St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HFN LH 130 DEG 13MM X 280MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006085
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN LH 130 DEG 13MM X 300MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006086
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN LH 130 DEG 13MM X 300MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006086
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN LH 130 DEG 13MM X 320MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006087
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN LH 130 DEG 13MM X 320MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006087
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN LH 130 DEG 13MM X 340MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006088
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN LH 130 DEG 13MM X 340MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006088
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN LH 130 DEG 13MM X 360MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006089
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN LH 130 DEG 13MM X 360MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006089
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN LH 130 DEG 13MM X 380MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006090
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN LH 130 DEG 13MM X 380MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006090
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN LH 130 DEG 13MM X 400MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006091
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN LH 130 DEG 13MM X 400MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006091
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN LH 130 DEG 13MM X 420MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006092
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN LH 130 DEG 13MM X 420MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006092
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN LH 130 DEG 13MM X 440MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006093
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN LH 130 DEG 13MM X 440MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006093
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN LH 130 DEG 13MM X 460MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006094
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN LH 130 DEG 13MM X 460MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006094
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN LH 130 DEG 15MM X 320MM

Facility

$6,768.00

Service Code	HCPCS C1713
Hospital Charge Code	40006095
Hospital Revenue Code	278
Min. Negotiated Rate	$3,384.00
Max. Negotiated Rate	$3,384.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,384.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,384.00

HFN LH 130 DEG 15MM X 320MM

Facility

$6,768.00

Service Code	HCPCS C1713
Hospital Charge Code	40006095
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,106.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,722.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,060.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,384.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,891.60
Rate for Payer: EmblemHealth Commercial	$3,384.00
Rate for Payer: Fidelis Medicare Advantage	$7,106.40
Rate for Payer: Group Health Inc Commercial	$3,384.00
Rate for Payer: Group Health Inc Medicare	$2,368.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,384.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,384.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,399.20

HFN LH 130 DEG 15MM X 360MM

Facility

$6,768.00

Service Code	HCPCS C1713
Hospital Charge Code	40006096
Hospital Revenue Code	278
Min. Negotiated Rate	$3,384.00
Max. Negotiated Rate	$3,384.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,384.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,384.00

HFN LH 130 DEG 15MM X 360MM

Facility

$6,768.00

Service Code	HCPCS C1713
Hospital Charge Code	40006096
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,106.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,722.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,060.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,384.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,891.60
Rate for Payer: EmblemHealth Commercial	$3,384.00
Rate for Payer: Fidelis Medicare Advantage	$7,106.40
Rate for Payer: Group Health Inc Commercial	$3,384.00
Rate for Payer: Group Health Inc Medicare	$2,368.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,384.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,384.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,399.20

HFN LH 130 DEG 15MM X 400MM

Facility

$6,768.00

Service Code	HCPCS C1713
Hospital Charge Code	40006097
Hospital Revenue Code	278
Min. Negotiated Rate	$3,384.00
Max. Negotiated Rate	$3,384.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,384.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,384.00

HFN LH 130 DEG 15MM X 400MM

Facility

$6,768.00

Service Code	HCPCS C1713
Hospital Charge Code	40006097
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,106.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,722.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,060.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,384.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,891.60
Rate for Payer: EmblemHealth Commercial	$3,384.00
Rate for Payer: Fidelis Medicare Advantage	$7,106.40
Rate for Payer: Group Health Inc Commercial	$3,384.00
Rate for Payer: Group Health Inc Medicare	$2,368.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,384.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,384.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,399.20

Know your out-of-pocket cost for care.

All Charges