St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BOLT LOCKING TI 28MM

Facility

$274.00

Service Code	HCPCS C1713
Hospital Charge Code	40200124
Hospital Revenue Code	278
Min. Negotiated Rate	$137.00
Max. Negotiated Rate	$137.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00

BOLT LOCKING TI 28MM

Facility

$274.00

Service Code	HCPCS C1713
Hospital Charge Code	40200124
Hospital Revenue Code	278
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$287.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$164.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$137.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.55
Rate for Payer: EmblemHealth Commercial	$137.00
Rate for Payer: Fidelis Medicare Advantage	$287.70
Rate for Payer: Group Health Inc Commercial	$137.00
Rate for Payer: Group Health Inc Medicare	$95.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$178.10

BOLT LOCKING TI 3.9MM

Facility

$274.00

Service Code	HCPCS C1713
Hospital Charge Code	40200125
Hospital Revenue Code	278
Min. Negotiated Rate	$137.00
Max. Negotiated Rate	$137.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00

BOLT LOCKING TI 3.9MM

Facility

$274.00

Service Code	HCPCS C1713
Hospital Charge Code	40200125
Hospital Revenue Code	278
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$287.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$164.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$137.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.55
Rate for Payer: EmblemHealth Commercial	$137.00
Rate for Payer: Fidelis Medicare Advantage	$287.70
Rate for Payer: Group Health Inc Commercial	$137.00
Rate for Payer: Group Health Inc Medicare	$95.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$178.10

BOLT LOCKING TI 4.0X46MM

Facility

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40200126
Hospital Revenue Code	278
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$327.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$187.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$156.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.40
Rate for Payer: EmblemHealth Commercial	$156.00
Rate for Payer: Fidelis Medicare Advantage	$327.60
Rate for Payer: Group Health Inc Commercial	$156.00
Rate for Payer: Group Health Inc Medicare	$109.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$202.80

BOLT LOCKING TI 4.0X46MM

Facility

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40200126
Hospital Revenue Code	278
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$156.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00

BOLT LOCKING TI 4.9X36MM

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200127
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: Brighton Health Commercial	$177.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: EmblemHealth Commercial	$148.00
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

BOLT LOCKING TI 4.9X36MM

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200127
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

BOLT LOCKING TI 4.9X38MM

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200128
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

BOLT LOCKING TI 4.9X38MM

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200128
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: Brighton Health Commercial	$177.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: EmblemHealth Commercial	$148.00
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

BOLT LOCKING TI 4.9X40MM

Facility

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40200129
Hospital Revenue Code	278
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$156.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00

BOLT LOCKING TI 4.9X40MM

Facility

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40200129
Hospital Revenue Code	278
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$327.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$187.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$156.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.40
Rate for Payer: EmblemHealth Commercial	$156.00
Rate for Payer: Fidelis Medicare Advantage	$327.60
Rate for Payer: Group Health Inc Commercial	$156.00
Rate for Payer: Group Health Inc Medicare	$109.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$202.80

BOLT LOCKING TI 4.9X42MM

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200130
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: Brighton Health Commercial	$177.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: EmblemHealth Commercial	$148.00
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

BOLT LOCKING TI 4.9X42MM

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200130
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

BOLT LOCKING TI 4.9X44MM

Facility

$304.00

Service Code	HCPCS C1713
Hospital Charge Code	40200131
Hospital Revenue Code	278
Min. Negotiated Rate	$106.40
Max. Negotiated Rate	$319.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$167.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$182.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$152.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.80
Rate for Payer: EmblemHealth Commercial	$152.00
Rate for Payer: Fidelis Medicare Advantage	$319.20
Rate for Payer: Group Health Inc Commercial	$152.00
Rate for Payer: Group Health Inc Medicare	$106.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.00
Rate for Payer: Hamaspik Choice Inc Medicare	$152.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.60

BOLT LOCKING TI 4.9X44MM

Facility

$304.00

Service Code	HCPCS C1713
Hospital Charge Code	40200131
Hospital Revenue Code	278
Min. Negotiated Rate	$152.00
Max. Negotiated Rate	$152.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.00
Rate for Payer: Hamaspik Choice Inc Medicare	$152.00

