St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BONE MARROW DISP NDLE

Facility

$63.43

Hospital Charge Code	40200651
Hospital Revenue Code	270
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$50.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.72
Rate for Payer: Aetna Government	$31.72
Rate for Payer: Brighton Health Commercial	$47.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.13
Rate for Payer: Group Health Inc Commercial	$31.72
Rate for Payer: Group Health Inc Medicare	$22.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.72
Rate for Payer: Hamaspik Choice Inc Medicare	$31.72

BONE MARROW TRAY

Facility

$100.00

Service Code	HCPCS A4550
Hospital Charge Code	40509889
Hospital Revenue Code	270
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$80.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.57
Rate for Payer: Aetna Government	$13.57
Rate for Payer: Brighton Health Commercial	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

BONE MICRO MORSEL 10CC SYN CAN

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40202293
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

BONE MICRO MORSEL 10CC SYN CAN

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40202293
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,575.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$900.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$862.50
Rate for Payer: EmblemHealth Commercial	$750.00
Rate for Payer: Fidelis Medicare Advantage	$1,575.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$975.00

BONE PLATE #7 VITALLIUM

Facility

$36.86

Hospital Charge Code	40200654
Hospital Revenue Code	270
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$29.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.43
Rate for Payer: Aetna Government	$18.43
Rate for Payer: Brighton Health Commercial	$27.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.06
Rate for Payer: Group Health Inc Commercial	$18.43
Rate for Payer: Group Health Inc Medicare	$12.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.43
Rate for Payer: Hamaspik Choice Inc Medicare	$18.43

BONE PLUG

Facility

$428.09

Hospital Charge Code	40207002
Hospital Revenue Code	270
Min. Negotiated Rate	$149.83
Max. Negotiated Rate	$342.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$214.04
Rate for Payer: Aetna Government	$214.04
Rate for Payer: Brighton Health Commercial	$321.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$342.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$291.10
Rate for Payer: Group Health Inc Commercial	$214.04
Rate for Payer: Group Health Inc Medicare	$149.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.04
Rate for Payer: Hamaspik Choice Inc Medicare	$214.04

BONE PLUGS EXETER

Facility

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907262
Hospital Revenue Code	278
Min. Negotiated Rate	$142.71
Max. Negotiated Rate	$428.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$244.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$203.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.46
Rate for Payer: EmblemHealth Commercial	$203.88
Rate for Payer: Fidelis Medicare Advantage	$428.14
Rate for Payer: Group Health Inc Commercial	$203.88
Rate for Payer: Group Health Inc Medicare	$142.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$265.04

BONE PLUGS EXETER

Facility

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907262
Hospital Revenue Code	278
Min. Negotiated Rate	$203.88
Max. Negotiated Rate	$203.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88

BONE REPLCMNT GRAFT-1ST SITE QUAD

Facility

$626.54

Service Code	HCPCS D4263
Hospital Charge Code	42303307
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

BONE REPLCMNT GRAFT-1ST SITE QUAD

Facility

$626.54

Service Code	HCPCS D4263
Hospital Charge Code	42303307
Hospital Revenue Code	361
Min. Negotiated Rate	$313.27
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$344.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$469.90
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.27
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

BONE REPLCMNT GRAFT- EA ADD. SITE

Facility

$248.06

Service Code	HCPCS D4264
Hospital Charge Code	42303308
Hospital Revenue Code	361
Min. Negotiated Rate	$86.82
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$136.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$106.69
Rate for Payer: Aetna Government	$106.69
Rate for Payer: Brighton Health Commercial	$186.04
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	$124.03
Rate for Payer: Group Health Inc Medicare	$86.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$124.03
Rate for Payer: Hamaspik Choice Inc Medicare	$124.03

BONE REPL.GRAFT-SINGLE SITE(INCL

Facility

$798.77

Service Code	HCPCS D4261
Hospital Charge Code	42300875
Hospital Revenue Code	361
Min. Negotiated Rate	$399.38
Max. Negotiated Rate	$3,797.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$439.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,723.23
Rate for Payer: Aetna Government	$3,723.23
Rate for Payer: Affinity Essential Plan 1&2	$2,606.26
Rate for Payer: Affinity Essential Plan 3&4	$2,606.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,606.26
Rate for Payer: Brighton Health Commercial	$599.08
Rate for Payer: Cash Price	$3,723.23
Rate for Payer: Cash Price	$3,723.23
Rate for Payer: Cash Price	$3,723.23
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,723.23
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	$3,723.23
Rate for Payer: EmblemHealth Commercial	$3,723.23
Rate for Payer: Fidelis Essential Plan Aliesa	$3,164.75
Rate for Payer: Fidelis Essential Plan QHP	$3,313.67
Rate for Payer: Fidelis Medicare Advantage	$3,723.23
Rate for Payer: Fidelis Qualified Health Plan	$3,313.67
Rate for Payer: Group Health Inc Commercial	$3,723.23
Rate for Payer: Group Health Inc Medicare	$3,723.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$399.38
Rate for Payer: Hamaspik Choice Inc Medicare	$3,723.23
Rate for Payer: Healthfirst Medicare Advantage	$3,164.75
Rate for Payer: Healthfirst QHP	$3,723.23
Rate for Payer: Humana Medicare	$3,797.69
Rate for Payer: Senior Whole Health Medicare Advantage	$3,723.23
Rate for Payer: United Healthcare Medicare Advantage	$3,723.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,723.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,978.58
Rate for Payer: Wellcare Medicare	$3,537.07

