St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GRANULES 20.0CC 2-4MM

Facility

$7,206.50

Service Code	HCPCS C1713
Hospital Charge Code	64905387
Hospital Revenue Code	278
Min. Negotiated Rate	$3,603.25
Max. Negotiated Rate	$3,603.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,603.25
Rate for Payer: Hamaspik Choice Inc Medicare	$3,603.25

GRANULES BONE GRFT 10CC 2-4MM

Facility

$4,504.08

Service Code	HCPCS C1713
Hospital Charge Code	64905383
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,729.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,477.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,702.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,252.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,589.85
Rate for Payer: EmblemHealth Commercial	$2,252.04
Rate for Payer: Fidelis Medicare Advantage	$4,729.28
Rate for Payer: Group Health Inc Commercial	$2,252.04
Rate for Payer: Group Health Inc Medicare	$1,576.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,252.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2,252.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,927.65

GRANULES BONE GRFT 10CC 2-4MM

Facility

$4,504.08

Service Code	HCPCS C1713
Hospital Charge Code	64905383
Hospital Revenue Code	278
Min. Negotiated Rate	$2,252.04
Max. Negotiated Rate	$2,252.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,252.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2,252.04

GRANULES BONE GRFT 1.0CC 2-4MM

Facility

$1,071.98

Service Code	HCPCS C1713
Hospital Charge Code	64905380
Hospital Revenue Code	278
Min. Negotiated Rate	$535.99
Max. Negotiated Rate	$535.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$535.99
Rate for Payer: Hamaspik Choice Inc Medicare	$535.99

GRANULES BONE GRFT 1.0CC 2-4MM

Facility

$1,071.98

Service Code	HCPCS C1713
Hospital Charge Code	64905380
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,125.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$589.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$643.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$535.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$616.39
Rate for Payer: EmblemHealth Commercial	$535.99
Rate for Payer: Fidelis Medicare Advantage	$1,125.58
Rate for Payer: Group Health Inc Commercial	$535.99
Rate for Payer: Group Health Inc Medicare	$375.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$535.99
Rate for Payer: Hamaspik Choice Inc Medicare	$535.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$696.79

GRANULES BONE GRFT 15CC 2-4MM

Facility

$6,099.80

Service Code	HCPCS C1713
Hospital Charge Code	64905385
Hospital Revenue Code	278
Min. Negotiated Rate	$3,049.90
Max. Negotiated Rate	$3,049.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,049.90
Rate for Payer: Hamaspik Choice Inc Medicare	$3,049.90

GRANULES BONE GRFT 15CC 2-4MM

Facility

$6,099.80

Service Code	HCPCS C1713
Hospital Charge Code	64905385
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,404.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,354.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,659.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,049.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,507.38
Rate for Payer: EmblemHealth Commercial	$3,049.90
Rate for Payer: Fidelis Medicare Advantage	$6,404.79
Rate for Payer: Group Health Inc Commercial	$3,049.90
Rate for Payer: Group Health Inc Medicare	$2,134.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,049.90
Rate for Payer: Hamaspik Choice Inc Medicare	$3,049.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,964.87

GRANULES BONE GRFT 2.5CC 2-4MM

Facility

$1,711.55

Service Code	HCPCS C1713
Hospital Charge Code	64905381
Hospital Revenue Code	278
Min. Negotiated Rate	$855.78
Max. Negotiated Rate	$855.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$855.78
Rate for Payer: Hamaspik Choice Inc Medicare	$855.78

GRANULES BONE GRFT 2.5CC 2-4MM

Facility

$1,711.55

Service Code	HCPCS C1713
Hospital Charge Code	64905381
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,797.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$941.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,026.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$855.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$984.14
Rate for Payer: EmblemHealth Commercial	$855.78
Rate for Payer: Fidelis Medicare Advantage	$1,797.13
Rate for Payer: Group Health Inc Commercial	$855.78
Rate for Payer: Group Health Inc Medicare	$599.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$855.78
Rate for Payer: Hamaspik Choice Inc Medicare	$855.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,112.51

GRANULES BONE GRFT <2MM 10.0CC

Facility

$4,504.08

Service Code	HCPCS C1713
Hospital Charge Code	64905375
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,729.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,477.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,702.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,252.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,589.85
Rate for Payer: EmblemHealth Commercial	$2,252.04
Rate for Payer: Fidelis Medicare Advantage	$4,729.28
Rate for Payer: Group Health Inc Commercial	$2,252.04
Rate for Payer: Group Health Inc Medicare	$1,576.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,252.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2,252.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,927.65

GRANULES BONE GRFT <2MM 10.0CC

Facility

$4,504.08

Service Code	HCPCS C1713
Hospital Charge Code	64905375
Hospital Revenue Code	278
Min. Negotiated Rate	$2,252.04
Max. Negotiated Rate	$2,252.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,252.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2,252.04

GRANULES BONE GRFT <2MM 1.0CC

Facility

$1,071.98

Service Code	HCPCS C1713
Hospital Charge Code	64905372
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,125.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$589.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$643.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$535.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$616.39
Rate for Payer: EmblemHealth Commercial	$535.99
Rate for Payer: Fidelis Medicare Advantage	$1,125.58
Rate for Payer: Group Health Inc Commercial	$535.99
Rate for Payer: Group Health Inc Medicare	$375.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$535.99
Rate for Payer: Hamaspik Choice Inc Medicare	$535.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$696.79

