St. Barnabas Hospital

All Charges

Charge

Type

Price

5 HOLE PL,2MM ADV MDFC LOC

Facility IP

$352.00

Service Code	HCPCS C1713
Hospital Charge Code	40201089
Hospital Revenue Code	278
Min. Negotiated Rate	$176.00
Max. Negotiated Rate	$176.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$176.00
Rate for Payer: Hamaspik Choice Inc Medicare	$176.00

5 HOLE PL,2MM ADV MDFC LOC

Facility OP

$352.00

Service Code	HCPCS C1713
Hospital Charge Code	40201089
Hospital Revenue Code	278
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$369.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$193.60
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	$176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$202.40
Rate for Payer: Fidelis Medicare Advantage	$369.60
Rate for Payer: Group Health Inc Commercial	$176.00
Rate for Payer: Group Health Inc Medicare	$123.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$176.00
Rate for Payer: Hamaspik Choice Inc Medicare	$176.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$228.80

5 HOLE PLT,5MM ADV MDFC LOC

Facility IP

$376.00

Service Code	HCPCS C1713
Hospital Charge Code	40201090
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 HOLE PLT,5MM ADV MDFC LOC

Facility OP

$376.00

Service Code	HCPCS C1713
Hospital Charge Code	40201090
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 HOLE PLT MIDFACE

Facility IP

$268.00

Service Code	HCPCS C1713
Hospital Charge Code	40201088
Hospital Revenue Code	278
Min. Negotiated Rate	$134.00
Max. Negotiated Rate	$134.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00

5 HOLE PLT MIDFACE

Facility OP

$268.00

Service Code	HCPCS C1713
Hospital Charge Code	40201088
Hospital Revenue Code	278
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$281.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.40
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	$134.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$154.10
Rate for Payer: Fidelis Medicare Advantage	$281.40
Rate for Payer: Group Health Inc Commercial	$134.00
Rate for Payer: Group Health Inc Medicare	$93.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$174.20

5 HOLE Y PLT W/4MM BAR MDFC

Facility IP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201091
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$141.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00

5 HOLE Y PLT W/4MM BAR MDFC

Facility OP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201091
Hospital Revenue Code	278
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$296.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$155.10
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	$141.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.15
Rate for Payer: Fidelis Medicare Advantage	$296.10
Rate for Payer: Group Health Inc Commercial	$141.00
Rate for Payer: Group Health Inc Medicare	$98.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$183.30

5H PLATE MIDFACE

Facility IP

$268.00

Service Code	HCPCS C1713
Hospital Charge Code	40202248
Hospital Revenue Code	278
Min. Negotiated Rate	$134.00
Max. Negotiated Rate	$134.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00

5H PLATE MIDFACE

Facility OP

$268.00

Service Code	HCPCS C1713
Hospital Charge Code	40202248
Hospital Revenue Code	278
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$281.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.40
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	$134.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$154.10
Rate for Payer: Fidelis Medicare Advantage	$281.40
Rate for Payer: Group Health Inc Commercial	$134.00
Rate for Payer: Group Health Inc Medicare	$93.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$174.20

5H PLATE W/4MM BAR MDFC

Facility OP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40202249
Hospital Revenue Code	278
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$296.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$155.10
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	$141.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.15
Rate for Payer: Fidelis Medicare Advantage	$296.10
Rate for Payer: Group Health Inc Commercial	$141.00
Rate for Payer: Group Health Inc Medicare	$98.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$183.30

5H PLATE W/4MM BAR MDFC

Facility IP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40202249
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$141.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00

5H PLATE W/8MM BAR MDFC

Facility OP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40202250
Hospital Revenue Code	278
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$296.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$155.10
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	$141.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.15
Rate for Payer: Fidelis Medicare Advantage	$296.10
Rate for Payer: Group Health Inc Commercial	$141.00
Rate for Payer: Group Health Inc Medicare	$98.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$183.30

5H PLATE W/8MM BAR MDFC

Facility IP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40202250
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$141.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00

5H Y-BONE PLT NO BAR

Facility OP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40202257
Hospital Revenue Code	278
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$310.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
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	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: Fidelis Medicare Advantage	$310.80
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

5H Y-BONE PLT NO BAR

Facility IP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40202257
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

5H Y-BONE PLT W/ BAR

Facility IP

$396.00

Service Code	HCPCS C1713
Hospital Charge Code	40202258
Hospital Revenue Code	278
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$198.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$198.00
Rate for Payer: Hamaspik Choice Inc Medicare	$198.00

5H Y-BONE PLT W/ BAR

Facility OP

$396.00

Service Code	HCPCS C1713
Hospital Charge Code	40202258
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$415.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.80
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	$198.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$227.70
Rate for Payer: Fidelis Medicare Advantage	$415.80
Rate for Payer: Group Health Inc Commercial	$198.00
Rate for Payer: Group Health Inc Medicare	$138.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$198.00
Rate for Payer: Hamaspik Choice Inc Medicare	$198.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$257.40

5H Y PLATE W/4MM BAR MDFC LOC

Facility IP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40202255
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$141.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00

5H Y PLATE W/4MM BAR MDFC LOC

Facility OP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40202255
Hospital Revenue Code	278
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$296.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$155.10
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	$141.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.15
Rate for Payer: Fidelis Medicare Advantage	$296.10
Rate for Payer: Group Health Inc Commercial	$141.00
Rate for Payer: Group Health Inc Medicare	$98.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$183.30

5H Y PLATE W/8MM BAR MDFC LOC

Facility OP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40202256
Hospital Revenue Code	278
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$310.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
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	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: Fidelis Medicare Advantage	$310.80
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

5H Y PLATE W/8MM BAR MDFC LOC

Facility IP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40202256
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

5% HYPROTIGEN 1000CC

Facility OP

$28.71

Hospital Charge Code	40509000
Hospital Revenue Code	260
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$22.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.36
Rate for Payer: Aetna Government	$14.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.52
Rate for Payer: Group Health Inc Commercial	$14.36
Rate for Payer: Group Health Inc Medicare	$10.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.36
Rate for Payer: Hamaspik Choice Inc Medicare	$14.36

5% HYPROTIGEN -5% DEXTROSE

Facility OP

$28.71

Hospital Charge Code	40509120
Hospital Revenue Code	260
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$22.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.36
Rate for Payer: Aetna Government	$14.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.52
Rate for Payer: Group Health Inc Commercial	$14.36
Rate for Payer: Group Health Inc Medicare	$10.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.36
Rate for Payer: Hamaspik Choice Inc Medicare	$14.36

5% LACTATED RINGERS - 1000CC

Facility OP

$10.64

Hospital Charge Code	40193510
Hospital Revenue Code	710
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$8.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.32
Rate for Payer: Aetna Government	$5.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.51
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	$3.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.32
Rate for Payer: Hamaspik Choice Inc Medicare	$5.32

Price Transparency.

All Charges