St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HEAD UNIV BIPOLAR 44 X 28MM

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Charge Code	64902383
Hospital Revenue Code	278
Min. Negotiated Rate	$2,050.00
Max. Negotiated Rate	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,050.00

HEAD UNIV BIPOLAR 45 X 26MM

Facility

$2,062.50

Service Code	HCPCS C1713
Hospital Charge Code	64901792
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,165.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,134.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,237.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,031.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,185.94
Rate for Payer: EmblemHealth Commercial	$1,031.25
Rate for Payer: Fidelis Medicare Advantage	$2,165.62
Rate for Payer: Group Health Inc Commercial	$1,031.25
Rate for Payer: Group Health Inc Medicare	$721.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,031.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,340.62

HEAD UNIV BIPOLAR 45 X 26MM

Facility

$2,062.50

Service Code	HCPCS C1713
Hospital Charge Code	64901792
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,031.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,031.25

HEAD UNIV BIPOLAR 45 X 28MM

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Charge Code	64902450
Hospital Revenue Code	278
Min. Negotiated Rate	$2,050.00
Max. Negotiated Rate	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,050.00

HEAD UNIV BIPOLAR 45 X 28MM

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Charge Code	64902450
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,305.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,255.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,460.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,050.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,357.50
Rate for Payer: EmblemHealth Commercial	$2,050.00
Rate for Payer: Fidelis Medicare Advantage	$4,305.00
Rate for Payer: Group Health Inc Commercial	$2,050.00
Rate for Payer: Group Health Inc Medicare	$1,435.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,050.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,665.00

HEAD UNIV BIPOLAR 46 X 26MM

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Charge Code	64901793
Hospital Revenue Code	278
Min. Negotiated Rate	$2,050.00
Max. Negotiated Rate	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,050.00

HEAD UNIV BIPOLAR 46 X 26MM

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Charge Code	64901793
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,305.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,255.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,460.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,050.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,357.50
Rate for Payer: EmblemHealth Commercial	$2,050.00
Rate for Payer: Fidelis Medicare Advantage	$4,305.00
Rate for Payer: Group Health Inc Commercial	$2,050.00
Rate for Payer: Group Health Inc Medicare	$1,435.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,050.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,665.00

HEAD UNIV BIPOLAR 48 X 26MM

Facility

$2,062.50

Service Code	HCPCS C1713
Hospital Charge Code	64901788
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,031.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,031.25

HEAD UNIV BIPOLAR 48 X 26MM

Facility

$2,062.50

Service Code	HCPCS C1713
Hospital Charge Code	64901788
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,165.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,134.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,237.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,031.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,185.94
Rate for Payer: EmblemHealth Commercial	$1,031.25
Rate for Payer: Fidelis Medicare Advantage	$2,165.62
Rate for Payer: Group Health Inc Commercial	$1,031.25
Rate for Payer: Group Health Inc Medicare	$721.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,031.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,340.62

HEAD UNIV BIPOLAR 48 X 28MM

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Charge Code	64902043
Hospital Revenue Code	278
Min. Negotiated Rate	$2,050.00
Max. Negotiated Rate	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,050.00

HEAD UNIV BIPOLAR 48 X 28MM

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Charge Code	64902043
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,305.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,255.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,460.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,050.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,357.50
Rate for Payer: EmblemHealth Commercial	$2,050.00
Rate for Payer: Fidelis Medicare Advantage	$4,305.00
Rate for Payer: Group Health Inc Commercial	$2,050.00
Rate for Payer: Group Health Inc Medicare	$1,435.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,050.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,665.00

HEAD UNIV BIPOLAR 49 X 26MM

Facility

$2,062.50

Service Code	HCPCS C1713
Hospital Charge Code	64901695
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,165.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,134.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,237.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,031.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,185.94
Rate for Payer: EmblemHealth Commercial	$1,031.25
Rate for Payer: Fidelis Medicare Advantage	$2,165.62
Rate for Payer: Group Health Inc Commercial	$1,031.25
Rate for Payer: Group Health Inc Medicare	$721.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,031.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,340.62

HEAD UNIV BIPOLAR 49 X 26MM

Facility

$2,062.50

Service Code	HCPCS C1713
Hospital Charge Code	64901695
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,031.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,031.25