GRANULES BONE GRFT <2MM 1.0CC

Facility

$1,071.98

Service Code	HCPCS C1713
Hospital Charge Code	64905372
Hospital Revenue Code	278
Min. Negotiated Rate	$535.99
Max. Negotiated Rate	$535.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$535.99
Rate for Payer: Hamaspik Choice Inc Medicare	$535.99

GRANULES BONE GRFT <2MM 15.0CC

Facility

$6,099.80

Service Code	HCPCS C1713
Hospital Charge Code	64905377
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,404.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,354.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,659.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,049.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,507.38
Rate for Payer: EmblemHealth Commercial	$3,049.90
Rate for Payer: Fidelis Medicare Advantage	$6,404.79
Rate for Payer: Group Health Inc Commercial	$3,049.90
Rate for Payer: Group Health Inc Medicare	$2,134.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,049.90
Rate for Payer: Hamaspik Choice Inc Medicare	$3,049.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,964.87

GRANULES BONE GRFT <2MM 15.0CC

Facility

$6,099.80

Service Code	HCPCS C1713
Hospital Charge Code	64905377
Hospital Revenue Code	278
Min. Negotiated Rate	$3,049.90
Max. Negotiated Rate	$3,049.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,049.90
Rate for Payer: Hamaspik Choice Inc Medicare	$3,049.90

GRANULES BONE GRFT 2MM 20.0CC

Facility

$12,732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905378
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$13,369.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,002.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$7,639.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,366.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,321.19
Rate for Payer: EmblemHealth Commercial	$6,366.25
Rate for Payer: Fidelis Medicare Advantage	$13,369.12
Rate for Payer: Group Health Inc Commercial	$6,366.25
Rate for Payer: Group Health Inc Medicare	$4,456.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$6,366.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,276.12

GRANULES BONE GRFT 2MM 20.0CC

Facility

$12,732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905378
Hospital Revenue Code	278
Min. Negotiated Rate	$6,366.25
Max. Negotiated Rate	$6,366.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$6,366.25

GRANULES BONE GRFT <2MM 2.5CC

Facility

$1,711.55

Service Code	HCPCS C1713
Hospital Charge Code	64905373
Hospital Revenue Code	278
Min. Negotiated Rate	$855.78
Max. Negotiated Rate	$855.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$855.78
Rate for Payer: Hamaspik Choice Inc Medicare	$855.78

GRANULES BONE GRFT <2MM 2.5CC

Facility

$1,711.55

Service Code	HCPCS C1713
Hospital Charge Code	64905373
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,797.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$941.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,026.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$855.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$984.14
Rate for Payer: EmblemHealth Commercial	$855.78
Rate for Payer: Fidelis Medicare Advantage	$1,797.13
Rate for Payer: Group Health Inc Commercial	$855.78
Rate for Payer: Group Health Inc Medicare	$599.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$855.78
Rate for Payer: Hamaspik Choice Inc Medicare	$855.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,112.51

GRANULES BONE GRFT <2MM 5.0CC

Facility

$2,702.45

Service Code	HCPCS C1713
Hospital Charge Code	64905374
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.22
Max. Negotiated Rate	$1,351.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,351.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1,351.22

GRANULES BONE GRFT <2MM 5.0CC

Facility

$2,702.45

Service Code	HCPCS C1713
Hospital Charge Code	64905374
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,837.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,486.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,621.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,351.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,553.91
Rate for Payer: EmblemHealth Commercial	$1,351.22
Rate for Payer: Fidelis Medicare Advantage	$2,837.57
Rate for Payer: Group Health Inc Commercial	$1,351.22
Rate for Payer: Group Health Inc Medicare	$945.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,351.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1,351.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,756.59

GRANULES BONE GRFT 5.0CC 2-4MM

Facility

$2,702.45

Service Code	HCPCS C1713
Hospital Charge Code	64905382
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.22
Max. Negotiated Rate	$1,351.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,351.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1,351.22

GRANULES BONE GRFT 5.0CC 2-4MM

Facility

$2,702.45

Service Code	HCPCS C1713
Hospital Charge Code	64905382
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,837.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,486.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,621.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,351.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,553.91
Rate for Payer: EmblemHealth Commercial	$1,351.22
Rate for Payer: Fidelis Medicare Advantage	$2,837.57
Rate for Payer: Group Health Inc Commercial	$1,351.22
Rate for Payer: Group Health Inc Medicare	$945.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,351.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1,351.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,756.59

GRANULES CONDUIT TCP 30CC

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	40200945
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00

GRANULES CONDUIT TCP 30CC

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	40200945
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,320.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,440.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,380.00
Rate for Payer: EmblemHealth Commercial	$1,200.00
Rate for Payer: Fidelis Medicare Advantage	$2,520.00
Rate for Payer: Group Health Inc Commercial	$1,200.00
Rate for Payer: Group Health Inc Medicare	$840.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,560.00

Know your out-of-pocket cost for care.

All Charges