St. Barnabas Hospital

All Charges

Charge

Type

Price

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

CMF PLT TIT NEURO ADAP 7 H L/P

Facility IP

$570.00

Service Code	HCPCS C1713
Hospital Charge Code	40205560
Hospital Revenue Code	278
Min. Negotiated Rate	$285.00
Max. Negotiated Rate	$285.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$285.00

CMF PLT TIT NEURO ADAP 7 H L/P

Facility OP

$570.00

Service Code	HCPCS C1713
Hospital Charge Code	40205560
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$598.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$313.50
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	$285.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$327.75
Rate for Payer: Fidelis Medicare Advantage	$598.50
Rate for Payer: Group Health Inc Commercial	$285.00
Rate for Payer: Group Health Inc Medicare	$199.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$285.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$370.50

CMF PLT TIT NEURO ADAPT 4H LWPROF

Facility IP

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40201179
Hospital Revenue Code	278
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$156.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00

CMF PLT TIT NEURO ADAPT 4H LWPROF

Facility OP

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40201179
Hospital Revenue Code	278
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$327.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.60
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	$156.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.40
Rate for Payer: Fidelis Medicare Advantage	$327.60
Rate for Payer: Group Health Inc Commercial	$156.00
Rate for Payer: Group Health Inc Medicare	$109.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$202.80

CMF PLT TIT NEURO STR2H 12MM LPRO

Facility OP

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	40202347
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.00
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	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.00
Rate for Payer: Fidelis Medicare Advantage	$84.00
Rate for Payer: Group Health Inc Commercial	$40.00
Rate for Payer: Group Health Inc Medicare	$28.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.00

CMF PLT TIT NEURO STR2H 12MM LPRO

Facility IP

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	40202347
Hospital Revenue Code	278
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$40.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00

CMF PLT TIT NEURO STRGHT 2H 12MM

Facility OP

$925.00

Service Code	HCPCS C1713
Hospital Charge Code	40209979
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$971.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$508.75
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	$462.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$531.88
Rate for Payer: Fidelis Medicare Advantage	$971.25
Rate for Payer: Group Health Inc Commercial	$462.50
Rate for Payer: Group Health Inc Medicare	$323.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$462.50
Rate for Payer: Hamaspik Choice Inc Medicare	$462.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$601.25

CMF PLT TIT NEURO STRGHT 2H 12MM

Facility IP

$925.00

Service Code	HCPCS C1713
Hospital Charge Code	40209979
Hospital Revenue Code	278
Min. Negotiated Rate	$462.50
Max. Negotiated Rate	$462.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$462.50
Rate for Payer: Hamaspik Choice Inc Medicare	$462.50

CMF PLT TIT NEURO XTYPE 4H LWPROF

Facility IP

$246.00

Service Code	HCPCS C1713
Hospital Charge Code	40202326
Hospital Revenue Code	278
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$123.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.00
Rate for Payer: Hamaspik Choice Inc Medicare	$123.00

CMF PLT TIT NEURO XTYPE 4H LWPROF

Facility OP

$246.00

Service Code	HCPCS C1713
Hospital Charge Code	40202326
Hospital Revenue Code	278
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$258.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$135.30
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	$123.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$141.45
Rate for Payer: Fidelis Medicare Advantage	$258.30
Rate for Payer: Group Health Inc Commercial	$123.00
Rate for Payer: Group Health Inc Medicare	$86.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.00
Rate for Payer: Hamaspik Choice Inc Medicare	$123.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$159.90

CMF PLT TIT NEURO YTYPE 5H LWPROF

Facility OP

$416.00

Service Code	HCPCS C1713
Hospital Charge Code	40202356
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$436.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$228.80
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	$208.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$239.20
Rate for Payer: Fidelis Medicare Advantage	$436.80
Rate for Payer: Group Health Inc Commercial	$208.00
Rate for Payer: Group Health Inc Medicare	$145.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$208.00
Rate for Payer: Hamaspik Choice Inc Medicare	$208.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$270.40

CMF PLT TIT NEURO YTYPE 5H LWPROF

Facility IP

$416.00

Service Code	HCPCS C1713
Hospital Charge Code	40202356
Hospital Revenue Code	278
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$208.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$208.00
Rate for Payer: Hamaspik Choice Inc Medicare	$208.00

CMF PLT TIT N MALLE 100MM DIA M/P

Facility IP

$4,300.00

Service Code	HCPCS C1713
Hospital Charge Code	40205642
Hospital Revenue Code	278
Min. Negotiated Rate	$2,150.00
Max. Negotiated Rate	$2,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,150.00