HEAD UNIV BIPOLAR 50 X 26MM

Facility

$2,731.50

Service Code	HCPCS C1713
Hospital Charge Code	64901693
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,868.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,502.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,638.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,365.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,570.61
Rate for Payer: EmblemHealth Commercial	$1,365.75
Rate for Payer: Fidelis Medicare Advantage	$2,868.08
Rate for Payer: Group Health Inc Commercial	$1,365.75
Rate for Payer: Group Health Inc Medicare	$956.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,365.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,775.48

HEAD UNIV BIPOLAR 50 X 26MM

Facility

$2,731.50

Service Code	HCPCS C1713
Hospital Charge Code	64901693
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.75
Max. Negotiated Rate	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,365.75

HEAD UNIV BIPOLAR 50 X 28MM

Facility

$3,690.00

Service Code	HCPCS C1713
Hospital Charge Code	64902020
Hospital Revenue Code	278
Min. Negotiated Rate	$1,845.00
Max. Negotiated Rate	$1,845.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,845.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,845.00

HEAD UNIV BIPOLAR 50 X 28MM

Facility

$3,690.00

Service Code	HCPCS C1713
Hospital Charge Code	64902020
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,874.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,029.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,214.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,845.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,121.75
Rate for Payer: EmblemHealth Commercial	$1,845.00
Rate for Payer: Fidelis Medicare Advantage	$3,874.50
Rate for Payer: Group Health Inc Commercial	$1,845.00
Rate for Payer: Group Health Inc Medicare	$1,291.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,845.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,845.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,398.50

HEAD UNIV BIPOLAR 53 X 26MM

Facility

$3,070.00

Service Code	HCPCS C1713
Hospital Charge Code	64906773
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,223.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,688.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,842.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,535.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,765.25
Rate for Payer: EmblemHealth Commercial	$1,535.00
Rate for Payer: Fidelis Medicare Advantage	$3,223.50
Rate for Payer: Group Health Inc Commercial	$1,535.00
Rate for Payer: Group Health Inc Medicare	$1,074.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,535.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,535.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,995.50

HEAD UNIV BIPOLAR 53 X 26MM

Facility

$3,070.00

Service Code	HCPCS C1713
Hospital Charge Code	64906773
Hospital Revenue Code	278
Min. Negotiated Rate	$1,535.00
Max. Negotiated Rate	$1,535.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,535.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,535.00

HEAD V40 COCR LFIT 22.2MM/3

Facility

$2,731.50

Service Code	HCPCS C1776
Hospital Charge Code	64905739
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,868.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,502.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,638.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,365.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,570.61
Rate for Payer: EmblemHealth Commercial	$1,365.75
Rate for Payer: Fidelis Medicare Advantage	$2,868.08
Rate for Payer: Group Health Inc Commercial	$1,365.75
Rate for Payer: Group Health Inc Medicare	$956.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,365.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,775.48

HEAD V40 COCR LFIT 22.2MM/3

Facility

$2,731.50

Service Code	HCPCS C1776
Hospital Charge Code	64905739
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.75
Max. Negotiated Rate	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,365.75

HEAD V40 COCR LFIT 22.2MM/8

Facility

$2,731.50

Service Code	HCPCS C1776
Hospital Charge Code	64905738
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.75
Max. Negotiated Rate	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,365.75

HEAD V40 COCR LFIT 22.2MM/8

Facility

$2,731.50

Service Code	HCPCS C1776
Hospital Charge Code	64905738
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,868.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,502.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,638.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,365.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,570.61
Rate for Payer: EmblemHealth Commercial	$1,365.75
Rate for Payer: Fidelis Medicare Advantage	$2,868.08
Rate for Payer: Group Health Inc Commercial	$1,365.75
Rate for Payer: Group Health Inc Medicare	$956.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,365.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,775.48

HEAD VERSYS FEM 12/14 28MM

Facility

$2,385.00

Service Code	HCPCS C1776
Hospital Charge Code	64907022
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,504.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,311.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,431.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,192.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,371.38
Rate for Payer: EmblemHealth Commercial	$1,192.50
Rate for Payer: Fidelis Medicare Advantage	$2,504.25
Rate for Payer: Group Health Inc Commercial	$1,192.50
Rate for Payer: Group Health Inc Medicare	$834.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,192.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,192.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,550.25

HEAD VERSYS FEM 12/14 28MM

Facility

$2,385.00

Service Code	HCPCS C1776
Hospital Charge Code	64907022
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.50
Max. Negotiated Rate	$1,192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,192.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,192.50

Know your out-of-pocket cost for care.

All Charges