St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

5 PRONGED MANIFOLD

Facility

$6.03

Hospital Charge Code	42905235
Hospital Revenue Code	801
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$4.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.02
Rate for Payer: Aetna Government	$3.02
Rate for Payer: Brighton Health Commercial	$4.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.10
Rate for Payer: Group Health Inc Commercial	$3.02
Rate for Payer: Group Health Inc Medicare	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.02
Rate for Payer: Hamaspik Choice Inc Medicare	$3.02

5% SODIUM BICARBONATE 500CC

Facility

$23.04

Hospital Charge Code	40504981
Hospital Revenue Code	260
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.52
Rate for Payer: Aetna Government	$11.52
Rate for Payer: Brighton Health Commercial	$17.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.67
Rate for Payer: Group Health Inc Commercial	$11.52
Rate for Payer: Group Health Inc Medicare	$8.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.52
Rate for Payer: Hamaspik Choice Inc Medicare	$11.52
Rate for Payer: United Healthcare Commercial	$76.00

5X115MM FULLY THREADED

Facility

$266.00

Service Code	HCPCS C1713
Hospital Charge Code	40200550
Hospital Revenue Code	278
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$279.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$159.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$152.95
Rate for Payer: EmblemHealth Commercial	$133.00
Rate for Payer: Fidelis Medicare Advantage	$279.30
Rate for Payer: Group Health Inc Commercial	$133.00
Rate for Payer: Group Health Inc Medicare	$93.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.00
Rate for Payer: Hamaspik Choice Inc Medicare	$133.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$172.90

5X115MM FULLY THREADED

Facility

$266.00

Service Code	HCPCS C1713
Hospital Charge Code	40200550
Hospital Revenue Code	278
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$133.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.00
Rate for Payer: Hamaspik Choice Inc Medicare	$133.00

5X120X35MM SLFDRILLING/SLFTAPPING

Facility

$225.40

Service Code	HCPCS C1713
Hospital Charge Code	40200551
Hospital Revenue Code	278
Min. Negotiated Rate	$78.89
Max. Negotiated Rate	$236.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$135.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$129.60
Rate for Payer: EmblemHealth Commercial	$112.70
Rate for Payer: Fidelis Medicare Advantage	$236.67
Rate for Payer: Group Health Inc Commercial	$112.70
Rate for Payer: Group Health Inc Medicare	$78.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.70
Rate for Payer: Hamaspik Choice Inc Medicare	$112.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$146.51

5X120X35MM SLFDRILLING/SLFTAPPING

Facility

$225.40

Service Code	HCPCS C1713
Hospital Charge Code	40200551
Hospital Revenue Code	278
Min. Negotiated Rate	$112.70
Max. Negotiated Rate	$112.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.70
Rate for Payer: Hamaspik Choice Inc Medicare	$112.70

60MM PARTIAL THREAD

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40200558
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$180.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: EmblemHealth Commercial	$150.00
Rate for Payer: Fidelis Medicare Advantage	$315.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$195.00

60MM PARTIAL THREAD

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40200558
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

6% DEXTRAN-75NS 500CC

Facility

$48.55

Hospital Charge Code	40509601
Hospital Revenue Code	260
Min. Negotiated Rate	$16.99
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.28
Rate for Payer: Aetna Government	$24.28
Rate for Payer: Brighton Health Commercial	$36.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.01
Rate for Payer: Group Health Inc Commercial	$24.28
Rate for Payer: Group Health Inc Medicare	$16.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.28
Rate for Payer: Hamaspik Choice Inc Medicare	$24.28
Rate for Payer: United Healthcare Commercial	$76.00

6F GLIDESHEATH

Facility

$213.00

Hospital Charge Code	66526891
Hospital Revenue Code	270
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$170.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$117.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$106.50
Rate for Payer: Aetna Government	$106.50
Rate for Payer: Brighton Health Commercial	$159.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$170.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.84
Rate for Payer: Group Health Inc Commercial	$106.50
Rate for Payer: Group Health Inc Medicare	$74.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.50
Rate for Payer: Hamaspik Choice Inc Medicare	$106.50

6H 2.3MM COMPRESSION PLATE

Facility

$728.00

Service Code	HCPCS C1713
Hospital Charge Code	40202259
Hospital Revenue Code	278
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$364.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$364.00
Rate for Payer: Hamaspik Choice Inc Medicare	$364.00

6H 2.3MM COMPRESSION PLATE

Facility

$728.00

Service Code	HCPCS C1713
Hospital Charge Code	40202259
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$764.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$400.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$436.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$364.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$418.60
Rate for Payer: EmblemHealth Commercial	$364.00
Rate for Payer: Fidelis Medicare Advantage	$764.40
Rate for Payer: Group Health Inc Commercial	$364.00
Rate for Payer: Group Health Inc Medicare	$254.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$364.00
Rate for Payer: Hamaspik Choice Inc Medicare	$364.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$473.20

