St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TI2.9MM LCKNG SCR,SELF-TAPPING6MM

Facility

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40209502
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$336.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$192.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.00
Rate for Payer: EmblemHealth Commercial	$160.00
Rate for Payer: Fidelis Medicare Advantage	$336.00
Rate for Payer: Group Health Inc Commercial	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.00

TI2.9MM LCKNGSCRW SELFTAP/12MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	40209510
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,680.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$960.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$920.00
Rate for Payer: EmblemHealth Commercial	$800.00
Rate for Payer: Fidelis Medicare Advantage	$1,680.00
Rate for Payer: Group Health Inc Commercial	$800.00
Rate for Payer: Group Health Inc Medicare	$560.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$800.00
Rate for Payer: Hamaspik Choice Inc Medicare	$800.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,040.00

TI2.9MM LCKNGSCRW SELFTAP/12MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	40209510
Hospital Revenue Code	278
Min. Negotiated Rate	$800.00
Max. Negotiated Rate	$800.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$800.00
Rate for Payer: Hamaspik Choice Inc Medicare	$800.00

TI2.9MM LCKNGSCRW,SELFTAPPING10MM

Facility

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40209507
Hospital Revenue Code	278
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00

TI2.9MM LCKNGSCRW,SELFTAPPING10MM

Facility

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40209507
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$336.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$192.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.00
Rate for Payer: EmblemHealth Commercial	$160.00
Rate for Payer: Fidelis Medicare Advantage	$336.00
Rate for Payer: Group Health Inc Commercial	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.00

TI2.9MM LCKNGSCRW SELFTAPPING12MM

Facility

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40209509
Hospital Revenue Code	278
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00

TI2.9MM LCKNGSCRW SELFTAPPING12MM

Facility

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40209509
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$336.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$192.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.00
Rate for Payer: EmblemHealth Commercial	$160.00
Rate for Payer: Fidelis Medicare Advantage	$336.00
Rate for Payer: Group Health Inc Commercial	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.00

TI2.9MM LCKNGSCRW,SELFTAPPING8MM

Facility

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40209505
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$336.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$192.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.00
Rate for Payer: EmblemHealth Commercial	$160.00
Rate for Payer: Fidelis Medicare Advantage	$336.00
Rate for Payer: Group Health Inc Commercial	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.00

TI2.9MM LCKNGSCRW,SELFTAPPING8MM

Facility

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40209505
Hospital Revenue Code	278
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00

TI2.9MM NONLCKNGSCRW SELFTAP 6MM

Facility

$200.00

Service Code	HCPCS C1713
Hospital Charge Code	40209513
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$210.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$120.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.00
Rate for Payer: EmblemHealth Commercial	$100.00
Rate for Payer: Fidelis Medicare Advantage	$210.00
Rate for Payer: Group Health Inc Commercial	$100.00
Rate for Payer: Group Health Inc Medicare	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$130.00

TI2.9MM NONLCKNGSCRW SELFTAP 6MM

Facility

$200.00

Service Code	HCPCS C1713
Hospital Charge Code	40209513
Hospital Revenue Code	278
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00

TIAGABINE 2 MG TAB

Facility

$11.00

Hospital Charge Code	41652746
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

TIAGABINE 2 MG TAB

Facility

$11.00

Hospital Charge Code	41642746
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

TIAGABINE 4 MG TAB

Facility

$11.00

Hospital Charge Code	41642650
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

TIAGABINE 4 MG TAB

Facility

$11.00

Hospital Charge Code	41652650
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

TIAGABINE HCL 2 MG PO TABS [27178]

Facility

$7.94

Service Code	NDC 00093503056
Hospital Charge Code	00093503056
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$6.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.97
Rate for Payer: Aetna Government	$3.97
Rate for Payer: Brighton Health Commercial	$5.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.40
Rate for Payer: Group Health Inc Commercial	$3.97
Rate for Payer: Group Health Inc Medicare	$2.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.97
Rate for Payer: Hamaspik Choice Inc Medicare	$3.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.16

