St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT SCROTL ANG W-PMP 22CM

Facility

$20,214.00

Service Code	HCPCS C1762
Hospital Charge Code	64906925
Hospital Revenue Code	278
Min. Negotiated Rate	$1,879.82
Max. Negotiated Rate	$21,224.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11,117.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$12,128.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10,107.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11,623.05
Rate for Payer: EmblemHealth Commercial	$10,107.00
Rate for Payer: Fidelis Medicare Advantage	$21,224.70
Rate for Payer: Group Health Inc Commercial	$10,107.00
Rate for Payer: Group Health Inc Medicare	$7,074.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,107.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10,107.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13,139.10

IMPLANT SCROTL ANG W-PMP 22CM

Facility

$20,214.00

Service Code	HCPCS C1762
Hospital Charge Code	64906925
Hospital Revenue Code	278
Min. Negotiated Rate	$10,107.00
Max. Negotiated Rate	$10,107.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,107.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10,107.00

IMPLANT SOLID PIN MINI

Facility

$3,700.00

Service Code	HCPCS C1713
Hospital Charge Code	64907063
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,885.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,035.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,220.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,850.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,127.50
Rate for Payer: EmblemHealth Commercial	$1,850.00
Rate for Payer: Fidelis Medicare Advantage	$3,885.00
Rate for Payer: Group Health Inc Commercial	$1,850.00
Rate for Payer: Group Health Inc Medicare	$1,295.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,850.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,405.00

IMPLANT SOLID PIN MINI

Facility

$3,700.00

Service Code	HCPCS C1713
Hospital Charge Code	64907063
Hospital Revenue Code	278
Min. Negotiated Rate	$1,850.00
Max. Negotiated Rate	$1,850.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,850.00

IMPLANT SPINE 11X14MM 24.5

Facility

$10,950.00

Service Code	HCPCS C1776
Hospital Charge Code	64905094
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$11,497.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,022.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$6,570.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,475.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,296.25
Rate for Payer: EmblemHealth Commercial	$5,475.00
Rate for Payer: Fidelis Medicare Advantage	$11,497.50
Rate for Payer: Group Health Inc Commercial	$5,475.00
Rate for Payer: Group Health Inc Medicare	$3,832.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,475.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,117.50

IMPLANT SPINE 11X14MM 24.5

Facility

$10,950.00

Service Code	HCPCS C1776
Hospital Charge Code	64905094
Hospital Revenue Code	278
Min. Negotiated Rate	$5,475.00
Max. Negotiated Rate	$5,475.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,475.00

IMPLANT,STY 10 390 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905537
Hospital Revenue Code	278
Min. Negotiated Rate	$893.75
Max. Negotiated Rate	$893.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$893.75
Rate for Payer: Hamaspik Choice Inc Medicare	$893.75

IMPLANT,STY 10 390 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905537
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,876.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$983.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,072.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$893.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,027.81
Rate for Payer: EmblemHealth Commercial	$893.75
Rate for Payer: Fidelis Medicare Advantage	$1,876.88
Rate for Payer: Group Health Inc Commercial	$893.75
Rate for Payer: Group Health Inc Medicare	$625.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$893.75
Rate for Payer: Hamaspik Choice Inc Medicare	$893.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,161.88

IMPLANT STY 10 390 CC 10-390

Facility

$1,854.00

Service Code	HCPCS L8600
Hospital Charge Code	40005939
Hospital Revenue Code	278
Min. Negotiated Rate	$326.16
Max. Negotiated Rate	$1,946.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,019.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$326.16
Rate for Payer: Aetna Government	$326.16
Rate for Payer: Brighton Health Commercial	$1,112.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$927.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,066.05
Rate for Payer: EmblemHealth Commercial	$927.00
Rate for Payer: Fidelis Medicare Advantage	$1,946.70
Rate for Payer: Group Health Inc Commercial	$927.00
Rate for Payer: Group Health Inc Medicare	$648.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$927.00
Rate for Payer: Hamaspik Choice Inc Medicare	$927.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,205.10

IMPLANT STY 10 390 CC 10-390

Facility

$1,854.00

Service Code	HCPCS L8600
Hospital Charge Code	40005939
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$927.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$927.00
Rate for Payer: Hamaspik Choice Inc Medicare	$927.00

IMPLANT,STY 10 420 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905539
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,876.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$983.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,072.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$893.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,027.81
Rate for Payer: EmblemHealth Commercial	$893.75
Rate for Payer: Fidelis Medicare Advantage	$1,876.88
Rate for Payer: Group Health Inc Commercial	$893.75
Rate for Payer: Group Health Inc Medicare	$625.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$893.75
Rate for Payer: Hamaspik Choice Inc Medicare	$893.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,161.88

IMPLANT,STY 10 420 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905539
Hospital Revenue Code	278
Min. Negotiated Rate	$893.75
Max. Negotiated Rate	$893.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$893.75
Rate for Payer: Hamaspik Choice Inc Medicare	$893.75

IMPLANT STY 10 420 CC 10-420

Facility

$1,854.00

Service Code	HCPCS L8600
Hospital Charge Code	40005940
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$927.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$927.00
Rate for Payer: Hamaspik Choice Inc Medicare	$927.00