6H DBL Y-BONE PLT NO BAR

Facility

$472.00

Service Code	HCPCS C1713
Hospital Charge Code	40202261
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$495.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$259.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$283.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$236.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$271.40
Rate for Payer: EmblemHealth Commercial	$236.00
Rate for Payer: Fidelis Medicare Advantage	$495.60
Rate for Payer: Group Health Inc Commercial	$236.00
Rate for Payer: Group Health Inc Medicare	$165.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.00
Rate for Payer: Hamaspik Choice Inc Medicare	$236.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$306.80

6H DBL Y-BONE PLT NO BAR

Facility

$472.00

Service Code	HCPCS C1713
Hospital Charge Code	40202261
Hospital Revenue Code	278
Min. Negotiated Rate	$236.00
Max. Negotiated Rate	$236.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.00
Rate for Payer: Hamaspik Choice Inc Medicare	$236.00

6H L PLATE, 12MM ADV MDFC LOC

Facility

$406.00

Service Code	HCPCS C1713
Hospital Charge Code	40202274
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$426.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$223.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$243.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$203.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$233.45
Rate for Payer: EmblemHealth Commercial	$203.00
Rate for Payer: Fidelis Medicare Advantage	$426.30
Rate for Payer: Group Health Inc Commercial	$203.00
Rate for Payer: Group Health Inc Medicare	$142.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$263.90

6H L PLATE, 12MM ADV MDFC LOC

Facility

$406.00

Service Code	HCPCS C1713
Hospital Charge Code	40202274
Hospital Revenue Code	278
Min. Negotiated Rate	$203.00
Max. Negotiated Rate	$203.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00

6H L PLATE12MM ADVMT 100D LFT,STD

Facility

$126.36

Service Code	HCPCS C1713
Hospital Charge Code	40202265
Hospital Revenue Code	278
Min. Negotiated Rate	$44.23
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$75.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.66
Rate for Payer: EmblemHealth Commercial	$63.18
Rate for Payer: Fidelis Medicare Advantage	$132.68
Rate for Payer: Group Health Inc Commercial	$63.18
Rate for Payer: Group Health Inc Medicare	$44.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.18
Rate for Payer: Hamaspik Choice Inc Medicare	$63.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$82.13

6H L PLATE12MM ADVMT 100D LFT,STD

Facility

$126.36

Service Code	HCPCS C1713
Hospital Charge Code	40202265
Hospital Revenue Code	278
Min. Negotiated Rate	$63.18
Max. Negotiated Rate	$63.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.18
Rate for Payer: Hamaspik Choice Inc Medicare	$63.18

6H L PLATE, 8MM ADV MDFC LOC

Facility

$396.00

Service Code	HCPCS C1713
Hospital Charge Code	40202275
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: Brighton Health Commercial	$237.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$198.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$227.70
Rate for Payer: EmblemHealth Commercial	$198.00
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

6H L PLATE, 8MM ADV MDFC LOC

Facility

$396.00

Service Code	HCPCS C1713
Hospital Charge Code	40202275
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

6H L PT 12MM ADVC 100D LT STD

Facility

$364.00

Service Code	HCPCS C1713
Hospital Charge Code	40202276
Hospital Revenue Code	278
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$182.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.00
Rate for Payer: Hamaspik Choice Inc Medicare	$182.00

6H L PT 12MM ADVC 100D LT STD

Facility

$364.00

Service Code	HCPCS C1713
Hospital Charge Code	40202276
Hospital Revenue Code	278
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$382.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$200.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$218.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$182.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$209.30
Rate for Payer: EmblemHealth Commercial	$182.00
Rate for Payer: Fidelis Medicare Advantage	$382.20
Rate for Payer: Group Health Inc Commercial	$182.00
Rate for Payer: Group Health Inc Medicare	$127.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.00
Rate for Payer: Hamaspik Choice Inc Medicare	$182.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$236.60

6H L PT 12MM ADVC 100D RT STD

Facility

$364.00

Service Code	HCPCS C1713
Hospital Charge Code	40202277
Hospital Revenue Code	278
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$382.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$200.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$218.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$182.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$209.30
Rate for Payer: EmblemHealth Commercial	$182.00
Rate for Payer: Fidelis Medicare Advantage	$382.20
Rate for Payer: Group Health Inc Commercial	$182.00
Rate for Payer: Group Health Inc Medicare	$127.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.00
Rate for Payer: Hamaspik Choice Inc Medicare	$182.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$236.60

6H L PT 12MM ADVC 100D RT STD

Facility

$364.00

Service Code	HCPCS C1713
Hospital Charge Code	40202277
Hospital Revenue Code	278
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$182.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.00
Rate for Payer: Hamaspik Choice Inc Medicare	$182.00

6H L PT 8MM ADVC 100D LT STD

Facility

$346.00

Service Code	HCPCS C1713
Hospital Charge Code	40202278
Hospital Revenue Code	278
Min. Negotiated Rate	$173.00
Max. Negotiated Rate	$173.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.00
Rate for Payer: Hamaspik Choice Inc Medicare	$173.00

Know your out-of-pocket cost for care.

All Charges