182.22
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	$182.22
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$154.89
Rate for Payer: Fidelis Essential Plan QHP	$162.18
Rate for Payer: Fidelis Medicare Advantage	$182.22
Rate for Payer: Fidelis Qualified Health Plan	$162.18
Rate for Payer: Group Health Inc Commercial	$182.22
Rate for Payer: Group Health Inc Medicare	$182.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$202.54
Rate for Payer: Hamaspik Choice Inc Medicare	$182.22
Rate for Payer: Healthfirst Medicare Advantage	$154.89
Rate for Payer: Healthfirst QHP	$182.22
Rate for Payer: Senior Whole Health Medicare Advantage	$182.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$182.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$145.78
Rate for Payer: Wellcare Medicare	$173.11

SPLINT APPLICATION LONG

Facility

$405.08

Service Code	HCPCS 29515
Hospital Charge Code	30302026
Hospital Revenue Code	510
Rate for Payer: Cash Price	$182.22

SPLINT APPLICATION LONG

Facility

$405.08

Service Code	HCPCS 29515
Hospital Charge Code	30302026
Hospital Revenue Code	510
Min. Negotiated Rate	$145.78
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$182.22
Rate for Payer: Aetna Government	$182.22
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$182.22
Rate for Payer: Cash Price	$182.22
Rate for Payer: Cash Price	$182.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$182.22
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	$182.22
Rate for Payer: Fidelis Essential Plan Aliesa	$154.89
Rate for Payer: Fidelis Essential Plan QHP	$162.18
Rate for Payer: Fidelis Medicare Advantage	$182.22
Rate for Payer: Fidelis Qualified Health Plan	$162.18
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	$202.54
Rate for Payer: Hamaspik Choice Inc Medicare	$182.22
Rate for Payer: Healthfirst Medicare Advantage	$154.89
Rate for Payer: Healthfirst QHP	$182.22
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$182.22
Rate for Payer: Senior Whole Health Medicare Advantage	$182.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$182.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$145.78
Rate for Payer: Wellcare Medicare	$173.11

SPLINT APPLICATION LONG

Facility

$405.08

Service Code	HCPCS 29505
Hospital Charge Code	40023230
Hospital Revenue Code	360
Rate for Payer: Cash Price	$182.22

SPLINT APPLICATION SHORT

Facility

$405.08

Service Code	HCPCS 29505
Hospital Charge Code	40023231
Hospital Revenue Code	360
Min. Negotiated Rate	$145.78
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$182.22
Rate for Payer: Aetna Government	$182.22
Rate for Payer: Brighton Health Commercial	$303.81
Rate for Payer: Cash Price	$182.22
Rate for Payer: Cash Price	$182.22
Rate for Payer: Cash Price	$182.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$182.22
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	$182.22
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$154.89
Rate for Payer: Fidelis Essential Plan QHP	$162.18
Rate for Payer: Fidelis Medicare Advantage	$182.22
Rate for Payer: Fidelis Qualified Health Plan	$162.18
Rate for Payer: Group Health Inc Commercial	$182.22
Rate for Payer: Group Health Inc Medicare	$182.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$202.54
Rate for Payer: Hamaspik Choice Inc Medicare	$182.22
Rate for Payer: Healthfirst Medicare Advantage	$154.89
Rate for Payer: Healthfirst QHP	$182.22
Rate for Payer: Senior Whole Health Medicare Advantage	$182.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$182.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$145.78
Rate for Payer: Wellcare Medicare	$173.11

SPLINT APPLICATION SHORT

Facility

$405.08

Service Code	HCPCS 29505
Hospital Charge Code	40023231
Hospital Revenue Code	360
Rate for Payer: Cash Price	$182.22

SPLINT CLAVICLE LG.

Facility

$10.65

Hospital Charge Code	64902272
Hospital Revenue Code	270
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$8.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.32
Rate for Payer: Aetna Government	$5.32
Rate for Payer: Brighton Health Commercial	$7.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.24
Rate for Payer: Group Health Inc Commercial	$5.32
Rate for Payer: Group Health Inc Medicare	$3.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.32
Rate for Payer: Hamaspik Choice Inc Medicare	$5.32

SPLINT CLAVICLE MED.

Facility

$10.97

Hospital Charge Code	64902270
Hospital Revenue Code	270
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.48
Rate for Payer: Aetna Government	$5.48
Rate for Payer: Brighton Health Commercial	$8.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.46
Rate for Payer: Group Health Inc Commercial	$5.48
Rate for Payer: Group Health Inc Medicare	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.48
Rate for Payer: Hamaspik Choice Inc Medicare	$5.48

SPLINT CLAVICLE SM.

