St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT FIBERSTITCH

Facility

$1,237.50

Service Code	HCPCS C1821
Hospital Charge Code	64907435
Hospital Revenue Code	278
Min. Negotiated Rate	$433.12
Max. Negotiated Rate	$1,609.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$680.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,609.27
Rate for Payer: Aetna Government	$1,609.27
Rate for Payer: Brighton Health Commercial	$742.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$618.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$711.56
Rate for Payer: EmblemHealth Commercial	$618.75
Rate for Payer: Fidelis Medicare Advantage	$1,299.38
Rate for Payer: Group Health Inc Commercial	$618.75
Rate for Payer: Group Health Inc Medicare	$433.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$618.75
Rate for Payer: Hamaspik Choice Inc Medicare	$618.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$804.38

IMPLANT FIBERSTITCH

Facility

$1,237.50

Service Code	HCPCS C1821
Hospital Charge Code	64907435
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$618.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$618.75
Rate for Payer: Hamaspik Choice Inc Medicare	$618.75

IMPLANT GREAT TOE JOINT

Facility

$2,150.00

Service Code	HCPCS C1776
Hospital Charge Code	40200698
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,257.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,182.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,290.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,075.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,236.25
Rate for Payer: EmblemHealth Commercial	$1,075.00
Rate for Payer: Fidelis Medicare Advantage	$2,257.50
Rate for Payer: Group Health Inc Commercial	$1,075.00
Rate for Payer: Group Health Inc Medicare	$752.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,075.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,075.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,397.50

IMPLANT GREAT TOE JOINT

Facility

$2,150.00

Service Code	HCPCS C1776
Hospital Charge Code	40200698
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.00
Max. Negotiated Rate	$1,075.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,075.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,075.00

IMPLANT HAND LIG

Facility

$3,737.50

Service Code	HCPCS C1776
Hospital Charge Code	64907238
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.75
Max. Negotiated Rate	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,868.75

IMPLANT HAND LIG

Facility

$3,737.50

Service Code	HCPCS C1776
Hospital Charge Code	64907238
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,924.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,055.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,242.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,868.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,149.06
Rate for Payer: EmblemHealth Commercial	$1,868.75
Rate for Payer: Fidelis Medicare Advantage	$3,924.38
Rate for Payer: Group Health Inc Commercial	$1,868.75
Rate for Payer: Group Health Inc Medicare	$1,308.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,868.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,429.38

IMPLANT MAINT. INCL- REMOV., CLEA

Facility

$284.00

Service Code	HCPCS D6080
Hospital Charge Code	42301435
Hospital Revenue Code	361
Min. Negotiated Rate	$31.69
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.69
Rate for Payer: Aetna Government	$31.69
Rate for Payer: Brighton Health Commercial	$213.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$142.00
Rate for Payer: Group Health Inc Medicare	$99.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.00
Rate for Payer: Hamaspik Choice Inc Medicare	$142.00

IMPLANT-MANDIBLE/AUGMENTATION B/R

Facility

$2,500.00

Service Code	HCPCS D7996
Hospital Charge Code	42303455
Hospital Revenue Code	361
Min. Negotiated Rate	$852.47
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,375.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$852.47
Rate for Payer: Aetna Government	$852.47
Rate for Payer: Brighton Health Commercial	$1,875.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$1,250.00
Rate for Payer: Group Health Inc Medicare	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00

IMPLANT MEDPOR MID

Facility

$40,001.85

Service Code	HCPCS C1889
Hospital Charge Code	64907497
Hospital Revenue Code	278
Min. Negotiated Rate	$14,000.65
Max. Negotiated Rate	$42,001.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22,001.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,000.92
Rate for Payer: Aetna Government	$20,000.92
Rate for Payer: Brighton Health Commercial	$24,001.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20,000.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$23,001.06
Rate for Payer: EmblemHealth Commercial	$20,000.92
Rate for Payer: Fidelis Medicare Advantage	$42,001.94
Rate for Payer: Group Health Inc Commercial	$20,000.92
Rate for Payer: Group Health Inc Medicare	$14,000.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,000.92
Rate for Payer: Hamaspik Choice Inc Medicare	$20,000.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26,001.20

