St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

6X2H 3D PLATE UPPER FC MALLEABLE

Facility

$676.00

Service Code	HCPCS C1713
Hospital Charge Code	40200556
Hospital Revenue Code	278
Min. Negotiated Rate	$338.00
Max. Negotiated Rate	$338.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$338.00
Rate for Payer: Hamaspik Choice Inc Medicare	$338.00

6X2 HOLE 3D PLTE UPPERFACE

Facility

$636.00

Service Code	HCPCS C1713
Hospital Charge Code	40201154
Hospital Revenue Code	278
Min. Negotiated Rate	$318.00
Max. Negotiated Rate	$318.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.00
Rate for Payer: Hamaspik Choice Inc Medicare	$318.00

6X2 HOLE 3D PLTE UPPERFACE

Facility

$636.00

Service Code	HCPCS C1713
Hospital Charge Code	40201154
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$667.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$349.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$381.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$318.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$365.70
Rate for Payer: EmblemHealth Commercial	$318.00
Rate for Payer: Fidelis Medicare Advantage	$667.80
Rate for Payer: Group Health Inc Commercial	$318.00
Rate for Payer: Group Health Inc Medicare	$222.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.00
Rate for Payer: Hamaspik Choice Inc Medicare	$318.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$413.40

6X2 HOLE 3D PLT UPPERFACE

Facility

$636.00

Service Code	HCPCS C1713
Hospital Charge Code	40201159
Hospital Revenue Code	278
Min. Negotiated Rate	$318.00
Max. Negotiated Rate	$318.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.00
Rate for Payer: Hamaspik Choice Inc Medicare	$318.00

6X2 HOLE 3D PLT UPPERFACE

Facility

$636.00

Service Code	HCPCS C1713
Hospital Charge Code	40201159
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$667.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$349.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$381.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$318.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$365.70
Rate for Payer: EmblemHealth Commercial	$318.00
Rate for Payer: Fidelis Medicare Advantage	$667.80
Rate for Payer: Group Health Inc Commercial	$318.00
Rate for Payer: Group Health Inc Medicare	$222.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.00
Rate for Payer: Hamaspik Choice Inc Medicare	$318.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$413.40

6X2 HOLE 3D PLT UPPER FC MALLBL

Facility

$1,560.00

Service Code	HCPCS C1713
Hospital Charge Code	40201160
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

6X2 HOLE 3D PLT UPPER FC MALLBL

Facility

$1,560.00

Service Code	HCPCS C1713
Hospital Charge Code	40201160
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: Brighton Health Commercial	$936.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$780.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$897.00
Rate for Payer: EmblemHealth Commercial	$780.00
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

6X6H 3D PLATE UPPER FC MALLEABLE

Facility

$676.00

Service Code	HCPCS C1713
Hospital Charge Code	40200557
Hospital Revenue Code	278
Min. Negotiated Rate	$338.00
Max. Negotiated Rate	$338.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$338.00
Rate for Payer: Hamaspik Choice Inc Medicare	$338.00

6X6H 3D PLATE UPPER FC MALLEABLE

Facility

$676.00

Service Code	HCPCS C1713
Hospital Charge Code	40200557
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$709.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$371.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$405.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$338.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$388.70
Rate for Payer: EmblemHealth Commercial	$338.00
Rate for Payer: Fidelis Medicare Advantage	$709.80
Rate for Payer: Group Health Inc Commercial	$338.00
Rate for Payer: Group Health Inc Medicare	$236.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$338.00
Rate for Payer: Hamaspik Choice Inc Medicare	$338.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$439.40

6X6 HOLE 3D PLTE UPPERFACE

Facility

$1,508.00

Service Code	HCPCS C1713
Hospital Charge Code	40201155
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 PLTE UPPERFACE

Facility

$1,508.00

Service Code	HCPCS C1713
Hospital Charge Code	40201155
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,583.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$829.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$904.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$754.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$867.10
Rate for Payer: EmblemHealth Commercial	$754.00
Rate for Payer: Fidelis Medicare Advantage	$1,583.40
Rate for Payer: Group Health Inc Commercial	$754.00
Rate for Payer: Group Health Inc Medicare	$527.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$754.00
Rate for Payer: Hamaspik Choice Inc Medicare	$754.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$980.20

6X6HOLE 3D PLT UPPERFACE

Facility

$1,508.00

Service Code	HCPCS C1713
Hospital Charge Code	40201161
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,583.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$829.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$904.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$754.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$867.10
Rate for Payer: EmblemHealth Commercial	$754.00
Rate for Payer: Fidelis Medicare Advantage	$1,583.40
Rate for Payer: Group Health Inc Commercial	$754.00
Rate for Payer: Group Health Inc Medicare	$527.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$754.00
Rate for Payer: Hamaspik Choice Inc Medicare	$754.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$980.20

6X6HOLE 3D PLT UPPERFACE

Facility

$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

$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: Brighton Health Commercial	$936.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$780.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$897.00
Rate for Payer: EmblemHealth Commercial	$780.00
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

$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

$0.01

Service Code	HCPCS G2193
Hospital Charge Code	30300321
Hospital Revenue Code	929
Max. Negotiated Rate	$94.00
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: Brighton Health Commercial	$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
Rate for Payer: United Healthcare Commercial	$94.00

733334 10 DRUG-SCR

Facility

$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: Brighton Health Commercial	$116.51
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
Rate for Payer: United Healthcare Commercial	$31.48

.75MM 12-LOCH STEINH PLT GEB

Facility

$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

$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: Brighton Health Commercial	$348.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$290.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$333.50
Rate for Payer: EmblemHealth Commercial	$290.00
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

$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: Brighton Health Commercial	$709.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$591.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$679.65
Rate for Payer: EmblemHealth Commercial	$591.00
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

$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

$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: Brighton Health Commercial	$331.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$276.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$317.98
Rate for Payer: EmblemHealth Commercial	$276.50
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

$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

$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 8-LOCH STEINH PLT Y-FORM

Facility

$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: Brighton Health Commercial	$331.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$276.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$317.98
Rate for Payer: EmblemHealth Commercial	$276.50
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

Know your out-of-pocket cost for care.

All Charges