St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

STYKER SCREW 3.5 X 14 MM

Facility

$2,160.00

Service Code	HCPCS C1776
Hospital Charge Code	40205006
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,268.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,188.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,296.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,080.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,242.00
Rate for Payer: EmblemHealth Commercial	$1,080.00
Rate for Payer: Fidelis Medicare Advantage	$2,268.00
Rate for Payer: Group Health Inc Commercial	$1,080.00
Rate for Payer: Group Health Inc Medicare	$756.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,080.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,080.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,404.00

STYKER SCREW 3.5 X 14 MM

Facility

$2,160.00

Service Code	HCPCS C1776
Hospital Charge Code	40205006
Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$1,080.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,080.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,080.00

STYKER SCREW LAG 6.5X90MM

Facility

$343.00

Service Code	HCPCS C1713
Hospital Charge Code	40205083
Hospital Revenue Code	278
Min. Negotiated Rate	$171.50
Max. Negotiated Rate	$171.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.50
Rate for Payer: Hamaspik Choice Inc Medicare	$171.50

STYKER SCREW LAG 6.5X90MM

Facility

$343.00

Service Code	HCPCS C1713
Hospital Charge Code	40205083
Hospital Revenue Code	278
Min. Negotiated Rate	$120.05
Max. Negotiated Rate	$360.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$188.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$205.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$171.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$197.22
Rate for Payer: EmblemHealth Commercial	$171.50
Rate for Payer: Fidelis Medicare Advantage	$360.15
Rate for Payer: Group Health Inc Commercial	$171.50
Rate for Payer: Group Health Inc Medicare	$120.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.50
Rate for Payer: Hamaspik Choice Inc Medicare	$171.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$222.95

STYKER SCREW LOCKING 2.7

Facility

$243.60

Service Code	HCPCS C1713
Hospital Charge Code	40205547
Hospital Revenue Code	278
Min. Negotiated Rate	$85.26
Max. Negotiated Rate	$255.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$133.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$146.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$121.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.07
Rate for Payer: EmblemHealth Commercial	$121.80
Rate for Payer: Fidelis Medicare Advantage	$255.78
Rate for Payer: Group Health Inc Commercial	$121.80
Rate for Payer: Group Health Inc Medicare	$85.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.80
Rate for Payer: Hamaspik Choice Inc Medicare	$121.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$158.34

STYKER SCREW LOCKING 2.7

Facility

$243.60

Service Code	HCPCS C1713
Hospital Charge Code	40205547
Hospital Revenue Code	278
Min. Negotiated Rate	$121.80
Max. Negotiated Rate	$121.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.80
Rate for Payer: Hamaspik Choice Inc Medicare	$121.80

STYLET, 59CM TAPERED SOFT

Facility

$125.00

Hospital Charge Code	64902644
Hospital Revenue Code	270
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.50
Rate for Payer: Aetna Government	$62.50
Rate for Payer: Brighton Health Commercial	$93.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.00
Rate for Payer: Group Health Inc Commercial	$62.50
Rate for Payer: Group Health Inc Medicare	$43.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.50
Rate for Payer: Hamaspik Choice Inc Medicare	$62.50

STYLET ENDOTRACH NEONAT SLICK 6FR

Facility

$6.75

Hospital Charge Code	64902431
Hospital Revenue Code	270
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.38
Rate for Payer: Aetna Government	$3.38
Rate for Payer: Brighton Health Commercial	$5.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.59
Rate for Payer: Group Health Inc Commercial	$3.38
Rate for Payer: Group Health Inc Medicare	$2.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.38
Rate for Payer: Hamaspik Choice Inc Medicare	$3.38

STYLET FLEXI-SLIP 14FR

Facility

$4.60

Hospital Charge Code	64904081
Hospital Revenue Code	270
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$3.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.30
Rate for Payer: Aetna Government	$2.30
Rate for Payer: Brighton Health Commercial	$3.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.13
Rate for Payer: Group Health Inc Commercial	$2.30
Rate for Payer: Group Health Inc Medicare	$1.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.30
Rate for Payer: Hamaspik Choice Inc Medicare	$2.30