CMF PLT TIT N MALLE 100MM DIA M/P

Facility OP

$4,300.00

Service Code	HCPCS C1713
Hospital Charge Code	40205642
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,515.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,365.00
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	$2,150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,472.50
Rate for Payer: Fidelis Medicare Advantage	$4,515.00
Rate for Payer: Group Health Inc Commercial	$2,150.00
Rate for Payer: Group Health Inc Medicare	$1,505.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,795.00

CMF PLT YTYPE TIT 1.5MM 5H LWPROF

Facility OP

$318.00

Service Code	HCPCS C1713
Hospital Charge Code	40202355
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$333.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$174.90
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	$159.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.85
Rate for Payer: Fidelis Medicare Advantage	$333.90
Rate for Payer: Group Health Inc Commercial	$159.00
Rate for Payer: Group Health Inc Medicare	$111.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.00
Rate for Payer: Hamaspik Choice Inc Medicare	$159.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$206.70

CMF PLT YTYPE TIT 1.5MM 5H LWPROF

Facility IP

$318.00

Service Code	HCPCS C1713
Hospital Charge Code	40202355
Hospital Revenue Code	278
Min. Negotiated Rate	$159.00
Max. Negotiated Rate	$159.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.00
Rate for Payer: Hamaspik Choice Inc Medicare	$159.00

CMF SCR 1.5MM TIT CRA-SLFDRILL 6M

Facility OP

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	40202350
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$577.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
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	$275.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$316.25
Rate for Payer: Fidelis Medicare Advantage	$577.50
Rate for Payer: Group Health Inc Commercial	$275.00
Rate for Payer: Group Health Inc Medicare	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$357.50

CMF SCR 1.5MM TIT CRA-SLFDRILL 6M

Facility IP

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	40202350
Hospital Revenue Code	278
Min. Negotiated Rate	$275.00
Max. Negotiated Rate	$275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00

CMF SCR 1.5MM TIT CRA-SLFDRLL 5MM

Facility IP

$590.00

Service Code	HCPCS C1713
Hospital Charge Code	40202349
Hospital Revenue Code	278
Min. Negotiated Rate	$295.00
Max. Negotiated Rate	$295.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$295.00

CMF SCR 1.5MM TIT CRA-SLFDRLL 5MM

Facility OP

$590.00

Service Code	HCPCS C1713
Hospital Charge Code	40202349
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$619.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$324.50
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	$295.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$339.25
Rate for Payer: Fidelis Medicare Advantage	$619.50
Rate for Payer: Group Health Inc Commercial	$295.00
Rate for Payer: Group Health Inc Medicare	$206.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$295.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$383.50

CMF SCR TIT NEU EMER SLFTP 3MM LP

Facility OP

$802.00

Service Code	HCPCS C1713
Hospital Charge Code	40202352
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$842.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$441.10
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	$401.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$461.15
Rate for Payer: Fidelis Medicare Advantage	$842.10
Rate for Payer: Group Health Inc Commercial	$401.00
Rate for Payer: Group Health Inc Medicare	$280.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$401.00
Rate for Payer: Hamaspik Choice Inc Medicare	$401.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$521.30

CMF SCR TIT NEU EMER SLFTP 3MM LP

Facility IP

$802.00

Service Code	HCPCS C1713
Hospital Charge Code	40202352
Hospital Revenue Code	278
Min. Negotiated Rate	$401.00
Max. Negotiated Rate	$401.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$401.00
Rate for Payer: Hamaspik Choice Inc Medicare	$401.00

CMF SCR TIT NEU EMER SLFTP 4MM LP

Facility IP

$616.00

Service Code	HCPCS C1713
Hospital Charge Code	40202353
Hospital Revenue Code	278
Min. Negotiated Rate	$308.00
Max. Negotiated Rate	$308.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$308.00
Rate for Payer: Hamaspik Choice Inc Medicare	$308.00

CMF SCR TIT NEU EMER SLFTP 4MM LP

Facility OP

$616.00

Service Code	HCPCS C1713
Hospital Charge Code	40202353
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$646.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$338.80
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	$308.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$354.20
Rate for Payer: Fidelis Medicare Advantage	$646.80
Rate for Payer: Group Health Inc Commercial	$308.00
Rate for Payer: Group Health Inc Medicare	$215.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$308.00
Rate for Payer: Hamaspik Choice Inc Medicare	$308.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$400.40

Price Transparency.

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