St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LACTULOSE ENCEPHALOPATHY 10 GM/15ML PO SOLN [38969]

Facility

$0.08

Service Code	NDC 45963043864
Hospital Charge Code	45963043864
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

LAG SCREW 100MMX10.5

Facility

$819.00

Service Code	HCPCS C1713
Hospital Charge Code	40200782
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$859.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$450.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$491.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$409.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$470.92
Rate for Payer: EmblemHealth Commercial	$409.50
Rate for Payer: Fidelis Medicare Advantage	$859.95
Rate for Payer: Group Health Inc Commercial	$409.50
Rate for Payer: Group Health Inc Medicare	$286.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$409.50
Rate for Payer: Hamaspik Choice Inc Medicare	$409.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$532.35

LAG SCREW 100MMX10.5

Facility

$819.00

Service Code	HCPCS C1713
Hospital Charge Code	40200782
Hospital Revenue Code	278
Min. Negotiated Rate	$409.50
Max. Negotiated Rate	$409.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$409.50
Rate for Payer: Hamaspik Choice Inc Medicare	$409.50

LAG SCREW 3.2MM SLEEVE

Facility

$1,472.00

Service Code	HCPCS C1713
Hospital Charge Code	40006131
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,545.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$809.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$883.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$736.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$846.40
Rate for Payer: EmblemHealth Commercial	$736.00
Rate for Payer: Fidelis Medicare Advantage	$1,545.60
Rate for Payer: Group Health Inc Commercial	$736.00
Rate for Payer: Group Health Inc Medicare	$515.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$736.00
Rate for Payer: Hamaspik Choice Inc Medicare	$736.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$956.80

LAG SCREW 3.2MM SLEEVE

Facility

$1,472.00

Service Code	HCPCS C1713
Hospital Charge Code	40006131
Hospital Revenue Code	278
Min. Negotiated Rate	$736.00
Max. Negotiated Rate	$736.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$736.00
Rate for Payer: Hamaspik Choice Inc Medicare	$736.00

LAG SCREW 95MMX10.5

Facility

$682.00

Service Code	HCPCS C1713
Hospital Charge Code	40200783
Hospital Revenue Code	278
Min. Negotiated Rate	$341.00
Max. Negotiated Rate	$341.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$341.00
Rate for Payer: Hamaspik Choice Inc Medicare	$341.00

LAG SCREW 95MMX10.5

Facility

$682.00

Service Code	HCPCS C1713
Hospital Charge Code	40200783
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$716.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$375.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$409.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$341.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$392.15
Rate for Payer: EmblemHealth Commercial	$341.00
Rate for Payer: Fidelis Medicare Advantage	$716.10
Rate for Payer: Group Health Inc Commercial	$341.00
Rate for Payer: Group Health Inc Medicare	$238.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$341.00
Rate for Payer: Hamaspik Choice Inc Medicare	$341.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$443.30

LAG SCREW COUPLING ROD

Facility

$1,888.00

Service Code	HCPCS C1713
Hospital Charge Code	40006134
Hospital Revenue Code	278
Min. Negotiated Rate	$944.00
Max. Negotiated Rate	$944.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$944.00
Rate for Payer: Hamaspik Choice Inc Medicare	$944.00

LAG SCREW COUPLING ROD

Facility

$1,888.00

Service Code	HCPCS C1713
Hospital Charge Code	40006134
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,982.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,038.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,132.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$944.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,085.60
Rate for Payer: EmblemHealth Commercial	$944.00
Rate for Payer: Fidelis Medicare Advantage	$1,982.40
Rate for Payer: Group Health Inc Commercial	$944.00
Rate for Payer: Group Health Inc Medicare	$660.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$944.00
Rate for Payer: Hamaspik Choice Inc Medicare	$944.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,227.20

LAG SCREW DEPTH GAUGE

Facility

$976.00

Service Code	HCPCS C1713
Hospital Charge Code	40006133
Hospital Revenue Code	278
Min. Negotiated Rate	$488.00
Max. Negotiated Rate	$488.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$488.00
Rate for Payer: Hamaspik Choice Inc Medicare	$488.00

LAG SCREW DEPTH GAUGE

Facility

$976.00

Service Code	HCPCS C1713
Hospital Charge Code	40006133
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,024.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$536.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$585.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$488.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$561.20
Rate for Payer: EmblemHealth Commercial	$488.00
Rate for Payer: Fidelis Medicare Advantage	$1,024.80
Rate for Payer: Group Health Inc Commercial	$488.00
Rate for Payer: Group Health Inc Medicare	$341.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$488.00
Rate for Payer: Hamaspik Choice Inc Medicare	$488.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$634.40

LAG SCREW DRILL

Facility

$2,576.00

Service Code	HCPCS C1713
Hospital Charge Code	40006132
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,704.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,416.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,545.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,288.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,481.20
Rate for Payer: EmblemHealth Commercial	$1,288.00
Rate for Payer: Fidelis Medicare Advantage	$2,704.80
Rate for Payer: Group Health Inc Commercial	$1,288.00
Rate for Payer: Group Health Inc Medicare	$901.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,288.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,288.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,674.40

LAG SCREW DRILL

Facility

$2,576.00

Service Code	HCPCS C1713
Hospital Charge Code	40006132
Hospital Revenue Code	278
Min. Negotiated Rate	$1,288.00
Max. Negotiated Rate	$1,288.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,288.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,288.00