IMPLANT MEDPOR MID

Facility

$40,001.85

Service Code	HCPCS C1889
Hospital Charge Code	64907497
Hospital Revenue Code	278
Min. Negotiated Rate	$20,000.92
Max. Negotiated Rate	$20,000.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,000.92
Rate for Payer: Hamaspik Choice Inc Medicare	$20,000.92

IMPLANT,NAT INSP 485CC BREAST

Facility

$2,737.50

Service Code	HCPCS C1789
Hospital Charge Code	64905535
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,874.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,505.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,642.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,368.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,574.06
Rate for Payer: EmblemHealth Commercial	$1,368.75
Rate for Payer: Fidelis Medicare Advantage	$2,874.38
Rate for Payer: Group Health Inc Commercial	$1,368.75
Rate for Payer: Group Health Inc Medicare	$958.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,368.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,368.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,779.38

IMPLANT,NAT INSP 485CC BREAST

Facility

$2,737.50

Service Code	HCPCS C1789
Hospital Charge Code	64905535
Hospital Revenue Code	278
Min. Negotiated Rate	$1,368.75
Max. Negotiated Rate	$1,368.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,368.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,368.75

IMPLANT NAT INSP BREAST SCM-485

Facility

$2,700.00

Service Code	HCPCS L8600
Hospital Charge Code	40005938
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$1,350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,350.00

IMPLANT NAT INSP BREAST SCM-485

Facility

$2,700.00

Service Code	HCPCS L8600
Hospital Charge Code	40005938
Hospital Revenue Code	278
Min. Negotiated Rate	$326.16
Max. Negotiated Rate	$2,835.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$326.16
Rate for Payer: Aetna Government	$326.16
Rate for Payer: Brighton Health Commercial	$1,620.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,552.50
Rate for Payer: EmblemHealth Commercial	$1,350.00
Rate for Payer: Fidelis Medicare Advantage	$2,835.00
Rate for Payer: Group Health Inc Commercial	$1,350.00
Rate for Payer: Group Health Inc Medicare	$945.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,755.00

IMPLANT NEUROELECTRODES

Facility

$18,198.32

Service Code	HCPCS 64561
Hospital Charge Code	30307895
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$406,911.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7,908.94
Rate for Payer: Aetna Government	$7,908.94
Rate for Payer: Affinity Essential Plan 1&2	$9,155.50
Rate for Payer: Affinity Essential Plan 3&4	$9,155.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,069.11
Rate for Payer: Amida Care Medicaid	$4,069.11
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$7,908.94
Rate for Payer: Cash Price	$7,908.94
Rate for Payer: Cash Price	$7,908.94
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7,908.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$7,908.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$406,911.00
Rate for Payer: Fidelis Essential Plan Aliesa	$4,069.11
Rate for Payer: Fidelis Essential Plan QHP	$4,069.11
Rate for Payer: Fidelis Medicare Advantage	$7,908.94
Rate for Payer: Fidelis Qualified Health Plan	$4,272.57
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,069.11
Rate for Payer: Hamaspik Choice Inc Medicare	$7,908.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4,069.11
Rate for Payer: Healthfirst Essential Plan	$9,155.50
Rate for Payer: Healthfirst Medicare Advantage	$6,722.60
Rate for Payer: Healthfirst QHP	$4,069.11
Rate for Payer: Humana Medicare	$8,067.12
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7,908.94
Rate for Payer: Senior Whole Health Medicare Advantage	$7,908.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,069.11
Rate for Payer: SOMOS Essential	$9,155.50
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$9,155.50
Rate for Payer: United Healthcare Essential Plan 3&4	$4,476.02
Rate for Payer: United Healthcare Medicaid	$4,069.11
Rate for Payer: United Healthcare Medicare Advantage	$7,908.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,908.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,327.15
Rate for Payer: Wellcare Medicare	$7,513.49