TIAGABINE HCL 4 MG PO TABS [21827]

Facility

$7.94

Service Code	NDC 00093503156
Hospital Charge Code	00093503156
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$6.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.97
Rate for Payer: Aetna Government	$3.97
Rate for Payer: Brighton Health Commercial	$5.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.40
Rate for Payer: Group Health Inc Commercial	$3.97
Rate for Payer: Group Health Inc Medicare	$2.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.97
Rate for Payer: Hamaspik Choice Inc Medicare	$3.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.16

TI ASNIS III WASHER FOR 6.5/8

Facility

$86.13

Hospital Charge Code	64905575
Hospital Revenue Code	270
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$68.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.06
Rate for Payer: Aetna Government	$43.06
Rate for Payer: Brighton Health Commercial	$64.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.57
Rate for Payer: Group Health Inc Commercial	$43.06
Rate for Payer: Group Health Inc Medicare	$30.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.06
Rate for Payer: Hamaspik Choice Inc Medicare	$43.06

TIB BEAR DS FEM GRO

Facility

$9,148.12

Service Code	HCPCS C1776
Hospital Charge Code	64907277
Hospital Revenue Code	278
Min. Negotiated Rate	$4,574.06
Max. Negotiated Rate	$4,574.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,574.06
Rate for Payer: Hamaspik Choice Inc Medicare	$4,574.06

TIB BEAR DS FEM GRO

Facility

$9,148.12

Service Code	HCPCS C1776
Hospital Charge Code	64907277
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,605.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,031.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$5,488.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,574.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,260.17
Rate for Payer: EmblemHealth Commercial	$4,574.06
Rate for Payer: Fidelis Medicare Advantage	$9,605.53
Rate for Payer: Group Health Inc Commercial	$4,574.06
Rate for Payer: Group Health Inc Medicare	$3,201.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,574.06
Rate for Payer: Hamaspik Choice Inc Medicare	$4,574.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,946.28

TIB BEARING COMP

Facility

$2,079.38

Service Code	HCPCS C1776
Hospital Charge Code	64907318
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,183.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,143.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,247.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,039.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,195.64
Rate for Payer: EmblemHealth Commercial	$1,039.69
Rate for Payer: Fidelis Medicare Advantage	$2,183.35
Rate for Payer: Group Health Inc Commercial	$1,039.69
Rate for Payer: Group Health Inc Medicare	$727.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,039.69
Rate for Payer: Hamaspik Choice Inc Medicare	$1,039.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,351.60

TIB BEARING COMP

Facility

$2,079.38

Service Code	HCPCS C1776
Hospital Charge Code	64907318
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.69
Max. Negotiated Rate	$1,039.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,039.69
Rate for Payer: Hamaspik Choice Inc Medicare	$1,039.69

TIB GMRS

Facility

$3,864.38

Service Code	HCPCS C1776
Hospital Charge Code	64907274
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,057.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,125.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,318.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,932.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,222.02
Rate for Payer: EmblemHealth Commercial	$1,932.19
Rate for Payer: Fidelis Medicare Advantage	$4,057.60
Rate for Payer: Group Health Inc Commercial	$1,932.19
Rate for Payer: Group Health Inc Medicare	$1,352.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,932.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1,932.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,511.85

TIB GMRS

Facility

$3,864.38

Service Code	HCPCS C1776
Hospital Charge Code	64907274
Hospital Revenue Code	278
Min. Negotiated Rate	$1,932.19
Max. Negotiated Rate	$1,932.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,932.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1,932.19

TIB/HUM CALI DRILL-4.3MM STR

Facility

$250.56

Service Code	HCPCS C1713
Hospital Charge Code	40006469
Hospital Revenue Code	278
Min. Negotiated Rate	$125.28
Max. Negotiated Rate	$125.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.28
Rate for Payer: Hamaspik Choice Inc Medicare	$125.28

Know your out-of-pocket cost for care.

All Charges