St. Barnabas Hospital

All Charges

Charge

Type

Price

CMF PLT 1.5MM TIT CRAN BX 4H

Facility OP

$458.00

Service Code	HCPCS C1713
Hospital Charge Code	40200138
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$480.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$251.90
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	$229.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$263.35
Rate for Payer: Fidelis Medicare Advantage	$480.90
Rate for Payer: Group Health Inc Commercial	$229.00
Rate for Payer: Group Health Inc Medicare	$160.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.00
Rate for Payer: Hamaspik Choice Inc Medicare	$229.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$297.70

CMF PLT 1.5MM TIT CRAN BX 4H

Facility IP

$458.00

Service Code	HCPCS C1713
Hospital Charge Code	40200138
Hospital Revenue Code	278
Min. Negotiated Rate	$229.00
Max. Negotiated Rate	$229.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.00
Rate for Payer: Hamaspik Choice Inc Medicare	$229.00

CMF PLT1.5MM TIT CRANIAL ADAPT20H

Facility OP

$204.00

Service Code	HCPCS C1713
Hospital Charge Code	40209417
Hospital Revenue Code	278
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$214.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$112.20
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	$102.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$117.30
Rate for Payer: Fidelis Medicare Advantage	$214.20
Rate for Payer: Group Health Inc Commercial	$102.00
Rate for Payer: Group Health Inc Medicare	$71.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.00
Rate for Payer: Hamaspik Choice Inc Medicare	$102.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$132.60

CMF PLT1.5MM TIT CRANIAL ADAPT20H

Facility IP

$204.00

Service Code	HCPCS C1713
Hospital Charge Code	40209417
Hospital Revenue Code	278
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$102.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.00
Rate for Payer: Hamaspik Choice Inc Medicare	$102.00

CMF PLT 1.5MM TIT CRANIAL BX 4H

Facility OP

$458.00

Service Code	HCPCS C1713
Hospital Charge Code	40209988
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$480.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$251.90
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	$229.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$263.35
Rate for Payer: Fidelis Medicare Advantage	$480.90
Rate for Payer: Group Health Inc Commercial	$229.00
Rate for Payer: Group Health Inc Medicare	$160.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.00
Rate for Payer: Hamaspik Choice Inc Medicare	$229.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$297.70

CMF PLT 1.5MM TIT CRANIAL BX 4H

Facility IP

$458.00

Service Code	HCPCS C1713
Hospital Charge Code	40209988
Hospital Revenue Code	278
Min. Negotiated Rate	$229.00
Max. Negotiated Rate	$229.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.00
Rate for Payer: Hamaspik Choice Inc Medicare	$229.00

CMF PLT 1.5MM TIT CRANIALSTRGHT2H

Facility OP

$66.00

Service Code	HCPCS C1713
Hospital Charge Code	40209450
Hospital Revenue Code	278
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.30
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	$33.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.95
Rate for Payer: Fidelis Medicare Advantage	$69.30
Rate for Payer: Group Health Inc Commercial	$33.00
Rate for Payer: Group Health Inc Medicare	$23.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.00
Rate for Payer: Hamaspik Choice Inc Medicare	$33.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.90

CMF PLT 1.5MM TIT CRANIALSTRGHT2H

Facility IP

$66.00

Service Code	HCPCS C1713
Hospital Charge Code	40209450
Hospital Revenue Code	278
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$33.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.00
Rate for Payer: Hamaspik Choice Inc Medicare	$33.00

CMF PLT 1.5MM TIT CRANIALSTRGHT4H

Facility OP

$106.00

Service Code	HCPCS C1713
Hospital Charge Code	40209355
Hospital Revenue Code	278
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.30
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	$53.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.95
Rate for Payer: Fidelis Medicare Advantage	$111.30
Rate for Payer: Group Health Inc Commercial	$53.00
Rate for Payer: Group Health Inc Medicare	$37.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.00
Rate for Payer: Hamaspik Choice Inc Medicare	$53.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.90

CMF PLT 1.5MM TIT CRANIALSTRGHT4H

Facility IP

$106.00

Service Code	HCPCS C1713
Hospital Charge Code	40209355
Hospital Revenue Code	278
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$53.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.00
Rate for Payer: Hamaspik Choice Inc Medicare	$53.00

CMF PLT 1.5MM TIT CRANIALXTP 4H

Facility OP

$458.00

Service Code	HCPCS C1713
Hospital Charge Code	40209989
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$480.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$251.90
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	$229.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$263.35
Rate for Payer: Fidelis Medicare Advantage	$480.90
Rate for Payer: Group Health Inc Commercial	$229.00
Rate for Payer: Group Health Inc Medicare	$160.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.00
Rate for Payer: Hamaspik Choice Inc Medicare	$229.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$297.70

