St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

INSERT SOFT JAW DBLE 33MM FOGARTY

Facility

$28.00

Hospital Charge Code	40202198
Hospital Revenue Code	270
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$22.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.00
Rate for Payer: Aetna Government	$14.00
Rate for Payer: Brighton Health Commercial	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.04
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00

INSERT SOFTJAW DBLE 33MM FOGARTY

Facility

$3.85

Hospital Charge Code	64902770
Hospital Revenue Code	270
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$3.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.92
Rate for Payer: Aetna Government	$1.92
Rate for Payer: Brighton Health Commercial	$2.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.62
Rate for Payer: Group Health Inc Commercial	$1.92
Rate for Payer: Group Health Inc Medicare	$1.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.92
Rate for Payer: Hamaspik Choice Inc Medicare	$1.92

INSERT SOFTJAW DBLE 61MM DSOFT86

Facility

$3.87

Hospital Charge Code	64903153
Hospital Revenue Code	270
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$3.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.94
Rate for Payer: Aetna Government	$1.94
Rate for Payer: Brighton Health Commercial	$2.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.63
Rate for Payer: Group Health Inc Commercial	$1.94
Rate for Payer: Group Health Inc Medicare	$1.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1.94

INSERT TEMP BLAADDER CATH

Facility

$330.23

Service Code	HCPCS 51702
Hospital Charge Code	40014105
Hospital Revenue Code	360
Rate for Payer: Cash Price	$147.72

INSERT TEMP BLAADDER CATH

Facility

$330.23

Service Code	HCPCS 51702
Hospital Charge Code	40014105
Hospital Revenue Code	360
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.72
Rate for Payer: Aetna Government	$147.72
Rate for Payer: Affinity Essential Plan 1&2	$103.40
Rate for Payer: Affinity Essential Plan 3&4	$103.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$103.40
Rate for Payer: Brighton Health Commercial	$247.67
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$147.72
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	$147.72
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$125.56
Rate for Payer: Fidelis Essential Plan QHP	$131.47
Rate for Payer: Fidelis Medicare Advantage	$147.72
Rate for Payer: Fidelis Qualified Health Plan	$131.47
Rate for Payer: Group Health Inc Commercial	$147.72
Rate for Payer: Group Health Inc Medicare	$147.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.12
Rate for Payer: Hamaspik Choice Inc Medicare	$147.72
Rate for Payer: Healthfirst Medicare Advantage	$125.56
Rate for Payer: Healthfirst QHP	$147.72
Rate for Payer: Humana Medicare	$150.67
Rate for Payer: Senior Whole Health Medicare Advantage	$147.72
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$147.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$147.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$118.18
Rate for Payer: Wellcare Medicare	$140.33

INSERT TEMP BLADDER CATH

Facility

$330.23

Service Code	HCPCS 51702
Hospital Charge Code	30103234
Hospital Revenue Code	450
Rate for Payer: Cash Price	$147.72

INSERT TEMP BLADDER CATH

Facility

$330.23

Service Code	HCPCS 51702
Hospital Charge Code	30103234
Hospital Revenue Code	450
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.72
Rate for Payer: Aetna Government	$147.72
Rate for Payer: Affinity Essential Plan 1&2	$103.40
Rate for Payer: Affinity Essential Plan 3&4	$103.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$103.40
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$147.72
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$147.72
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	$147.72
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$125.56
Rate for Payer: Fidelis Essential Plan QHP	$131.47
Rate for Payer: Fidelis Medicare Advantage	$147.72
Rate for Payer: Fidelis Qualified Health Plan	$131.47
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.12
Rate for Payer: Hamaspik Choice Inc Medicare	$147.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$147.72
Rate for Payer: Humana Medicare	$150.67
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$147.72
Rate for Payer: Senior Whole Health Medicare Advantage	$147.72
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$147.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$147.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$118.18
Rate for Payer: Wellcare Medicare	$140.33

INSERT TIB BEAR PS SZ-7 11MM

Facility

$4,651.50

Service Code	HCPCS C1713
Hospital Charge Code	64901783
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.75
Max. Negotiated Rate	$2,325.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,325.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,325.75

