St. Barnabas Hospital

All Charges

Charge

Type

Price

6X6HOLE 3D PLT UPPERFACE

Facility IP

$1,508.00

Service Code	HCPCS C1713
Hospital Charge Code	40201161
Hospital Revenue Code	278
Min. Negotiated Rate	$754.00
Max. Negotiated Rate	$754.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$754.00
Rate for Payer: Hamaspik Choice Inc Medicare	$754.00

6X6 HOLE 3D PLT UPPER FC MALLBI

Facility OP

$1,560.00

Service Code	HCPCS C1713
Hospital Charge Code	40201162
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,638.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$858.00
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	$780.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$897.00
Rate for Payer: Fidelis Medicare Advantage	$1,638.00
Rate for Payer: Group Health Inc Commercial	$780.00
Rate for Payer: Group Health Inc Medicare	$546.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$780.00
Rate for Payer: Hamaspik Choice Inc Medicare	$780.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,014.00

6X6 HOLE 3D PLT UPPER FC MALLBI

Facility IP

$1,560.00

Service Code	HCPCS C1713
Hospital Charge Code	40201162
Hospital Revenue Code	278
Min. Negotiated Rate	$780.00
Max. Negotiated Rate	$780.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$780.00
Rate for Payer: Hamaspik Choice Inc Medicare	$780.00

<6YR NEW ONSET HD ACHE

Facility OP

$0.01

Service Code	HCPCS G2193
Hospital Charge Code	30300321
Hospital Revenue Code	929
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

733334 10 DRUG-SCR

Facility OP

$155.35

Service Code	HCPCS 80361
Hospital Charge Code	40609014
Hospital Revenue Code	300
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$124.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.64
Rate for Payer: Group Health Inc Commercial	$77.68
Rate for Payer: Group Health Inc Medicare	$54.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.68
Rate for Payer: Hamaspik Choice Inc Medicare	$77.68

.75MM 12-LOCH STEINH PLT GEB

Facility IP

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	40209747
Hospital Revenue Code	278
Min. Negotiated Rate	$290.00
Max. Negotiated Rate	$290.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00

.75MM 12-LOCH STEINH PLT GEB

Facility OP

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	40209747
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$609.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$319.00
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	$290.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$333.50
Rate for Payer: Fidelis Medicare Advantage	$609.00
Rate for Payer: Group Health Inc Commercial	$290.00
Rate for Payer: Group Health Inc Medicare	$203.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$377.00

.75MM 30-LOCH STEINH PLT STAND

Facility OP

$1,182.00

Service Code	HCPCS C1713
Hospital Charge Code	40209748
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,241.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$650.10
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	$591.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$679.65
Rate for Payer: Fidelis Medicare Advantage	$1,241.10
Rate for Payer: Group Health Inc Commercial	$591.00
Rate for Payer: Group Health Inc Medicare	$413.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$591.00
Rate for Payer: Hamaspik Choice Inc Medicare	$591.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$768.30

.75MM 30-LOCH STEINH PLT STAND

Facility IP

$1,182.00

Service Code	HCPCS C1713
Hospital Charge Code	40209748
Hospital Revenue Code	278
Min. Negotiated Rate	$591.00
Max. Negotiated Rate	$591.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$591.00
Rate for Payer: Hamaspik Choice Inc Medicare	$591.00

.75MM 8-LOCH STEINH PLT T-FORM

Facility OP

$553.00

Service Code	HCPCS C1713
Hospital Charge Code	40209749
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$580.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$304.15
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	$276.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$317.98
Rate for Payer: Fidelis Medicare Advantage	$580.65
Rate for Payer: Group Health Inc Commercial	$276.50
Rate for Payer: Group Health Inc Medicare	$193.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$276.50
Rate for Payer: Hamaspik Choice Inc Medicare	$276.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$359.45

.75MM 8-LOCH STEINH PLT T-FORM

Facility IP

$553.00

Service Code	HCPCS C1713
Hospital Charge Code	40209749
Hospital Revenue Code	278
Min. Negotiated Rate	$276.50
Max. Negotiated Rate	$276.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$276.50
Rate for Payer: Hamaspik Choice Inc Medicare	$276.50

.75MM 8-LOCH STEINH PLT Y-FORM

Facility OP

$553.00

Service Code	HCPCS C1713
Hospital Charge Code	40209750
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$580.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$304.15
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	$276.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$317.98
Rate for Payer: Fidelis Medicare Advantage	$580.65
Rate for Payer: Group Health Inc Commercial	$276.50
Rate for Payer: Group Health Inc Medicare	$193.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$276.50
Rate for Payer: Hamaspik Choice Inc Medicare	$276.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$359.45