STYLET LEAD .016IN 59CML STRAIGHT

Facility

$125.00

Hospital Charge Code	64902623
Hospital Revenue Code	270
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.50
Rate for Payer: Aetna Government	$62.50
Rate for Payer: Brighton Health Commercial	$93.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.00
Rate for Payer: Group Health Inc Commercial	$62.50
Rate for Payer: Group Health Inc Medicare	$43.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.50
Rate for Payer: Hamaspik Choice Inc Medicare	$62.50

STYLETTE SLICK DISP

Facility

$6.53

Hospital Charge Code	64903043
Hospital Revenue Code	270
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$5.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.26
Rate for Payer: Aetna Government	$3.26
Rate for Payer: Brighton Health Commercial	$4.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.44
Rate for Payer: Group Health Inc Commercial	$3.26
Rate for Payer: Group Health Inc Medicare	$2.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.26
Rate for Payer: Hamaspik Choice Inc Medicare	$3.26

STYRKER SCREW LOCKING 3.5X12MM

Facility

$247.80

Service Code	HCPCS C1713
Hospital Charge Code	40205501
Hospital Revenue Code	278
Min. Negotiated Rate	$123.90
Max. Negotiated Rate	$123.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.90
Rate for Payer: Hamaspik Choice Inc Medicare	$123.90

STYRKER SCREW LOCKING 3.5X12MM

Facility

$247.80

Service Code	HCPCS C1713
Hospital Charge Code	40205501
Hospital Revenue Code	278
Min. Negotiated Rate	$86.73
Max. Negotiated Rate	$260.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$136.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$148.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$123.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$142.48
Rate for Payer: EmblemHealth Commercial	$123.90
Rate for Payer: Fidelis Medicare Advantage	$260.19
Rate for Payer: Group Health Inc Commercial	$123.90
Rate for Payer: Group Health Inc Medicare	$86.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.90
Rate for Payer: Hamaspik Choice Inc Medicare	$123.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$161.07

STYR SLF DRIL HLF PIN 6M 200X60M

Facility

$165.75

Service Code	HCPCS C1713
Hospital Charge Code	40202635
Hospital Revenue Code	278
Min. Negotiated Rate	$82.88
Max. Negotiated Rate	$82.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.88
Rate for Payer: Hamaspik Choice Inc Medicare	$82.88

STYR SLF DRIL HLF PIN 6M 200X60M

Facility

$165.75

Service Code	HCPCS C1713
Hospital Charge Code	40202635
Hospital Revenue Code	278
Min. Negotiated Rate	$58.01
Max. Negotiated Rate	$174.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$99.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.31
Rate for Payer: EmblemHealth Commercial	$82.88
Rate for Payer: Fidelis Medicare Advantage	$174.04
Rate for Payer: Group Health Inc Commercial	$82.88
Rate for Payer: Group Health Inc Medicare	$58.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.88
Rate for Payer: Hamaspik Choice Inc Medicare	$82.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$107.74

SUBC INJ FILLING MARTRL>10.0CC

Facility

$967.73

Service Code	HCPCS 11954
Hospital Charge Code	30307883
Hospital Revenue Code	510
Min. Negotiated Rate	$233.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$726.29
Rate for Payer: Aetna Government	$726.29
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$726.29
Rate for Payer: Cash Price	$726.29
Rate for Payer: Cash Price	$726.29
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$726.29
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	$726.29
Rate for Payer: Fidelis Essential Plan Aliesa	$617.35
Rate for Payer: Fidelis Essential Plan QHP	$646.40
Rate for Payer: Fidelis Medicare Advantage	$726.29
Rate for Payer: Fidelis Qualified Health Plan	$646.40
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	$483.86
Rate for Payer: Hamaspik Choice Inc Medicare	$726.29
Rate for Payer: Healthfirst Medicare Advantage	$617.35
Rate for Payer: Healthfirst QHP	$726.29
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$726.29
Rate for Payer: Senior Whole Health Medicare Advantage	$726.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$726.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$581.03
Rate for Payer: Wellcare Medicare	$689.98

SUBC INJ FILLING MARTRL>10.0CC

Facility

$967.73

Service Code	HCPCS 11954
Hospital Charge Code	30307883
Hospital Revenue Code	510
Rate for Payer: Cash Price	$726.29