CMF PLT 1.5MM TIT CRANIALXTP 4H

Facility IP

$458.00

Service Code	HCPCS C1713
Hospital Charge Code	40209989
Hospital Revenue Code	278
Min. Negotiated Rate	$229.00
Max. Negotiated Rate	$229.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.00
Rate for Payer: Hamaspik Choice Inc Medicare	$229.00

CMF PLT1.5MM TIT CRA RGD MSH38X45

Facility IP

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	40202338
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00

CMF PLT1.5MM TIT CRA RGD MSH38X45

Facility OP

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	40202338
Hospital Revenue Code	278
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$352.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.80
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	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$193.20
Rate for Payer: Fidelis Medicare Advantage	$352.80
Rate for Payer: Group Health Inc Commercial	$168.00
Rate for Payer: Group Health Inc Medicare	$117.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$218.40

CMF PLT 1.5MM TIT XTYPE 4H LWPROF

Facility OP

$302.00

Service Code	HCPCS C1713
Hospital Charge Code	40202354
Hospital Revenue Code	278
Min. Negotiated Rate	$105.70
Max. Negotiated Rate	$317.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$166.10
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	$151.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.65
Rate for Payer: Fidelis Medicare Advantage	$317.10
Rate for Payer: Group Health Inc Commercial	$151.00
Rate for Payer: Group Health Inc Medicare	$105.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00
Rate for Payer: Hamaspik Choice Inc Medicare	$151.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$196.30

CMF PLT 1.5MM TIT XTYPE 4H LWPROF

Facility IP

$302.00

Service Code	HCPCS C1713
Hospital Charge Code	40202354
Hospital Revenue Code	278
Min. Negotiated Rate	$151.00
Max. Negotiated Rate	$151.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00
Rate for Payer: Hamaspik Choice Inc Medicare	$151.00

CMF PLT 2.0MMX4MM CORTEX ST SCRW

Facility OP

$120.00

Service Code	HCPCS C1776
Hospital Charge Code	40205165
Hospital Revenue Code	278
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: Fidelis Medicare Advantage	$126.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

CMF PLT 2.0MMX4MM CORTEX ST SCRW

Facility IP

$120.00

Service Code	HCPCS C1776
Hospital Charge Code	40205165
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

CMF PLT CRAN STR 4 HOLES

Facility IP

$195.00

Service Code	HCPCS C1713
Hospital Charge Code	40202325
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.50
Rate for Payer: Hamaspik Choice Inc Medicare	$97.50

CMF PLT CRAN STR 4 HOLES

Facility OP

$195.00

Service Code	HCPCS C1713
Hospital Charge Code	40202325
Hospital Revenue Code	278
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$204.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$107.25
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	$97.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.12
Rate for Payer: Fidelis Medicare Advantage	$204.75
Rate for Payer: Group Health Inc Commercial	$97.50
Rate for Payer: Group Health Inc Medicare	$68.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.50
Rate for Payer: Hamaspik Choice Inc Medicare	$97.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$126.75

CMF PLT NEURO STR 4H LOW PROF

Facility IP

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	40202348
Hospital Revenue Code	278
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$52.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00

CMF PLT NEURO STR 4H LOW PROF

Facility OP

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	40202348
Hospital Revenue Code	278
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.20
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	$52.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.80
Rate for Payer: Fidelis Medicare Advantage	$109.20
Rate for Payer: Group Health Inc Commercial	$52.00
Rate for Payer: Group Health Inc Medicare	$36.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$67.60

CMF PLT TIT CRAN STR 2 HOLE

Facility IP

$720.00

Service Code	HCPCS C1713
Hospital Charge Code	40202324
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$360.00
Rate for Payer: Hamaspik Choice Inc Medicare	$360.00

CMF PLT TIT CRAN STR 2 HOLE

Facility OP

$720.00

Service Code	HCPCS C1713
Hospital Charge Code	40202324
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$756.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$396.00
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	$360.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$414.00
Rate for Payer: Fidelis Medicare Advantage	$756.00
Rate for Payer: Group Health Inc Commercial	$360.00
Rate for Payer: Group Health Inc Medicare	$252.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$360.00
Rate for Payer: Hamaspik Choice Inc Medicare	$360.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$468.00

CMF PLT TIT DBL Y-PLT 6H 18MM L/P

Facility OP

$346.00

Service Code	HCPCS C1713
Hospital Charge Code	40205559
Hospital Revenue Code	278
Min. Negotiated Rate	$121.10
Max. Negotiated Rate	$363.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$190.30
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	$173.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$198.95
Rate for Payer: Fidelis Medicare Advantage	$363.30
Rate for Payer: Group Health Inc Commercial	$173.00
Rate for Payer: Group Health Inc Medicare	$121.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.00
Rate for Payer: Hamaspik Choice Inc Medicare	$173.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.90

Price Transparency.

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