St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

1 UNIT BLOOD (1 PINT 500CC)

Facility

$385.25

Service Code	HCPCS P9010
Hospital Charge Code	40701001
Hospital Revenue Code	382
Min. Negotiated Rate	$192.62
Max. Negotiated Rate	$308.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$211.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.51
Rate for Payer: Aetna Government	$246.51
Rate for Payer: Brighton Health Commercial	$246.51
Rate for Payer: Cash Price	$246.51
Rate for Payer: Cash Price	$246.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$308.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$261.97
Rate for Payer: Elderplan Medicare Advantage	$246.51
Rate for Payer: EmblemHealth Commercial	$246.51
Rate for Payer: Fidelis Essential Plan Aliesa	$209.53
Rate for Payer: Fidelis Essential Plan QHP	$219.39
Rate for Payer: Fidelis Medicare Advantage	$246.51
Rate for Payer: Fidelis Qualified Health Plan	$219.39
Rate for Payer: Group Health Inc Commercial	$246.51
Rate for Payer: Group Health Inc Medicare	$246.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.62
Rate for Payer: Hamaspik Choice Inc Medicare	$246.51
Rate for Payer: Healthfirst Medicare Advantage	$209.53
Rate for Payer: Healthfirst QHP	$246.51
Rate for Payer: Senior Whole Health Medicare Advantage	$246.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.21
Rate for Payer: Wellcare Medicare	$221.86

1 UNIT BLOOD (1 PINT 500CC)

Facility

$385.25

Service Code	HCPCS P9010
Hospital Charge Code	40701001
Hospital Revenue Code	382
Rate for Payer: Cash Price	$246.51

1 UNIT FROZEN PLASMA HUMAN 250CC

Facility

$459.10

Service Code	HCPCS 86927
Hospital Charge Code	40701011
Hospital Revenue Code	300
Min. Negotiated Rate	$12.66
Max. Negotiated Rate	$344.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$252.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$197.52
Rate for Payer: Aetna Government	$197.52
Rate for Payer: Brighton Health Commercial	$344.32
Rate for Payer: Cash Price	$197.52
Rate for Payer: Cash Price	$197.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$197.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.66
Rate for Payer: Elderplan Medicare Advantage	$197.52
Rate for Payer: EmblemHealth Commercial	$197.52
Rate for Payer: Fidelis Essential Plan Aliesa	$167.89
Rate for Payer: Fidelis Essential Plan QHP	$175.79
Rate for Payer: Fidelis Medicare Advantage	$197.52
Rate for Payer: Fidelis Qualified Health Plan	$175.79
Rate for Payer: Group Health Inc Commercial	$197.52
Rate for Payer: Group Health Inc Medicare	$197.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.55
Rate for Payer: Hamaspik Choice Inc Medicare	$197.52
Rate for Payer: Healthfirst Medicare Advantage	$197.52
Rate for Payer: Healthfirst QHP	$197.52
Rate for Payer: Senior Whole Health Medicare Advantage	$197.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$158.02
Rate for Payer: Wellcare Medicare	$177.77

1 UNIT FROZEN PLASMA HUMAN 250CC

Facility

$459.10

Service Code	HCPCS 86927
Hospital Charge Code	40701011
Hospital Revenue Code	300
Rate for Payer: Cash Price	$197.52

20% DEXTROSE IN WATER -500CC

Facility

$12.76

Hospital Charge Code	40501251
Hospital Revenue Code	260
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$10.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.38
Rate for Payer: Aetna Government	$6.38
Rate for Payer: Brighton Health Commercial	$9.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.68
Rate for Payer: Group Health Inc Commercial	$6.38
Rate for Payer: Group Health Inc Medicare	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.38
Rate for Payer: Hamaspik Choice Inc Medicare	$6.38

20 HL STRT PLT MDFC MALLEABLE

Facility

$864.00

Service Code	HCPCS C1713
Hospital Charge Code	40209823
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$907.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$475.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$518.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$432.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$496.80
Rate for Payer: EmblemHealth Commercial	$432.00
Rate for Payer: Fidelis Medicare Advantage	$907.20
Rate for Payer: Group Health Inc Commercial	$432.00
Rate for Payer: Group Health Inc Medicare	$302.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$432.00
Rate for Payer: Hamaspik Choice Inc Medicare	$432.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$561.60