.75MM 8-LOCH STEINH PLT Y-FORM

Facility IP

$553.00

Service Code	HCPCS C1713
Hospital Charge Code	40209750
Hospital Revenue Code	278
Min. Negotiated Rate	$276.50
Max. Negotiated Rate	$276.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$276.50
Rate for Payer: Hamaspik Choice Inc Medicare	$276.50

.75MM 9-LOCH STEINH LPLT LNKS 1

Facility IP

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	40209751
Hospital Revenue Code	278
Min. Negotiated Rate	$290.00
Max. Negotiated Rate	$290.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00

.75MM 9-LOCH STEINH LPLT LNKS 1

Facility OP

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	40209751
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$609.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$319.00
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	$290.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$333.50
Rate for Payer: Fidelis Medicare Advantage	$609.00
Rate for Payer: Group Health Inc Commercial	$290.00
Rate for Payer: Group Health Inc Medicare	$203.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$377.00

.75MM MP PLATE LOCKING L RIGHT

Facility OP

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	40209746
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$609.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$319.00
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	$290.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$333.50
Rate for Payer: Fidelis Medicare Advantage	$609.00
Rate for Payer: Group Health Inc Commercial	$290.00
Rate for Payer: Group Health Inc Medicare	$203.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$377.00

.75MM MP PLATE LOCKING L RIGHT

Facility IP

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	40209746
Hospital Revenue Code	278
Min. Negotiated Rate	$290.00
Max. Negotiated Rate	$290.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00

7-8 REGIONS

Facility OP

$164.83

Service Code	HCPCS 98928
Hospital Charge Code	30305016
Hospital Revenue Code	530
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$131.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$131.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.08
Rate for Payer: Elderplan Medicare Advantage	$30.00
Rate for Payer: EmblemHealth Commercial	$30.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$60.16
Rate for Payer: Fidelis Essential Plan Aliesa	$25.50
Rate for Payer: Fidelis Essential Plan QHP	$26.70
Rate for Payer: Fidelis Medicare Advantage	$30.00
Rate for Payer: Fidelis Qualified Health Plan	$26.70
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.42
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$66.84
Rate for Payer: Healthfirst Medicare Advantage	$25.50
Rate for Payer: Healthfirst QHP	$30.00
Rate for Payer: Senior Whole Health Medicare Advantage	$30.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.00
Rate for Payer: Wellcare Medicare	$28.50

7H DOUBLE Y PLATE UPFC MALLEABLE

Facility IP

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	40200560
Hospital Revenue Code	278
Min. Negotiated Rate	$146.00
Max. Negotiated Rate	$146.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.00
Rate for Payer: Hamaspik Choice Inc Medicare	$146.00

7H DOUBLE Y PLATE UPFC MALLEABLE

Facility OP

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	40200560
Hospital Revenue Code	278
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$306.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$160.60
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	$146.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$167.90
Rate for Payer: Fidelis Medicare Advantage	$306.60
Rate for Payer: Group Health Inc Commercial	$146.00
Rate for Payer: Group Health Inc Medicare	$102.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.00
Rate for Payer: Hamaspik Choice Inc Medicare	$146.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$189.80

7 HOLE DOUBLE Y PLATE UPPERFACE

Facility IP

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	40201164
Hospital Revenue Code	278
Min. Negotiated Rate	$146.00
Max. Negotiated Rate	$146.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.00
Rate for Payer: Hamaspik Choice Inc Medicare	$146.00

7 HOLE DOUBLE Y PLATE UPPERFACE

Facility OP

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	40201164
Hospital Revenue Code	278
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$306.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$160.60
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	$146.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$167.90
Rate for Payer: Fidelis Medicare Advantage	$306.60
Rate for Payer: Group Health Inc Commercial	$146.00
Rate for Payer: Group Health Inc Medicare	$102.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.00
Rate for Payer: Hamaspik Choice Inc Medicare	$146.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$189.80

7HOLE DOUBLE Y PLT UPFC MLBL

Facility IP

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	40201169
Hospital Revenue Code	278
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00

7HOLE DOUBLE Y PLT UPFC MLBL

Facility OP

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	40201169
Hospital Revenue Code	278
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$340.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.20
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	$162.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.30
Rate for Payer: Fidelis Medicare Advantage	$340.20
Rate for Payer: Group Health Inc Commercial	$162.00
Rate for Payer: Group Health Inc Medicare	$113.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$210.60

7HOLE NARROW T-PLATE

Facility OP

$1,796.00

Service Code	HCPCS C1713
Hospital Charge Code	40209947
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,885.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$987.80
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	$898.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,032.70
Rate for Payer: Fidelis Medicare Advantage	$1,885.80
Rate for Payer: Group Health Inc Commercial	$898.00
Rate for Payer: Group Health Inc Medicare	$628.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$898.00
Rate for Payer: Hamaspik Choice Inc Medicare	$898.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,167.40

Price Transparency.

All Charges