IMPLANT STY 10 420 CC 10-420

Facility

$1,854.00

Service Code	HCPCS L8600
Hospital Charge Code	40005940
Hospital Revenue Code	278
Min. Negotiated Rate	$326.16
Max. Negotiated Rate	$1,946.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,019.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$326.16
Rate for Payer: Aetna Government	$326.16
Rate for Payer: Brighton Health Commercial	$1,112.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$927.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,066.05
Rate for Payer: EmblemHealth Commercial	$927.00
Rate for Payer: Fidelis Medicare Advantage	$1,946.70
Rate for Payer: Group Health Inc Commercial	$927.00
Rate for Payer: Group Health Inc Medicare	$648.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$927.00
Rate for Payer: Hamaspik Choice Inc Medicare	$927.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,205.10

IMPLANT,STY 10 450 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905541
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,876.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$983.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,072.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$893.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,027.81
Rate for Payer: EmblemHealth Commercial	$893.75
Rate for Payer: Fidelis Medicare Advantage	$1,876.88
Rate for Payer: Group Health Inc Commercial	$893.75
Rate for Payer: Group Health Inc Medicare	$625.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$893.75
Rate for Payer: Hamaspik Choice Inc Medicare	$893.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,161.88

IMPLANT,STY 10 450 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905541
Hospital Revenue Code	278
Min. Negotiated Rate	$893.75
Max. Negotiated Rate	$893.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$893.75
Rate for Payer: Hamaspik Choice Inc Medicare	$893.75

IMPLANT STY 10 450 CC 10-450

Facility

$1,854.00

Service Code	HCPCS L8600
Hospital Charge Code	40005941
Hospital Revenue Code	278
Min. Negotiated Rate	$326.16
Max. Negotiated Rate	$1,946.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,019.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$326.16
Rate for Payer: Aetna Government	$326.16
Rate for Payer: Brighton Health Commercial	$1,112.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$927.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,066.05
Rate for Payer: EmblemHealth Commercial	$927.00
Rate for Payer: Fidelis Medicare Advantage	$1,946.70
Rate for Payer: Group Health Inc Commercial	$927.00
Rate for Payer: Group Health Inc Medicare	$648.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$927.00
Rate for Payer: Hamaspik Choice Inc Medicare	$927.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,205.10

IMPLANT STY 10 450 CC 10-450

Facility

$1,854.00

Service Code	HCPCS L8600
Hospital Charge Code	40005941
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$927.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$927.00
Rate for Payer: Hamaspik Choice Inc Medicare	$927.00

IMPLANT,STY 110 360 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905547
Hospital Revenue Code	278
Min. Negotiated Rate	$893.75
Max. Negotiated Rate	$893.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$893.75
Rate for Payer: Hamaspik Choice Inc Medicare	$893.75

IMPLANT,STY 110 360 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905547
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,876.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$983.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,072.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$893.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,027.81
Rate for Payer: EmblemHealth Commercial	$893.75
Rate for Payer: Fidelis Medicare Advantage	$1,876.88
Rate for Payer: Group Health Inc Commercial	$893.75
Rate for Payer: Group Health Inc Medicare	$625.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$893.75
Rate for Payer: Hamaspik Choice Inc Medicare	$893.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,161.88

IMPLANT STY 110 360 CC 110-360

Facility

$1,854.00

Service Code	HCPCS L8600
Hospital Charge Code	40005945
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$927.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$927.00
Rate for Payer: Hamaspik Choice Inc Medicare	$927.00

IMPLANT STY 110 360 CC 110-360

Facility

$1,854.00

Service Code	HCPCS L8600
Hospital Charge Code	40005945
Hospital Revenue Code	278
Min. Negotiated Rate	$326.16
Max. Negotiated Rate	$1,946.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,019.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$326.16
Rate for Payer: Aetna Government	$326.16
Rate for Payer: Brighton Health Commercial	$1,112.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$927.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,066.05
Rate for Payer: EmblemHealth Commercial	$927.00
Rate for Payer: Fidelis Medicare Advantage	$1,946.70
Rate for Payer: Group Health Inc Commercial	$927.00
Rate for Payer: Group Health Inc Medicare	$648.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$927.00
Rate for Payer: Hamaspik Choice Inc Medicare	$927.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,205.10

IMPLANT,STY 15, 397 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905542
Hospital Revenue Code	278
Min. Negotiated Rate	$893.75
Max. Negotiated Rate	$893.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$893.75
Rate for Payer: Hamaspik Choice Inc Medicare	$893.75

IMPLANT,STY 15, 397 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905542
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,876.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$983.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,072.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$893.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,027.81
Rate for Payer: EmblemHealth Commercial	$893.75
Rate for Payer: Fidelis Medicare Advantage	$1,876.88
Rate for Payer: Group Health Inc Commercial	$893.75
Rate for Payer: Group Health Inc Medicare	$625.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$893.75
Rate for Payer: Hamaspik Choice Inc Medicare	$893.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,161.88

IMPLANT STY 15 397 CC 15-397

Facility

$1,854.00

Service Code	HCPCS L8600
Hospital Charge Code	40005942
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$927.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$927.00
Rate for Payer: Hamaspik Choice Inc Medicare	$927.00

Know your out-of-pocket cost for care.

All Charges