SUBCLAVIAN CATH INSERT TRAY

Facility

$160.89

Hospital Charge Code	40200045
Hospital Revenue Code	270
Min. Negotiated Rate	$56.31
Max. Negotiated Rate	$128.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.44
Rate for Payer: Aetna Government	$80.44
Rate for Payer: Brighton Health Commercial	$120.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$128.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$109.41
Rate for Payer: Group Health Inc Commercial	$80.44
Rate for Payer: Group Health Inc Medicare	$56.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.44
Rate for Payer: Hamaspik Choice Inc Medicare	$80.44

SUBCLAVIAN CATH SET

Facility

$129.20

Hospital Charge Code	40207630
Hospital Revenue Code	270
Min. Negotiated Rate	$45.22
Max. Negotiated Rate	$103.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.60
Rate for Payer: Aetna Government	$64.60
Rate for Payer: Brighton Health Commercial	$96.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.86
Rate for Payer: Group Health Inc Commercial	$64.60
Rate for Payer: Group Health Inc Medicare	$45.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.60
Rate for Payer: Hamaspik Choice Inc Medicare	$64.60

SUBCLAVIAN TRAY(RU)

Facility

$57.76

Hospital Charge Code	40207805
Hospital Revenue Code	270
Min. Negotiated Rate	$20.22
Max. Negotiated Rate	$46.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.88
Rate for Payer: Aetna Government	$28.88
Rate for Payer: Brighton Health Commercial	$43.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.28
Rate for Payer: Group Health Inc Commercial	$28.88
Rate for Payer: Group Health Inc Medicare	$20.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.88
Rate for Payer: Hamaspik Choice Inc Medicare	$28.88

SUBCUTANEOUS INFUSION INITIAL

Facility

$556.50

Service Code	HCPCS 96369
Hospital Charge Code	40509898
Hospital Revenue Code	269
Rate for Payer: Cash Price	$247.87

SUBCUTANEOUS INFUSION INITIAL

Facility

$556.50

Service Code	HCPCS 96369
Hospital Charge Code	40509898
Hospital Revenue Code	269
Min. Negotiated Rate	$198.30
Max. Negotiated Rate	$445.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$247.87
Rate for Payer: Aetna Government	$247.87
Rate for Payer: Brighton Health Commercial	$417.38
Rate for Payer: Cash Price	$247.87
Rate for Payer: Cash Price	$247.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$247.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$445.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$378.42
Rate for Payer: Elderplan Medicare Advantage	$247.87
Rate for Payer: EmblemHealth Commercial	$247.87
Rate for Payer: Fidelis Essential Plan Aliesa	$210.69
Rate for Payer: Fidelis Essential Plan QHP	$220.60
Rate for Payer: Fidelis Medicare Advantage	$247.87
Rate for Payer: Fidelis Qualified Health Plan	$220.60
Rate for Payer: Group Health Inc Commercial	$247.87
Rate for Payer: Group Health Inc Medicare	$247.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.25
Rate for Payer: Hamaspik Choice Inc Medicare	$247.87
Rate for Payer: Healthfirst Medicare Advantage	$210.69
Rate for Payer: Healthfirst QHP	$247.87
Rate for Payer: Senior Whole Health Medicare Advantage	$247.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$247.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$198.30
Rate for Payer: Wellcare Medicare	$235.48

SUBEPITHELIAL CONN. TISSUE GRAFT

Facility

$750.00

Service Code	HCPCS D4273
Hospital Charge Code	42303311
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,763.60

SUBEPITHELIAL CONN. TISSUE GRAFT

Facility

$750.00

Service Code	HCPCS D4273
Hospital Charge Code	42303311
Hospital Revenue Code	361
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$412.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,763.60
Rate for Payer: Aetna Government	$1,763.60
Rate for Payer: Brighton Health Commercial	$562.50
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	$375.00
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: Senior Whole Health 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

SUBPERIOSTEAL IMPLANT

Facility

$10,302.00

Service Code	HCPCS D6040
Hospital Charge Code	42301420
Hospital Revenue Code	361
Min. Negotiated Rate	$2,313.78
Max. Negotiated Rate	$7,726.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,666.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,313.78
Rate for Payer: Aetna Government	$2,313.78
Rate for Payer: Brighton Health Commercial	$7,726.50
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	$5,151.00
Rate for Payer: Group Health Inc Medicare	$3,605.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,151.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,151.00

Know your out-of-pocket cost for care.

All Charges