20 HL STRT PLT MDFC MALLEABLE

Facility

$864.00

Service Code	HCPCS C1713
Hospital Charge Code	40209823
Hospital Revenue Code	278
Min. Negotiated Rate	$432.00
Max. Negotiated Rate	$432.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$432.00
Rate for Payer: Hamaspik Choice Inc Medicare	$432.00

2.0 K-WIRE

Facility

$189.00

Hospital Charge Code	40202759
Hospital Revenue Code	272
Min. Negotiated Rate	$66.15
Max. Negotiated Rate	$151.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$94.50
Rate for Payer: Aetna Government	$94.50
Rate for Payer: Brighton Health Commercial	$141.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$151.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.52
Rate for Payer: Group Health Inc Commercial	$94.50
Rate for Payer: Group Health Inc Medicare	$66.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.50
Rate for Payer: Hamaspik Choice Inc Medicare	$94.50

2.0 LOCKING FRACTURE PLT 4 HOLE

Facility

$748.00

Service Code	HCPCS C1713
Hospital Charge Code	40209987
Hospital Revenue Code	278
Min. Negotiated Rate	$374.00
Max. Negotiated Rate	$374.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$374.00
Rate for Payer: Hamaspik Choice Inc Medicare	$374.00

2.0 LOCKING FRACTURE PLT 4 HOLE

Facility

$748.00

Service Code	HCPCS C1713
Hospital Charge Code	40209987
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$785.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$411.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$448.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$374.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$430.10
Rate for Payer: EmblemHealth Commercial	$374.00
Rate for Payer: Fidelis Medicare Advantage	$785.40
Rate for Payer: Group Health Inc Commercial	$374.00
Rate for Payer: Group Health Inc Medicare	$261.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$374.00
Rate for Payer: Hamaspik Choice Inc Medicare	$374.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$486.20

20% MANNITOL IN WATER - 500CC

Facility

$48.55

Hospital Charge Code	40501781
Hospital Revenue Code	260
Min. Negotiated Rate	$16.99
Max. Negotiated Rate	$38.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.28
Rate for Payer: Aetna Government	$24.28
Rate for Payer: Brighton Health Commercial	$36.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.01
Rate for Payer: Group Health Inc Commercial	$24.28
Rate for Payer: Group Health Inc Medicare	$16.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.28
Rate for Payer: Hamaspik Choice Inc Medicare	$24.28

2.0 MATRIX 12MM SCREW

Facility

$172.00

Service Code	HCPCS C1713
Hospital Charge Code	40200143
Hospital Revenue Code	278
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$180.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$103.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.90
Rate for Payer: EmblemHealth Commercial	$86.00
Rate for Payer: Fidelis Medicare Advantage	$180.60
Rate for Payer: Group Health Inc Commercial	$86.00
Rate for Payer: Group Health Inc Medicare	$60.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.80

2.0 MATRIX 12MM SCREW

Facility

$172.00

Service Code	HCPCS C1713
Hospital Charge Code	40200143
Hospital Revenue Code	278
Min. Negotiated Rate	$86.00
Max. Negotiated Rate	$86.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00

20MM LOCKING SCREW 212.106

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40202752
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.00
Rate for Payer: Hamaspik Choice Inc Medicare	$135.00

20MM LOCKING SCREW 212.106

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40202752
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$283.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$148.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$162.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$155.25
Rate for Payer: EmblemHealth Commercial	$135.00
Rate for Payer: Fidelis Medicare Advantage	$283.50
Rate for Payer: Group Health Inc Commercial	$135.00
Rate for Payer: Group Health Inc Medicare	$94.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.00
Rate for Payer: Hamaspik Choice Inc Medicare	$135.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$175.50

2.0MM SMOOTH WIRE

Facility

$496.00

Hospital Charge Code	40203553
Hospital Revenue Code	272
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$396.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$272.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$248.00
Rate for Payer: Aetna Government	$248.00
Rate for Payer: Brighton Health Commercial	$372.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$396.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$337.28
Rate for Payer: Group Health Inc Commercial	$248.00
Rate for Payer: Group Health Inc Medicare	$173.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$248.00
Rate for Payer: Hamaspik Choice Inc Medicare	$248.00

