St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

210 OPEN RING

Facility

$906.00

Hospital Charge Code	40200591
Hospital Revenue Code	270
Min. Negotiated Rate	$317.10
Max. Negotiated Rate	$724.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$498.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$453.00
Rate for Payer: Aetna Government	$453.00
Rate for Payer: Brighton Health Commercial	$679.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$724.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$616.08
Rate for Payer: Group Health Inc Commercial	$453.00
Rate for Payer: Group Health Inc Medicare	$317.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$453.00
Rate for Payer: Hamaspik Choice Inc Medicare	$453.00

2 1/2 DEXTROSE IN WATR-1000CC

Facility

$10.28

Hospital Charge Code	40501000
Hospital Revenue Code	260
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.14
Rate for Payer: Aetna Government	$5.14
Rate for Payer: Brighton Health Commercial	$7.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.99
Rate for Payer: Group Health Inc Commercial	$5.14
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14
Rate for Payer: Hamaspik Choice Inc Medicare	$5.14

2.2MMDRILLBIT JLATCH10MMSTOP135MM

Facility

$300.00

Hospital Charge Code	40209521
Hospital Revenue Code	270
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$150.00
Rate for Payer: Aetna Government	$150.00
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

2.2MMDRILLBIT JLATCH12MMSTOP135MM

Facility

$300.00

Hospital Charge Code	40209522
Hospital Revenue Code	270
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$150.00
Rate for Payer: Aetna Government	$150.00
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

2.2MMDRILLBIT JLATCH14MMSTOP135MM

Facility

$300.00

Hospital Charge Code	40209523
Hospital Revenue Code	270
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$150.00
Rate for Payer: Aetna Government	$150.00
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

2.2MM DRILLBIT JLATCH6MMSTOP135MM

Facility

$300.00

Hospital Charge Code	40209519
Hospital Revenue Code	270
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$150.00
Rate for Payer: Aetna Government	$150.00
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

2.2MM DRILLBIT JLATCH8MMSTOP135MM

Facility

$300.00

Hospital Charge Code	40209520
Hospital Revenue Code	270
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$150.00
Rate for Payer: Aetna Government	$150.00
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

2.2MM THREADEDDRILL GUIDE LCKNGPL

Facility

$700.00

Hospital Charge Code	40209518
Hospital Revenue Code	270
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$560.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$350.00
Rate for Payer: Aetna Government	$350.00
Rate for Payer: Brighton Health Commercial	$525.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$560.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$476.00
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

23.5X3.1 PIPELLE ENDO SUC CURETTE

Facility

$11.00

Hospital Charge Code	40205480
Hospital Revenue Code	270
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50

24H STRAIGHT PLT MIDFACE

Facility

$796.00

Service Code	HCPCS C1713
Hospital Charge Code	40209829
Hospital Revenue Code	278
Min. Negotiated Rate	$398.00
Max. Negotiated Rate	$398.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$398.00
Rate for Payer: Hamaspik Choice Inc Medicare	$398.00

24H STRAIGHT PLT MIDFACE

Facility

$796.00

Service Code	HCPCS C1713
Hospital Charge Code	40209829
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$835.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$437.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$477.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$398.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$457.70
Rate for Payer: EmblemHealth Commercial	$398.00
Rate for Payer: Fidelis Medicare Advantage	$835.80
Rate for Payer: Group Health Inc Commercial	$398.00
Rate for Payer: Group Health Inc Medicare	$278.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$398.00
Rate for Payer: Hamaspik Choice Inc Medicare	$398.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$517.40

24H STRAIGHT PLT UPPERFACE

Facility

$756.00

Service Code	HCPCS C1713
Hospital Charge Code	40209826
Hospital Revenue Code	278
Min. Negotiated Rate	$378.00
Max. Negotiated Rate	$378.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$378.00
Rate for Payer: Hamaspik Choice Inc Medicare	$378.00

24H STRAIGHT PLT UPPERFACE

Facility

$756.00

Service Code	HCPCS C1713
Hospital Charge Code	40209826
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$793.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$415.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$453.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$378.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$434.70
Rate for Payer: EmblemHealth Commercial	$378.00
Rate for Payer: Fidelis Medicare Advantage	$793.80
Rate for Payer: Group Health Inc Commercial	$378.00
Rate for Payer: Group Health Inc Medicare	$264.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$378.00
Rate for Payer: Hamaspik Choice Inc Medicare	$378.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$491.40

24H STRT PLATE UP MALL CNDSD

Facility

$874.00

Service Code	HCPCS C1713
Hospital Charge Code	40200593
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$917.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$480.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$524.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$437.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$502.55
Rate for Payer: EmblemHealth Commercial	$437.00
Rate for Payer: Fidelis Medicare Advantage	$917.70
Rate for Payer: Group Health Inc Commercial	$437.00
Rate for Payer: Group Health Inc Medicare	$305.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.00
Rate for Payer: Hamaspik Choice Inc Medicare	$437.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$568.10