BONE REPL.GRAFT-SINGLE SITE(INCL

Facility

$798.77

Service Code	HCPCS D4261
Hospital Charge Code	42300875
Hospital Revenue Code	361
Rate for Payer: Cash Price	$3,723.23

BONE SCREW

Facility

$105.00

Service Code	HCPCS C1713
Hospital Charge Code	40203567
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.38
Rate for Payer: EmblemHealth Commercial	$52.50
Rate for Payer: Fidelis Medicare Advantage	$110.25
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.25

BONE SCREW

Facility

$105.00

Service Code	HCPCS C1713
Hospital Charge Code	40203567
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

BONE SCREW 1.4 X 4MM

Facility

$97.74

Service Code	HCPCS C1713
Hospital Charge Code	40005307
Hospital Revenue Code	278
Min. Negotiated Rate	$48.87
Max. Negotiated Rate	$48.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.87
Rate for Payer: Hamaspik Choice Inc Medicare	$48.87

BONE SCREW 1.4 X 4MM

Facility

$97.74

Service Code	HCPCS C1713
Hospital Charge Code	40005307
Hospital Revenue Code	278
Min. Negotiated Rate	$34.21
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$58.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.20
Rate for Payer: EmblemHealth Commercial	$48.87
Rate for Payer: Fidelis Medicare Advantage	$102.63
Rate for Payer: Group Health Inc Commercial	$48.87
Rate for Payer: Group Health Inc Medicare	$34.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.87
Rate for Payer: Hamaspik Choice Inc Medicare	$48.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.53

BONE SCREW 2.3X22MM

Facility

$232.50

Service Code	HCPCS C1713
Hospital Charge Code	64905155
Hospital Revenue Code	278
Min. Negotiated Rate	$81.38
Max. Negotiated Rate	$244.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$139.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$116.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$133.69
Rate for Payer: EmblemHealth Commercial	$116.25
Rate for Payer: Fidelis Medicare Advantage	$244.12
Rate for Payer: Group Health Inc Commercial	$116.25
Rate for Payer: Group Health Inc Medicare	$81.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.25
Rate for Payer: Hamaspik Choice Inc Medicare	$116.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$151.12

BONE SCREW 2.3X22MM

Facility

$232.50

Service Code	HCPCS C1713
Hospital Charge Code	64905155
Hospital Revenue Code	278
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.25
Rate for Payer: Hamaspik Choice Inc Medicare	$116.25

BONE SCREW 2.7X26MM

Facility

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905162
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$769.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$402.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$439.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$366.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$421.19
Rate for Payer: EmblemHealth Commercial	$366.25
Rate for Payer: Fidelis Medicare Advantage	$769.12
Rate for Payer: Group Health Inc Commercial	$366.25
Rate for Payer: Group Health Inc Medicare	$256.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$476.12

BONE SCREW 2.7X26MM

Facility

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905162
Hospital Revenue Code	278
Min. Negotiated Rate	$366.25
Max. Negotiated Rate	$366.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25

BONE SCREW 2.7X32MM

Facility

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905164
Hospital Revenue Code	278
Min. Negotiated Rate	$366.25
Max. Negotiated Rate	$366.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25

BONE SCREW 2.7X32MM

Facility

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905164
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$769.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$402.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$439.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$366.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$421.19
Rate for Payer: EmblemHealth Commercial	$366.25
Rate for Payer: Fidelis Medicare Advantage	$769.12
Rate for Payer: Group Health Inc Commercial	$366.25
Rate for Payer: Group Health Inc Medicare	$256.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$476.12

BONE SCREW 2.7X34MM

Facility

$737.50

Service Code	HCPCS C1713
Hospital Charge Code	64905166
Hospital Revenue Code	278
Min. Negotiated Rate	$368.75
Max. Negotiated Rate	$368.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.75
Rate for Payer: Hamaspik Choice Inc Medicare	$368.75

BONE SCREW 2.7X34MM

Facility

$737.50

Service Code	HCPCS C1713
Hospital Charge Code	64905166
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$774.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$405.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$442.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$368.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$424.06
Rate for Payer: EmblemHealth Commercial	$368.75
Rate for Payer: Fidelis Medicare Advantage	$774.38
Rate for Payer: Group Health Inc Commercial	$368.75
Rate for Payer: Group Health Inc Medicare	$258.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.75
Rate for Payer: Hamaspik Choice Inc Medicare	$368.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$479.38

Know your out-of-pocket cost for care.

All Charges