INSERT TIB BEAR PS SZ-7 11MM

Facility

$4,651.50

Service Code	HCPCS C1713
Hospital Charge Code	64901783
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,884.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,558.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,790.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,325.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,674.61
Rate for Payer: EmblemHealth Commercial	$2,325.75
Rate for Payer: Fidelis Medicare Advantage	$4,884.08
Rate for Payer: Group Health Inc Commercial	$2,325.75
Rate for Payer: Group Health Inc Medicare	$1,628.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,325.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,325.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,023.48

INSERT TIBIAL 4MM DIA LOCKING F

Facility

$88.75

Service Code	HCPCS C1713
Hospital Charge Code	64901431
Hospital Revenue Code	278
Min. Negotiated Rate	$44.38
Max. Negotiated Rate	$44.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.38
Rate for Payer: Hamaspik Choice Inc Medicare	$44.38

INSERT TIBIAL 4MM DIA LOCKING F

Facility

$88.75

Service Code	HCPCS C1713
Hospital Charge Code	64901431
Hospital Revenue Code	278
Min. Negotiated Rate	$31.06
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$53.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.03
Rate for Payer: EmblemHealth Commercial	$44.38
Rate for Payer: Fidelis Medicare Advantage	$93.19
Rate for Payer: Group Health Inc Commercial	$44.38
Rate for Payer: Group Health Inc Medicare	$31.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.38
Rate for Payer: Hamaspik Choice Inc Medicare	$44.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57.69

INSERT TIBIAL AR SZ CD/3-5

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905751
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: EmblemHealth Commercial	$2,125.00
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

INSERT TIBIAL AR SZ CD/3-5

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905751
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

INSERT TIBIAL AR SZ EF/6-9

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905748
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

INSERT TIBIAL AR SZ EF/6-9

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905748
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: EmblemHealth Commercial	$2,125.00
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

INSERT TIBIAL ARTICULAR SURFACE

Facility

$2,948.13

Service Code	HCPCS C1713
Hospital Charge Code	64903666
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,095.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,621.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,768.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,474.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,695.17
Rate for Payer: EmblemHealth Commercial	$1,474.06
Rate for Payer: Fidelis Medicare Advantage	$3,095.54
Rate for Payer: Group Health Inc Commercial	$1,474.06
Rate for Payer: Group Health Inc Medicare	$1,031.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,474.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1,474.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,916.28

INSERT TIBIAL ARTICULAR SURFACE

Facility

$2,948.13

Service Code	HCPCS C1713
Hospital Charge Code	64903666
Hospital Revenue Code	278
Min. Negotiated Rate	$1,474.06
Max. Negotiated Rate	$1,474.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,474.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1,474.06

INSERT TIBIAL ART SURFACE 5-6

Facility

$2,736.13

Service Code	HCPCS C1776
Hospital Charge Code	64904625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,368.06
Max. Negotiated Rate	$1,368.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,368.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1,368.06

INSERT TIBIAL ART SURFACE 5-6

Facility

$2,736.13

Service Code	HCPCS C1776
Hospital Charge Code	64904625
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,872.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,504.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,641.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,368.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,573.27
Rate for Payer: EmblemHealth Commercial	$1,368.06
Rate for Payer: Fidelis Medicare Advantage	$2,872.94
Rate for Payer: Group Health Inc Commercial	$1,368.06
Rate for Payer: Group Health Inc Medicare	$957.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,368.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1,368.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,778.48

INSERT TIBIAL ART SZ CD/6-9

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905771
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: EmblemHealth Commercial	$2,125.00
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

INSERT TIBIAL ART SZ CD/6-9

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905771
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

INSERT TIBIAL ART SZ EF/3-5

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905777
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: EmblemHealth Commercial	$2,125.00
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

INSERT TIBIAL ART SZ EF/3-5

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905777
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

INSERT TIBI SZ CD/3-5 12MM

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905758
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: EmblemHealth Commercial	$2,125.00
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

INSERT TIBI SZ CD/3-5 12MM

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905758
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

Know your out-of-pocket cost for care.

All Charges