St. Barnabas Hospital

All Charges

Charge

Type

Price

COMPRESSION/DISTRACTION TUBE

Facility OP

$750.00

Hospital Charge Code	40200531
Hospital Revenue Code	270
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$600.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$412.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$375.00
Rate for Payer: Aetna Government	$375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$510.00
Rate for Payer: Group Health Inc Commercial	$375.00
Rate for Payer: Group Health Inc Medicare	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00

COMPRESSION HIP

Facility OP

$911.45

Hospital Charge Code	40202140
Hospital Revenue Code	270
Min. Negotiated Rate	$319.01
Max. Negotiated Rate	$729.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$501.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$455.72
Rate for Payer: Aetna Government	$455.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$729.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$619.79
Rate for Payer: Group Health Inc Commercial	$455.72
Rate for Payer: Group Health Inc Medicare	$319.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$455.72
Rate for Payer: Hamaspik Choice Inc Medicare	$455.72

COMPRESSION PLATE, 6 HOLE

Facility IP

$728.00

Service Code	HCPCS C1713
Hospital Charge Code	40201321
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

COMPRESSION PLATE, 6 HOLE

Facility OP

$728.00

Service Code	HCPCS C1713
Hospital Charge Code	40201321
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: Cigna HMO/Network Benefit Plan/Open Access	$364.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$418.60
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

COMPRESSION PLATE, 8-HOLE

Facility IP

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	40203578
Hospital Revenue Code	278
Min. Negotiated Rate	$125.50
Max. Negotiated Rate	$125.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.50
Rate for Payer: Hamaspik Choice Inc Medicare	$125.50

COMPRESSION PLATE, 8-HOLE

Facility OP

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	40203578
Hospital Revenue Code	278
Min. Negotiated Rate	$87.85
Max. Negotiated Rate	$263.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.05
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	$125.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.32
Rate for Payer: Fidelis Medicare Advantage	$263.55
Rate for Payer: Group Health Inc Commercial	$125.50
Rate for Payer: Group Health Inc Medicare	$87.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.50
Rate for Payer: Hamaspik Choice Inc Medicare	$125.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.15

COMPRESSION PLATE, 9-HOLE

Facility OP

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	40203577
Hospital Revenue Code	278
Min. Negotiated Rate	$87.85
Max. Negotiated Rate	$263.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.05
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	$125.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.32
Rate for Payer: Fidelis Medicare Advantage	$263.55
Rate for Payer: Group Health Inc Commercial	$125.50
Rate for Payer: Group Health Inc Medicare	$87.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.50
Rate for Payer: Hamaspik Choice Inc Medicare	$125.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.15

COMPRESSION PLATE, 9-HOLE

Facility IP

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	40203577
Hospital Revenue Code	278
Min. Negotiated Rate	$125.50
Max. Negotiated Rate	$125.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.50
Rate for Payer: Hamaspik Choice Inc Medicare	$125.50

COMPRESSION PLT, 4 HOLES

Facility OP

$500.00

Service Code	HCPCS C1781
Hospital Charge Code	40209730
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

COMPRESSION PLT, 4 HOLES

Facility IP

$500.00

Service Code	HCPCS C1781
Hospital Charge Code	40209730
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

COMPRESSION PLT, 6 HOLES

Facility OP

$728.00

Service Code	HCPCS C1781
Hospital Charge Code	40209731
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$764.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$400.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$364.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$418.60
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

COMPRESSION PLT, 6 HOLES

Facility IP

$728.00

Service Code	HCPCS C1781
Hospital Charge Code	40209731
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

COMPRESSION WHEEL

Facility IP

$592.00

Service Code	HCPCS C1713
Hospital Charge Code	40006136
Hospital Revenue Code	278
Min. Negotiated Rate	$296.00
Max. Negotiated Rate	$296.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$296.00
Rate for Payer: Hamaspik Choice Inc Medicare	$296.00

COMPRESSION WHEEL

Facility OP

$592.00

Service Code	HCPCS C1713
Hospital Charge Code	40006136
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$621.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$325.60
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	$296.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.40
Rate for Payer: Fidelis Medicare Advantage	$621.60
Rate for Payer: Group Health Inc Commercial	$296.00
Rate for Payer: Group Health Inc Medicare	$207.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$296.00
Rate for Payer: Hamaspik Choice Inc Medicare	$296.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$384.80

COMPRESSION WHEEL CAPTURED

Facility IP

$2,016.00

Service Code	HCPCS C1713
Hospital Charge Code	40006141
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,008.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,008.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,008.00

COMPRESSION WHEEL CAPTURED

Facility OP

$2,016.00

Service Code	HCPCS C1713
Hospital Charge Code	40006141
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,116.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,108.80
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	$1,008.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,159.20
Rate for Payer: Fidelis Medicare Advantage	$2,116.80
Rate for Payer: Group Health Inc Commercial	$1,008.00
Rate for Payer: Group Health Inc Medicare	$705.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,008.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,008.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,310.40