BOLT LOCKING TI 4.9X50MM

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200132
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: Brighton Health Commercial	$177.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: EmblemHealth Commercial	$148.00
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

BOLT LOCKING TI 4.9X50MM

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200132
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

BONE BIOPSY OPEN DEEP

Facility

$7,183.50

Service Code	HCPCS 20245
Hospital Charge Code	30300356
Hospital Revenue Code	510
Rate for Payer: Cash Price	$3,285.96

BONE BIOPSY OPEN DEEP

Facility

$7,183.50

Service Code	HCPCS 20245
Hospital Charge Code	30300356
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$3,591.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,285.96
Rate for Payer: Aetna Government	$3,285.96
Rate for Payer: Affinity Essential Plan 1&2	$2,300.17
Rate for Payer: Affinity Essential Plan 3&4	$2,300.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,300.17
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$3,285.96
Rate for Payer: Cash Price	$3,285.96
Rate for Payer: Cash Price	$3,285.96
Rate for Payer: Cash Price	$3,285.96
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,285.96
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	$3,285.96
Rate for Payer: Fidelis Essential Plan Aliesa	$2,793.07
Rate for Payer: Fidelis Essential Plan QHP	$2,924.50
Rate for Payer: Fidelis Medicare Advantage	$3,285.96
Rate for Payer: Fidelis Qualified Health Plan	$2,924.50
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	$3,591.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,285.96
Rate for Payer: Healthfirst Medicare Advantage	$2,793.07
Rate for Payer: Healthfirst QHP	$3,285.96
Rate for Payer: Humana Medicare	$3,351.68
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$3,285.96
Rate for Payer: Senior Whole Health Medicare Advantage	$3,285.96
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$3,285.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,285.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,628.77
Rate for Payer: Wellcare Medicare	$3,121.66

BONE BLOCK

Facility

$8,400.00

Service Code	HCPCS C1713
Hospital Charge Code	40202292
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,820.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,620.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$5,040.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,830.00
Rate for Payer: EmblemHealth Commercial	$4,200.00
Rate for Payer: Fidelis Medicare Advantage	$8,820.00
Rate for Payer: Group Health Inc Commercial	$4,200.00
Rate for Payer: Group Health Inc Medicare	$2,940.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,460.00

BONE BLOCK

Facility

$8,400.00

Service Code	HCPCS C1713
Hospital Charge Code	40202292
Hospital Revenue Code	278
Min. Negotiated Rate	$4,200.00
Max. Negotiated Rate	$4,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,200.00

BONE BLOCK 1.2CC SYN CAN

Facility

$380.00

Service Code	HCPCS C1713
Hospital Charge Code	40202291
Hospital Revenue Code	278
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$399.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$228.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$218.50
Rate for Payer: EmblemHealth Commercial	$190.00
Rate for Payer: Fidelis Medicare Advantage	$399.00
Rate for Payer: Group Health Inc Commercial	$190.00
Rate for Payer: Group Health Inc Medicare	$133.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.00
Rate for Payer: Hamaspik Choice Inc Medicare	$190.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$247.00

BONE BLOCK 1.2CC SYN CAN

Facility

$380.00

Service Code	HCPCS C1713
Hospital Charge Code	40202291
Hospital Revenue Code	278
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.00
Rate for Payer: Hamaspik Choice Inc Medicare	$190.00

BONE BLOCK 1.2CC SYN CAN

Facility

$475.00

Hospital Charge Code	64904097
Hospital Revenue Code	270
Min. Negotiated Rate	$166.25
Max. Negotiated Rate	$380.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$261.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$237.50
Rate for Payer: Aetna Government	$237.50
Rate for Payer: Brighton Health Commercial	$356.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$380.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$323.00
Rate for Payer: Group Health Inc Commercial	$237.50
Rate for Payer: Group Health Inc Medicare	$166.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.50
Rate for Payer: Hamaspik Choice Inc Medicare	$237.50

Know your out-of-pocket cost for care.

All Charges