LAG SCREW DRIVER

Facility

$976.00

Service Code	HCPCS C1713
Hospital Charge Code	40006135
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,024.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$536.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$585.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$488.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$561.20
Rate for Payer: EmblemHealth Commercial	$488.00
Rate for Payer: Fidelis Medicare Advantage	$1,024.80
Rate for Payer: Group Health Inc Commercial	$488.00
Rate for Payer: Group Health Inc Medicare	$341.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$488.00
Rate for Payer: Hamaspik Choice Inc Medicare	$488.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$634.40

LAG SCREW DRIVER

Facility

$976.00

Service Code	HCPCS C1713
Hospital Charge Code	40006135
Hospital Revenue Code	278
Min. Negotiated Rate	$488.00
Max. Negotiated Rate	$488.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$488.00
Rate for Payer: Hamaspik Choice Inc Medicare	$488.00

LAG SCREW DRIVER CAPTURED

Facility

$1,984.00

Service Code	HCPCS C1713
Hospital Charge Code	40006140
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,083.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,091.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,190.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$992.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,140.80
Rate for Payer: EmblemHealth Commercial	$992.00
Rate for Payer: Fidelis Medicare Advantage	$2,083.20
Rate for Payer: Group Health Inc Commercial	$992.00
Rate for Payer: Group Health Inc Medicare	$694.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$992.00
Rate for Payer: Hamaspik Choice Inc Medicare	$992.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,289.60

LAG SCREW DRIVER CAPTURED

Facility

$1,984.00

Service Code	HCPCS C1713
Hospital Charge Code	40006140
Hospital Revenue Code	278
Min. Negotiated Rate	$992.00
Max. Negotiated Rate	$992.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$992.00
Rate for Payer: Hamaspik Choice Inc Medicare	$992.00

LAG SCREW SHEATH

Facility

$1,056.00

Service Code	HCPCS C1713
Hospital Charge Code	40006129
Hospital Revenue Code	278
Min. Negotiated Rate	$528.00
Max. Negotiated Rate	$528.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$528.00
Rate for Payer: Hamaspik Choice Inc Medicare	$528.00

LAG SCREW SHEATH

Facility

$1,056.00

Service Code	HCPCS C1713
Hospital Charge Code	40006129
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,108.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$580.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$633.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$528.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$607.20
Rate for Payer: EmblemHealth Commercial	$528.00
Rate for Payer: Fidelis Medicare Advantage	$1,108.80
Rate for Payer: Group Health Inc Commercial	$528.00
Rate for Payer: Group Health Inc Medicare	$369.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$528.00
Rate for Payer: Hamaspik Choice Inc Medicare	$528.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$686.40

LAG SCREW TAP

Facility

$1,488.00

Service Code	HCPCS C1713
Hospital Charge Code	40006138
Hospital Revenue Code	278
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$744.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$744.00
Rate for Payer: Hamaspik Choice Inc Medicare	$744.00

LAG SCREW TAP

Facility

$1,488.00

Service Code	HCPCS C1713
Hospital Charge Code	40006138
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,562.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$818.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$892.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$744.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$855.60
Rate for Payer: EmblemHealth Commercial	$744.00
Rate for Payer: Fidelis Medicare Advantage	$1,562.40
Rate for Payer: Group Health Inc Commercial	$744.00
Rate for Payer: Group Health Inc Medicare	$520.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$744.00
Rate for Payer: Hamaspik Choice Inc Medicare	$744.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$967.20

LAG SCREW TROCHAR

Facility

$816.00

Service Code	HCPCS C1713
Hospital Charge Code	40006130
Hospital Revenue Code	278
Min. Negotiated Rate	$408.00
Max. Negotiated Rate	$408.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$408.00
Rate for Payer: Hamaspik Choice Inc Medicare	$408.00

LAG SCREW TROCHAR

Facility

$816.00

Service Code	HCPCS C1713
Hospital Charge Code	40006130
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$856.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$448.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$489.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$408.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$469.20
Rate for Payer: EmblemHealth Commercial	$408.00
Rate for Payer: Fidelis Medicare Advantage	$856.80
Rate for Payer: Group Health Inc Commercial	$408.00
Rate for Payer: Group Health Inc Medicare	$285.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$408.00
Rate for Payer: Hamaspik Choice Inc Medicare	$408.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$530.40

LAMBSKIN

Facility

$107.73

Hospital Charge Code	40203601
Hospital Revenue Code	270
Min. Negotiated Rate	$37.71
Max. Negotiated Rate	$86.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$53.86
Rate for Payer: Aetna Government	$53.86
Rate for Payer: Brighton Health Commercial	$80.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.26
Rate for Payer: Group Health Inc Commercial	$53.86
Rate for Payer: Group Health Inc Medicare	$37.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.86
Rate for Payer: Hamaspik Choice Inc Medicare	$53.86

LAMBSKIN (REAL)

Facility

$194.20

Hospital Charge Code	40203602
Hospital Revenue Code	270
Min. Negotiated Rate	$67.97
Max. Negotiated Rate	$155.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$97.10
Rate for Payer: Aetna Government	$97.10
Rate for Payer: Brighton Health Commercial	$145.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.06
Rate for Payer: Group Health Inc Commercial	$97.10
Rate for Payer: Group Health Inc Medicare	$67.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.10
Rate for Payer: Hamaspik Choice Inc Medicare	$97.10

Know your out-of-pocket cost for care.

All Charges