IMPLANT NEUROELECTRODES

Facility

$18,198.32

Service Code	HCPCS 64561
Hospital Charge Code	30307895
Hospital Revenue Code	510
Rate for Payer: Cash Price	$7,908.94

IMPLANT NEUROFLEX

Facility

$2,981.08

Service Code	HCPCS C1713
Hospital Charge Code	64907162
Hospital Revenue Code	278
Min. Negotiated Rate	$1,490.54
Max. Negotiated Rate	$1,490.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,490.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1,490.54

IMPLANT NEUROFLEX

Facility

$2,981.08

Service Code	HCPCS C1713
Hospital Charge Code	64907162
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,130.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,639.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,788.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,490.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,714.12
Rate for Payer: EmblemHealth Commercial	$1,490.54
Rate for Payer: Fidelis Medicare Advantage	$3,130.13
Rate for Payer: Group Health Inc Commercial	$1,490.54
Rate for Payer: Group Health Inc Medicare	$1,043.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,490.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1,490.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,937.70

IMPLANT NEUROMEND

Facility

$5,272.50

Service Code	HCPCS C1713
Hospital Charge Code	64907161
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,536.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,899.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,163.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,636.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,031.69
Rate for Payer: EmblemHealth Commercial	$2,636.25
Rate for Payer: Fidelis Medicare Advantage	$5,536.12
Rate for Payer: Group Health Inc Commercial	$2,636.25
Rate for Payer: Group Health Inc Medicare	$1,845.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,636.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,636.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,427.12

IMPLANT NEUROMEND

Facility

$5,272.50

Service Code	HCPCS C1713
Hospital Charge Code	64907161
Hospital Revenue Code	278
Min. Negotiated Rate	$2,636.25
Max. Negotiated Rate	$2,636.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,636.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,636.25

IMPLANT NX AUG BL DS 10M F-3620

Facility

$2,199.00

Service Code	HCPCS C1776
Hospital Charge Code	64906491
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,308.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,209.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,319.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,099.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,264.42
Rate for Payer: EmblemHealth Commercial	$1,099.50
Rate for Payer: Fidelis Medicare Advantage	$2,308.95
Rate for Payer: Group Health Inc Commercial	$1,099.50
Rate for Payer: Group Health Inc Medicare	$769.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,099.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,099.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,429.35

IMPLANT NX AUG BL DS 10M F-3620

Facility

$2,199.00

Service Code	HCPCS C1776
Hospital Charge Code	64906491
Hospital Revenue Code	278
Min. Negotiated Rate	$1,099.50
Max. Negotiated Rate	$1,099.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,099.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,099.50

IMPLANT NXG AUG BL DS 5M F-3601

Facility

$2,199.00

Service Code	HCPCS C1776
Hospital Charge Code	64906490
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,308.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,209.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,319.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,099.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,264.42
Rate for Payer: EmblemHealth Commercial	$1,099.50
Rate for Payer: Fidelis Medicare Advantage	$2,308.95
Rate for Payer: Group Health Inc Commercial	$1,099.50
Rate for Payer: Group Health Inc Medicare	$769.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,099.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,099.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,429.35

IMPLANT NXG AUG BL DS 5M F-3601

Facility

$2,199.00

Service Code	HCPCS C1776
Hospital Charge Code	64906490
Hospital Revenue Code	278
Min. Negotiated Rate	$1,099.50
Max. Negotiated Rate	$1,099.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,099.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,099.50

IMPLANT REMOVAL, BY REPORT

Facility

$425.00

Service Code	HCPCS D6100
Hospital Charge Code	42301445
Hospital Revenue Code	361
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$233.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$218.55
Rate for Payer: Aetna Government	$218.55
Rate for Payer: Brighton Health Commercial	$318.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$212.50
Rate for Payer: Group Health Inc Medicare	$148.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$212.50
Rate for Payer: Hamaspik Choice Inc Medicare	$212.50

Know your out-of-pocket cost for care.

All Charges