St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TI PL 15 HOLES RIGHT RIB 3

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209491
Hospital Revenue Code	278
Min. Negotiated Rate	$1,250.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00

TI PL 15 HOLES RIGHT RIB 3

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209491
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,625.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,375.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,437.50
Rate for Payer: EmblemHealth Commercial	$1,250.00
Rate for Payer: Fidelis Medicare Advantage	$2,625.00
Rate for Payer: Group Health Inc Commercial	$1,250.00
Rate for Payer: Group Health Inc Medicare	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,625.00

TI PL 16 HOLES LEFT RIBS 4&5

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209492
Hospital Revenue Code	278
Min. Negotiated Rate	$1,250.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00

TI PL 16 HOLES LEFT RIBS 4&5

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209492
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,625.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,375.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,437.50
Rate for Payer: EmblemHealth Commercial	$1,250.00
Rate for Payer: Fidelis Medicare Advantage	$2,625.00
Rate for Payer: Group Health Inc Commercial	$1,250.00
Rate for Payer: Group Health Inc Medicare	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,625.00

TI PL 16 HOLES RIGHT RIBS 4&5

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209493
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,625.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,375.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,437.50
Rate for Payer: EmblemHealth Commercial	$1,250.00
Rate for Payer: Fidelis Medicare Advantage	$2,625.00
Rate for Payer: Group Health Inc Commercial	$1,250.00
Rate for Payer: Group Health Inc Medicare	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,625.00

TI PL 16 HOLES RIGHT RIBS 4&5

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209493
Hospital Revenue Code	278
Min. Negotiated Rate	$1,250.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00

TI PL 17 HOLES LEFT RIBS 6&7

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209494
Hospital Revenue Code	278
Min. Negotiated Rate	$1,250.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00

TI PL 17 HOLES LEFT RIBS 6&7

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209494
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,625.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,375.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,437.50
Rate for Payer: EmblemHealth Commercial	$1,250.00
Rate for Payer: Fidelis Medicare Advantage	$2,625.00
Rate for Payer: Group Health Inc Commercial	$1,250.00
Rate for Payer: Group Health Inc Medicare	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,625.00

TI PL 17 HOLES RIGHT RIBS 6&7

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209495
Hospital Revenue Code	278
Min. Negotiated Rate	$1,250.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00

TI PL 17 HOLES RIGHT RIBS 6&7

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209495
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,625.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,375.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,437.50
Rate for Payer: EmblemHealth Commercial	$1,250.00
Rate for Payer: Fidelis Medicare Advantage	$2,625.00
Rate for Payer: Group Health Inc Commercial	$1,250.00
Rate for Payer: Group Health Inc Medicare	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,625.00

TI PL 18 HOLES LEFT RIBS 8&9

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209496
Hospital Revenue Code	278
Min. Negotiated Rate	$1,250.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00

TI PL 18 HOLES LEFT RIBS 8&9

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209496
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,625.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,375.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,437.50
Rate for Payer: EmblemHealth Commercial	$1,250.00
Rate for Payer: Fidelis Medicare Advantage	$2,625.00
Rate for Payer: Group Health Inc Commercial	$1,250.00
Rate for Payer: Group Health Inc Medicare	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,625.00

TI PL 18 HOLES RIGHT RIBS 8&9

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209497
Hospital Revenue Code	278
Min. Negotiated Rate	$1,250.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00

TI PL 18 HOLES RIGHT RIBS 8&9

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209497
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,625.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,375.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,437.50
Rate for Payer: EmblemHealth Commercial	$1,250.00
Rate for Payer: Fidelis Medicare Advantage	$2,625.00
Rate for Payer: Group Health Inc Commercial	$1,250.00
Rate for Payer: Group Health Inc Medicare	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,625.00

TIP PHACO PACK CASSETTE W/TUBING

Facility

$250.00

Hospital Charge Code	40205989
Hospital Revenue Code	270
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$125.00
Rate for Payer: Aetna Government	$125.00
Rate for Payer: Brighton Health Commercial	$187.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.00
Rate for Payer: Group Health Inc Commercial	$125.00
Rate for Payer: Group Health Inc Medicare	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00

