St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$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, 421 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905544
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, 421 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905544
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 15 421 CC 15-421

Facility

$1,854.00

Service Code	HCPCS L8600
Hospital Charge Code	40005943
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 15 421 CC 15-421

Facility

$1,854.00

Service Code	HCPCS L8600
Hospital Charge Code	40005943
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 15, 457 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905545
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, 457 CC

Facility

$1,787.50

Service Code	HCPCS C1789
Hospital Charge Code	64905545
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 15 457 CC 15-457

Facility

$1,854.00

Service Code	HCPCS L8600
Hospital Charge Code	40005944
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 15 457 CC 15-457

Facility

$1,854.00

Service Code	HCPCS L8600
Hospital Charge Code	40005944
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 410, LF, 440G CC

Facility

$2,737.50

Service Code	HCPCS C1789
Hospital Charge Code	64905533
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,STY 410, LF, 440G CC

Facility

$2,737.50

Service Code	HCPCS C1789
Hospital Charge Code	64905533
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,STY 410, LM, 320G CC

Facility

$2,737.50

Service Code	HCPCS C1789
Hospital Charge Code	64905532
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,STY 410, LM, 320G CC

Facility

$2,737.50

Service Code	HCPCS C1789
Hospital Charge Code	64905532
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,STY 410, MM, 400 CC

Facility

$2,737.50

Service Code	HCPCS C1789
Hospital Charge Code	64905528
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,STY 410, MM, 400 CC

Facility

$2,737.50

Service Code	HCPCS C1789
Hospital Charge Code	64905528
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,STY 410, MM, 450 CC

Facility

$2,737.50

Service Code	HCPCS C1789
Hospital Charge Code	64905530
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,STY 410, MM, 450 CC

Facility

$2,737.50

Service Code	HCPCS C1789
Hospital Charge Code	64905530
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 STY LF-410440

Facility

$2,700.00

Service Code	HCPCS L8600
Hospital Charge Code	40005937
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 STY LF-410440

Facility

$2,700.00

Service Code	HCPCS L8600
Hospital Charge Code	40005937
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 STY LM-410320

Facility

$2,700.00

Service Code	HCPCS L8600
Hospital Charge Code	40005936
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 STY LM-410320

Facility

$2,700.00

Service Code	HCPCS L8600
Hospital Charge Code	40005936
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 STY MM-410400

Facility

$2,700.00

Service Code	HCPCS L8600
Hospital Charge Code	40005934
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 STY MM-410400

Facility

$2,700.00

Service Code	HCPCS L8600
Hospital Charge Code	40005934
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 STY MM-410450

Facility

$2,700.00

Service Code	HCPCS L8600
Hospital Charge Code	40005935
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 STY MM-410450

Facility

$2,700.00

Service Code	HCPCS L8600
Hospital Charge Code	40005935
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

Know your out-of-pocket cost for care.

All Charges