Facility

$20.81

Hospital Charge Code	64902268
Hospital Revenue Code	270
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$16.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.40
Rate for Payer: Aetna Government	$10.40
Rate for Payer: Brighton Health Commercial	$15.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.15
Rate for Payer: Group Health Inc Commercial	$10.40
Rate for Payer: Group Health Inc Medicare	$7.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.40
Rate for Payer: Hamaspik Choice Inc Medicare	$10.40

SPLINT COCK UP LEFT LARGE

Facility

$15.88

Hospital Charge Code	64901216
Hospital Revenue Code	270
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$12.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.94
Rate for Payer: Aetna Government	$7.94
Rate for Payer: Brighton Health Commercial	$11.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.80
Rate for Payer: Group Health Inc Commercial	$7.94
Rate for Payer: Group Health Inc Medicare	$5.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.94
Rate for Payer: Hamaspik Choice Inc Medicare	$7.94

SPLINT COCK UP LEFT MEDIUM

Facility

$15.88

Hospital Charge Code	64901218
Hospital Revenue Code	270
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$12.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.94
Rate for Payer: Aetna Government	$7.94
Rate for Payer: Brighton Health Commercial	$11.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.80
Rate for Payer: Group Health Inc Commercial	$7.94
Rate for Payer: Group Health Inc Medicare	$5.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.94
Rate for Payer: Hamaspik Choice Inc Medicare	$7.94

SPLINT COCK UP LEFT SMALL

Facility

$15.88

Hospital Charge Code	64901220
Hospital Revenue Code	270
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$12.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.94
Rate for Payer: Aetna Government	$7.94
Rate for Payer: Brighton Health Commercial	$11.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.80
Rate for Payer: Group Health Inc Commercial	$7.94
Rate for Payer: Group Health Inc Medicare	$5.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.94
Rate for Payer: Hamaspik Choice Inc Medicare	$7.94

SPLINT COCK UP RIGHT LARGE

Facility

$15.88

Hospital Charge Code	64901194
Hospital Revenue Code	270
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$12.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.94
Rate for Payer: Aetna Government	$7.94
Rate for Payer: Brighton Health Commercial	$11.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.80
Rate for Payer: Group Health Inc Commercial	$7.94
Rate for Payer: Group Health Inc Medicare	$5.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.94
Rate for Payer: Hamaspik Choice Inc Medicare	$7.94

SPLINT COCK UP RIGHT MEDIUM DERTX

Facility

$15.88

Hospital Charge Code	64901196
Hospital Revenue Code	270
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$12.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.94
Rate for Payer: Aetna Government	$7.94
Rate for Payer: Brighton Health Commercial	$11.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.80
Rate for Payer: Group Health Inc Commercial	$7.94
Rate for Payer: Group Health Inc Medicare	$5.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.94
Rate for Payer: Hamaspik Choice Inc Medicare	$7.94

SPLINT COCK UP RIGHT SMALL

Facility

$15.88

Hospital Charge Code	64901222
Hospital Revenue Code	270
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$12.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.94
Rate for Payer: Aetna Government	$7.94
Rate for Payer: Brighton Health Commercial	$11.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.80
Rate for Payer: Group Health Inc Commercial	$7.94
Rate for Payer: Group Health Inc Medicare	$5.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.94
Rate for Payer: Hamaspik Choice Inc Medicare	$7.94

SPLINT DENVER NASAL

Facility

$123.00

Hospital Charge Code	64904568
Hospital Revenue Code	270
Min. Negotiated Rate	$43.05
Max. Negotiated Rate	$98.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.50
Rate for Payer: Aetna Government	$61.50
Rate for Payer: Brighton Health Commercial	$92.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$98.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.64
Rate for Payer: Group Health Inc Commercial	$61.50
Rate for Payer: Group Health Inc Medicare	$43.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.50
Rate for Payer: Hamaspik Choice Inc Medicare	$61.50

SPLINT,FIBERGLASS,ORTHO,4X15'

Facility

$155.14

Hospital Charge Code	64902400
Hospital Revenue Code	270
Min. Negotiated Rate	$54.30
Max. Negotiated Rate	$124.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.57
Rate for Payer: Aetna Government	$77.57
Rate for Payer: Brighton Health Commercial	$116.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.50
Rate for Payer: Group Health Inc Commercial	$77.57
Rate for Payer: Group Health Inc Medicare	$54.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.57
Rate for Payer: Hamaspik Choice Inc Medicare	$77.57

SPLINT,FIBERGLASS,ORTHO,5X15Y

Facility

$182.71

Hospital Charge Code	64902402
Hospital Revenue Code	270
Min. Negotiated Rate	$63.95
Max. Negotiated Rate	$146.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$91.36
Rate for Payer: Aetna Government	$91.36
Rate for Payer: Brighton Health Commercial	$137.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.24
Rate for Payer: Group Health Inc Commercial	$91.36
Rate for Payer: Group Health Inc Medicare	$63.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.36
Rate for Payer: Hamaspik Choice Inc Medicare	$91.36

Know your out-of-pocket cost for care.

All Charges