St. Barnabas Hospital

All Charges

Charge

Type

Price

5H L-PLATE, RIGHT W/8MM BAR

Facility IP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	40202247
Hospital Revenue Code	278
Min. Negotiated Rate	$251.00
Max. Negotiated Rate	$251.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00

5H L PLT,2MM ADV MDFC LOC

Facility IP

$354.00

Service Code	HCPCS C1713
Hospital Charge Code	40202240
Hospital Revenue Code	278
Min. Negotiated Rate	$177.00
Max. Negotiated Rate	$177.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.00
Rate for Payer: Hamaspik Choice Inc Medicare	$177.00

5H L PLT,2MM ADV MDFC LOC

Facility OP

$354.00

Service Code	HCPCS C1713
Hospital Charge Code	40202240
Hospital Revenue Code	278
Min. Negotiated Rate	$123.90
Max. Negotiated Rate	$371.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.70
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	$177.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$203.55
Rate for Payer: Fidelis Medicare Advantage	$371.70
Rate for Payer: Group Health Inc Commercial	$177.00
Rate for Payer: Group Health Inc Medicare	$123.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.00
Rate for Payer: Hamaspik Choice Inc Medicare	$177.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.10

5H L PLT, 5MM ADV MDFC LOC

Facility OP

$376.00

Service Code	HCPCS C1713
Hospital Charge Code	40202241
Hospital Revenue Code	278
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$394.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$206.80
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	$188.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$216.20
Rate for Payer: Fidelis Medicare Advantage	$394.80
Rate for Payer: Group Health Inc Commercial	$188.00
Rate for Payer: Group Health Inc Medicare	$131.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.00
Rate for Payer: Hamaspik Choice Inc Medicare	$188.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$244.40

5H L PLT, 5MM ADV MDFC LOC

Facility IP

$376.00

Service Code	HCPCS C1713
Hospital Charge Code	40202241
Hospital Revenue Code	278
Min. Negotiated Rate	$188.00
Max. Negotiated Rate	$188.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.00
Rate for Payer: Hamaspik Choice Inc Medicare	$188.00

5H L PLTE 2MM ADV MDFC LOC

Facility OP

$354.00

Service Code	HCPCS C1713
Hospital Charge Code	40202393
Hospital Revenue Code	278
Min. Negotiated Rate	$123.90
Max. Negotiated Rate	$371.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.70
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	$177.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$203.55
Rate for Payer: Fidelis Medicare Advantage	$371.70
Rate for Payer: Group Health Inc Commercial	$177.00
Rate for Payer: Group Health Inc Medicare	$123.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.00
Rate for Payer: Hamaspik Choice Inc Medicare	$177.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.10

5H L PLTE 2MM ADV MDFC LOC

Facility IP

$354.00

Service Code	HCPCS C1713
Hospital Charge Code	40202393
Hospital Revenue Code	278
Min. Negotiated Rate	$177.00
Max. Negotiated Rate	$177.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.00
Rate for Payer: Hamaspik Choice Inc Medicare	$177.00

5 H L PLTE 5MM ADV MDFC LOC

Facility OP

$376.00

Service Code	HCPCS C1713
Hospital Charge Code	40202394
Hospital Revenue Code	278
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$394.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$206.80
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	$188.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$216.20
Rate for Payer: Fidelis Medicare Advantage	$394.80
Rate for Payer: Group Health Inc Commercial	$188.00
Rate for Payer: Group Health Inc Medicare	$131.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.00
Rate for Payer: Hamaspik Choice Inc Medicare	$188.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$244.40

5 H L PLTE 5MM ADV MDFC LOC

Facility IP

$376.00

Service Code	HCPCS C1713
Hospital Charge Code	40202394
Hospital Revenue Code	278
Min. Negotiated Rate	$188.00
Max. Negotiated Rate	$188.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.00
Rate for Payer: Hamaspik Choice Inc Medicare	$188.00