24H STRT PLATE UP MALL CNDSD

Facility

$874.00

Service Code	HCPCS C1713
Hospital Charge Code	40200593
Hospital Revenue Code	278
Min. Negotiated Rate	$437.00
Max. Negotiated Rate	$437.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.00
Rate for Payer: Hamaspik Choice Inc Medicare	$437.00

24H STRT PLT MDFC MLBL CNDS

Facility

$1,341.00

Service Code	HCPCS C1713
Hospital Charge Code	40209828
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,408.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$737.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$804.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$670.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$771.08
Rate for Payer: EmblemHealth Commercial	$670.50
Rate for Payer: Fidelis Medicare Advantage	$1,408.05
Rate for Payer: Group Health Inc Commercial	$670.50
Rate for Payer: Group Health Inc Medicare	$469.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$670.50
Rate for Payer: Hamaspik Choice Inc Medicare	$670.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$871.65

24H STRT PLT MDFC MLBL CNDS

Facility

$1,341.00

Service Code	HCPCS C1713
Hospital Charge Code	40209828
Hospital Revenue Code	278
Min. Negotiated Rate	$670.50
Max. Negotiated Rate	$670.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$670.50
Rate for Payer: Hamaspik Choice Inc Medicare	$670.50

24H STRT PLT UP MALL CNDSD

Facility

$874.00

Service Code	HCPCS C1713
Hospital Charge Code	40209830
Hospital Revenue Code	278
Min. Negotiated Rate	$437.00
Max. Negotiated Rate	$437.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.00
Rate for Payer: Hamaspik Choice Inc Medicare	$437.00

24H STRT PLT UP MALL CNDSD

Facility

$874.00

Service Code	HCPCS C1713
Hospital Charge Code	40209830
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$917.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$480.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$524.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$437.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$502.55
Rate for Payer: EmblemHealth Commercial	$437.00
Rate for Payer: Fidelis Medicare Advantage	$917.70
Rate for Payer: Group Health Inc Commercial	$437.00
Rate for Payer: Group Health Inc Medicare	$305.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.00
Rate for Payer: Hamaspik Choice Inc Medicare	$437.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$568.10

2.4 MATRIX MANDIBLE X 12M

Facility

$172.00

Service Code	HCPCS C1713
Hospital Charge Code	40200145
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

2.4 MATRIX MANDIBLE X 12M

Facility

$172.00

Service Code	HCPCS C1713
Hospital Charge Code	40200145
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

2.4MM X 100CM TR DROP GD

Facility

$348.56

Service Code	HCPCS C1713
Hospital Charge Code	40006476
Hospital Revenue Code	278
Min. Negotiated Rate	$174.28
Max. Negotiated Rate	$174.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.28
Rate for Payer: Hamaspik Choice Inc Medicare	$174.28

2.4MM X 100CM TR DROP GD

Facility

$348.56

Service Code	HCPCS C1713
Hospital Charge Code	40006476
Hospital Revenue Code	278
Min. Negotiated Rate	$122.00
Max. Negotiated Rate	$365.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$191.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$209.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$174.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$200.42
Rate for Payer: EmblemHealth Commercial	$174.28
Rate for Payer: Fidelis Medicare Advantage	$365.99
Rate for Payer: Group Health Inc Commercial	$174.28
Rate for Payer: Group Health Inc Medicare	$122.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.28
Rate for Payer: Hamaspik Choice Inc Medicare	$174.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$226.56

2.4MM X 70CM TEAR DROP GD

Facility

$304.06

Service Code	HCPCS C1713
Hospital Charge Code	40006478
Hospital Revenue Code	278
Min. Negotiated Rate	$152.03
Max. Negotiated Rate	$152.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.03
Rate for Payer: Hamaspik Choice Inc Medicare	$152.03

2.4MM X 70CM TEAR DROP GD

Facility

$304.06

Service Code	HCPCS C1713
Hospital Charge Code	40006478
Hospital Revenue Code	278
Min. Negotiated Rate	$106.42
Max. Negotiated Rate	$319.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$167.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$182.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$152.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.83
Rate for Payer: EmblemHealth Commercial	$152.03
Rate for Payer: Fidelis Medicare Advantage	$319.26
Rate for Payer: Group Health Inc Commercial	$152.03
Rate for Payer: Group Health Inc Medicare	$106.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.03
Rate for Payer: Hamaspik Choice Inc Medicare	$152.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.64

Know your out-of-pocket cost for care.

All Charges