TIP POLY I/A DISP

Facility

$30.00

Hospital Charge Code	64907116
Hospital Revenue Code	270
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$24.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.00
Rate for Payer: Aetna Government	$15.00
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.40
Rate for Payer: Group Health Inc Commercial	$15.00
Rate for Payer: Group Health Inc Medicare	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00

TIPRANAVIR 250 MG CAP

Facility

$16.00

Hospital Charge Code	41644173
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$12.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Brighton Health Commercial	$12.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.88
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

TIPRANAVIR 250 MG CAP

Facility

$16.00

Hospital Charge Code	41654173
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$12.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Brighton Health Commercial	$12.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.88
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

TIPRANAVIR 250 MG PO CAPS [41676]

Facility

$20.55

Service Code	NDC 00597000302
Hospital Charge Code	00597000302
Hospital Revenue Code	250
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$16.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.27
Rate for Payer: Aetna Government	$10.27
Rate for Payer: Brighton Health Commercial	$15.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.97
Rate for Payer: Group Health Inc Commercial	$10.27
Rate for Payer: Group Health Inc Medicare	$7.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.27
Rate for Payer: Hamaspik Choice Inc Medicare	$10.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.35

TIPS EAR BLUE 4MM 1908

Facility

$2.30

Hospital Charge Code	64903456
Hospital Revenue Code	270
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.15
Rate for Payer: Aetna Government	$1.15
Rate for Payer: Brighton Health Commercial	$1.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.56
Rate for Payer: Group Health Inc Commercial	$1.15
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.15
Rate for Payer: Hamaspik Choice Inc Medicare	$1.15

TIPS MULTI-PURP FLAT-BOT BLK 1

Facility

$9.73

Hospital Charge Code	64902998
Hospital Revenue Code	270
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$7.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.86
Rate for Payer: Aetna Government	$4.86
Rate for Payer: Brighton Health Commercial	$7.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.62
Rate for Payer: Group Health Inc Commercial	$4.86
Rate for Payer: Group Health Inc Medicare	$3.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.86
Rate for Payer: Hamaspik Choice Inc Medicare	$4.86

TI ROD 5.5 500MM

Facility

$2,432.50

Service Code	HCPCS C1713
Hospital Charge Code	64904168
Hospital Revenue Code	278
Min. Negotiated Rate	$1,216.25
Max. Negotiated Rate	$1,216.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,216.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,216.25

TI ROD 5.5 500MM

Facility

$2,432.50

Service Code	HCPCS C1713
Hospital Charge Code	64904168
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,554.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,337.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,459.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,216.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,398.69
Rate for Payer: EmblemHealth Commercial	$1,216.25
Rate for Payer: Fidelis Medicare Advantage	$2,554.12
Rate for Payer: Group Health Inc Commercial	$1,216.25
Rate for Payer: Group Health Inc Medicare	$851.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,216.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,216.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,581.12

TI ROD PREBENT LORDOTIC 40MM

Facility

$1,416.25

Service Code	HCPCS C1713
Hospital Charge Code	64905044
Hospital Revenue Code	278
Min. Negotiated Rate	$708.12
Max. Negotiated Rate	$708.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$708.12
Rate for Payer: Hamaspik Choice Inc Medicare	$708.12

TI ROD PREBENT LORDOTIC 40MM

Facility

$1,416.25

Service Code	HCPCS C1713
Hospital Charge Code	64905044
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,487.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$778.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$849.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$708.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$814.34
Rate for Payer: EmblemHealth Commercial	$708.12
Rate for Payer: Fidelis Medicare Advantage	$1,487.06
Rate for Payer: Group Health Inc Commercial	$708.12
Rate for Payer: Group Health Inc Medicare	$495.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$708.12
Rate for Payer: Hamaspik Choice Inc Medicare	$708.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$920.56

Know your out-of-pocket cost for care.

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