2.0X24MM CROSS-LAG SCREW

Facility

$148.00

Service Code	HCPCS C1781
Hospital Charge Code	40209819
Hospital Revenue Code	278
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$74.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.00
Rate for Payer: Hamaspik Choice Inc Medicare	$74.00

2.0X24MM CROSS-LAG SCREW

Facility

$148.00

Service Code	HCPCS C1781
Hospital Charge Code	40209819
Hospital Revenue Code	278
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$155.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$88.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$74.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.10
Rate for Payer: EmblemHealth Commercial	$74.00
Rate for Payer: Fidelis Medicare Advantage	$155.40
Rate for Payer: Group Health Inc Commercial	$74.00
Rate for Payer: Group Health Inc Medicare	$51.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.00
Rate for Payer: Hamaspik Choice Inc Medicare	$74.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.20

2.0X27MM CROSS-LAG SCREW

Facility

$148.00

Service Code	HCPCS C1781
Hospital Charge Code	40209820
Hospital Revenue Code	278
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$155.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$88.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$74.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.10
Rate for Payer: EmblemHealth Commercial	$74.00
Rate for Payer: Fidelis Medicare Advantage	$155.40
Rate for Payer: Group Health Inc Commercial	$74.00
Rate for Payer: Group Health Inc Medicare	$51.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.00
Rate for Payer: Hamaspik Choice Inc Medicare	$74.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.20

2.0X27MM CROSS-LAG SCREW

Facility

$148.00

Service Code	HCPCS C1781
Hospital Charge Code	40209820
Hospital Revenue Code	278
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$74.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.00
Rate for Payer: Hamaspik Choice Inc Medicare	$74.00

2.0X33MM CROSS-LAG SCREW

Facility

$148.00

Service Code	HCPCS C1781
Hospital Charge Code	40209821
Hospital Revenue Code	278
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$74.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.00
Rate for Payer: Hamaspik Choice Inc Medicare	$74.00

2.0X33MM CROSS-LAG SCREW

Facility

$148.00

Service Code	HCPCS C1781
Hospital Charge Code	40209821
Hospital Revenue Code	278
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$155.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$88.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$74.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.10
Rate for Payer: EmblemHealth Commercial	$74.00
Rate for Payer: Fidelis Medicare Advantage	$155.40
Rate for Payer: Group Health Inc Commercial	$74.00
Rate for Payer: Group Health Inc Medicare	$51.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.00
Rate for Payer: Hamaspik Choice Inc Medicare	$74.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.20

2.0X36MM CROSS-LAG SCREW

Facility

$148.00

Service Code	HCPCS C1781
Hospital Charge Code	40209822
Hospital Revenue Code	278
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$74.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.00
Rate for Payer: Hamaspik Choice Inc Medicare	$74.00

2.0X36MM CROSS-LAG SCREW

Facility

$148.00

Service Code	HCPCS C1781
Hospital Charge Code	40209822
Hospital Revenue Code	278
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$155.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$88.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$74.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.10
Rate for Payer: EmblemHealth Commercial	$74.00
Rate for Payer: Fidelis Medicare Advantage	$155.40
Rate for Payer: Group Health Inc Commercial	$74.00
Rate for Payer: Group Health Inc Medicare	$51.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.00
Rate for Payer: Hamaspik Choice Inc Medicare	$74.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.20

210MM FOOT RING

Facility

$1,118.00

Hospital Charge Code	40200592
Hospital Revenue Code	270
Min. Negotiated Rate	$391.30
Max. Negotiated Rate	$894.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$614.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$559.00
Rate for Payer: Aetna Government	$559.00
Rate for Payer: Brighton Health Commercial	$838.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$894.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$760.24
Rate for Payer: Group Health Inc Commercial	$559.00
Rate for Payer: Group Health Inc Medicare	$391.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$559.00
Rate for Payer: Hamaspik Choice Inc Medicare	$559.00

Know your out-of-pocket cost for care.

All Charges