5 H L PT 2MM ADVC 100D LT STD

Facility IP

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40202396
Hospital Revenue Code	278
Min. Negotiated Rate	$157.00
Max. Negotiated Rate	$157.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00

5 H L PT 2MM ADVC 100D LT STD

Facility OP

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40202396
Hospital Revenue Code	278
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$329.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.70
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	$157.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$180.55
Rate for Payer: Fidelis Medicare Advantage	$329.70
Rate for Payer: Group Health Inc Commercial	$157.00
Rate for Payer: Group Health Inc Medicare	$109.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.10

5H L PT 2MM ADVC 100D LT STD

Facility IP

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40202243
Hospital Revenue Code	278
Min. Negotiated Rate	$157.00
Max. Negotiated Rate	$157.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00

5H L PT 2MM ADVC 100D LT STD

Facility OP

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40202243
Hospital Revenue Code	278
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$329.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.70
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	$157.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$180.55
Rate for Payer: Fidelis Medicare Advantage	$329.70
Rate for Payer: Group Health Inc Commercial	$157.00
Rate for Payer: Group Health Inc Medicare	$109.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.10

5 H L PT 2MM ADVC 100D RT STD

Facility IP

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40202397
Hospital Revenue Code	278
Min. Negotiated Rate	$157.00
Max. Negotiated Rate	$157.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00

5 H L PT 2MM ADVC 100D RT STD

Facility OP

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40202397
Hospital Revenue Code	278
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$329.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.70
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	$157.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$180.55
Rate for Payer: Fidelis Medicare Advantage	$329.70
Rate for Payer: Group Health Inc Commercial	$157.00
Rate for Payer: Group Health Inc Medicare	$109.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.10

5H L PT 2MM ADVC 100D RT STD

Facility OP

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40202244
Hospital Revenue Code	278
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$329.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.70
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	$157.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$180.55
Rate for Payer: Fidelis Medicare Advantage	$329.70
Rate for Payer: Group Health Inc Commercial	$157.00
Rate for Payer: Group Health Inc Medicare	$109.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.10

5H L PT 2MM ADVC 100D RT STD

Facility IP

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40202244
Hospital Revenue Code	278
Min. Negotiated Rate	$157.00
Max. Negotiated Rate	$157.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00

5H L PT 5MM ADVC 100D LT STD

Facility OP

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40202245
Hospital Revenue Code	278
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$329.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.70
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	$157.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$180.55
Rate for Payer: Fidelis Medicare Advantage	$329.70
Rate for Payer: Group Health Inc Commercial	$157.00
Rate for Payer: Group Health Inc Medicare	$109.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.10

5H L PT 5MM ADVC 100D LT STD

Facility IP

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40202245
Hospital Revenue Code	278
Min. Negotiated Rate	$157.00
Max. Negotiated Rate	$157.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00

5 HOLE L PLT 5MM ADVMT 100D RGHT

Facility OP

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40202390
Hospital Revenue Code	278
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$329.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.70
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	$157.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$180.55
Rate for Payer: Fidelis Medicare Advantage	$329.70
Rate for Payer: Group Health Inc Commercial	$157.00
Rate for Payer: Group Health Inc Medicare	$109.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.10

5 HOLE L PLT 5MM ADVMT 100D RGHT

Facility IP

$314.00

Service Code	HCPCS C1713
Hospital Charge Code	40202390
Hospital Revenue Code	278
Min. Negotiated Rate	$157.00
Max. Negotiated Rate	$157.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.00
Rate for Payer: Hamaspik Choice Inc Medicare	$157.00

5 HOLE L-PLT LFT EXTND LONG

Facility OP

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	40200866
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
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	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

5 HOLE L-PLT LFT EXTND LONG

Facility IP

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	40200866
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

5 HOLE L-PLT RIGHT LONG BAR

Facility OP

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	40200867
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
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	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

5 HOLE L-PLT RIGHT LONG BAR

Facility IP

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	40200867
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

Price Transparency.

All Charges