COMPRESS LER LEG BIL

Facility OP

$405.08

Service Code	HCPCS 29581 50
Hospital Charge Code	42500170
Hospital Revenue Code	761
Min. Negotiated Rate	$202.54
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$222.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$202.54
Rate for Payer: Aetna Government	$202.54
Rate for Payer: Cash Price	$182.22
Rate for Payer: Cash Price	$182.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$202.54
Rate for Payer: Hamaspik Choice Inc Medicare	$202.54

COMPR MED SERVC/15 MIN

Facility OP

$250.63

Service Code	HCPCS H2010
Hospital Charge Code	30303120
Hospital Revenue Code	911
Min. Negotiated Rate	$37.85
Max. Negotiated Rate	$8,705.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.85
Rate for Payer: Aetna Government	$37.85
Rate for Payer: Amida Care Medicaid	$87.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$8,705.00
Rate for Payer: Fidelis Essential Plan Aliesa	$87.05
Rate for Payer: Fidelis Essential Plan QHP	$87.05
Rate for Payer: Fidelis Qualified Health Plan	$91.40
Rate for Payer: Group Health Inc Commercial	$125.32
Rate for Payer: Group Health Inc Medicare	$87.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.05
Rate for Payer: Hamaspik Choice Inc Medicare	$125.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$87.05
Rate for Payer: Healthfirst Essential Plan	$195.86
Rate for Payer: Healthfirst QHP	$87.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$87.05
Rate for Payer: SOMOS Essential	$195.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$87.05

COMPR MED SERVC/15 MIN

Facility OP

$250.36

Service Code	HCPCS H2010
Hospital Charge Code	30400079
Hospital Revenue Code	905
Min. Negotiated Rate	$37.85
Max. Negotiated Rate	$8,705.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.85
Rate for Payer: Aetna Government	$37.85
Rate for Payer: Amida Care Medicaid	$87.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$8,705.00
Rate for Payer: Fidelis Essential Plan Aliesa	$87.05
Rate for Payer: Fidelis Essential Plan QHP	$87.05
Rate for Payer: Fidelis Qualified Health Plan	$91.40
Rate for Payer: Group Health Inc Commercial	$125.18
Rate for Payer: Group Health Inc Medicare	$87.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.05
Rate for Payer: Hamaspik Choice Inc Medicare	$125.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$87.05
Rate for Payer: Healthfirst Essential Plan	$195.86
Rate for Payer: Healthfirst QHP	$87.05
Rate for Payer: Optum Commercial/Medicare	$143.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$87.05
Rate for Payer: SOMOS Essential	$195.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$87.05

COMP STD PATEL 28X8.0MM

Facility OP

$1,412.00

Service Code	HCPCS C1776
Hospital Charge Code	40204055
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,482.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$776.60
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	$706.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$811.90
Rate for Payer: Fidelis Medicare Advantage	$1,482.60
Rate for Payer: Group Health Inc Commercial	$706.00
Rate for Payer: Group Health Inc Medicare	$494.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$706.00
Rate for Payer: Hamaspik Choice Inc Medicare	$706.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$917.80

COMP STD PATEL 28X8.0MM

Facility IP

$1,412.00

Service Code	HCPCS C1776
Hospital Charge Code	40204055
Hospital Revenue Code	278
Min. Negotiated Rate	$706.00
Max. Negotiated Rate	$706.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$706.00
Rate for Payer: Hamaspik Choice Inc Medicare	$706.00

COMP TIB COMPLETE KNEE SZ 6

Facility IP

$4,550.90

Service Code	HCPCS C1776
Hospital Charge Code	40205065
Hospital Revenue Code	278
Min. Negotiated Rate	$2,275.45
Max. Negotiated Rate	$2,275.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,275.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2,275.45

COMP TIB COMPLETE KNEE SZ 6

Facility OP

$4,550.90

Service Code	HCPCS C1776
Hospital Charge Code	40205065
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,778.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,503.00
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	$2,275.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,616.77
Rate for Payer: Fidelis Medicare Advantage	$4,778.44
Rate for Payer: Group Health Inc Commercial	$2,275.45
Rate for Payer: Group Health Inc Medicare	$1,592.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,275.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2,275.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,958.08

COMP TIB CRU RET LT/RT 66MM

Facility OP

$5,391.13

Service Code	HCPCS C1713
Hospital Charge Code	64901473
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,660.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,965.12
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	$2,695.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,099.90
Rate for Payer: Fidelis Medicare Advantage	$5,660.69
Rate for Payer: Group Health Inc Commercial	$2,695.56
Rate for Payer: Group Health Inc Medicare	$1,886.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,695.56
Rate for Payer: Hamaspik Choice Inc Medicare	$2,695.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,504.23

COMP TIB CRU RET LT/RT 66MM

Facility IP

$5,391.13

Service Code	HCPCS C1713
Hospital Charge Code	64901473
Hospital Revenue Code	278
Min. Negotiated Rate	$2,695.56
Max. Negotiated Rate	$2,695.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,695.56
Rate for Payer: Hamaspik Choice Inc Medicare	$2,695.56

Price Transparency.

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