St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LOCKING SCREW T10 FT 2.7MM/L18MM

Facility

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64905723
Hospital Revenue Code	278
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$170.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$170.00
Rate for Payer: Hamaspik Choice Inc Medicare	$170.00

LOCKING SCREW T10 FT 2.7MM/L18MM

Facility

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64905723
Hospital Revenue Code	278
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$357.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$187.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$204.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$170.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$195.50
Rate for Payer: EmblemHealth Commercial	$170.00
Rate for Payer: Fidelis Medicare Advantage	$357.00
Rate for Payer: Group Health Inc Commercial	$170.00
Rate for Payer: Group Health Inc Medicare	$119.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$170.00
Rate for Payer: Hamaspik Choice Inc Medicare	$170.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$221.00

LOCKING SCREW T10 FT 2.7MM/L20MM

Facility

$626.88

Service Code	HCPCS C1713
Hospital Charge Code	64905725
Hospital Revenue Code	278
Min. Negotiated Rate	$313.44
Max. Negotiated Rate	$313.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.44
Rate for Payer: Hamaspik Choice Inc Medicare	$313.44

LOCKING SCREW T10 FT 2.7MM/L20MM

Facility

$626.88

Service Code	HCPCS C1713
Hospital Charge Code	64905725
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$658.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$344.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$376.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$313.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.46
Rate for Payer: EmblemHealth Commercial	$313.44
Rate for Payer: Fidelis Medicare Advantage	$658.22
Rate for Payer: Group Health Inc Commercial	$313.44
Rate for Payer: Group Health Inc Medicare	$219.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.44
Rate for Payer: Hamaspik Choice Inc Medicare	$313.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$407.47

LOCKING SCRW 4.0 X 28 MM

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	40201208
Hospital Revenue Code	278
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$388.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$203.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$222.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.75
Rate for Payer: EmblemHealth Commercial	$185.00
Rate for Payer: Fidelis Medicare Advantage	$388.50
Rate for Payer: Group Health Inc Commercial	$185.00
Rate for Payer: Group Health Inc Medicare	$129.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$240.50

LOCKING SCRW 4.0 X 28 MM

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	40201208
Hospital Revenue Code	278
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$185.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00

LOCKING SCRW 4.0 X 60MM

Facility

$190.00

Service Code	HCPCS C1713
Hospital Charge Code	40201211
Hospital Revenue Code	278
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$95.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00

LOCKING SCRW 4.0 X 60MM

Facility

$190.00

Service Code	HCPCS C1713
Hospital Charge Code	40201211
Hospital Revenue Code	278
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$199.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$114.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$109.25
Rate for Payer: EmblemHealth Commercial	$95.00
Rate for Payer: Fidelis Medicare Advantage	$199.50
Rate for Payer: Group Health Inc Commercial	$95.00
Rate for Payer: Group Health Inc Medicare	$66.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.50

LOCKING SCRW 4.O X 4 MM

Facility

$190.00

Service Code	HCPCS C1713
Hospital Charge Code	40201209
Hospital Revenue Code	278
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$199.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$114.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$109.25
Rate for Payer: EmblemHealth Commercial	$95.00
Rate for Payer: Fidelis Medicare Advantage	$199.50
Rate for Payer: Group Health Inc Commercial	$95.00
Rate for Payer: Group Health Inc Medicare	$66.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.50

LOCKING SCRW 4.O X 4 MM

Facility

$190.00

Service Code	HCPCS C1713
Hospital Charge Code	40201209
Hospital Revenue Code	278
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$95.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00

LOCKING SCRW 5 X 525

Facility

$429.00

Service Code	HCPCS C1713
Hospital Charge Code	64902809
Hospital Revenue Code	278
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$214.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.50
Rate for Payer: Hamaspik Choice Inc Medicare	$214.50

LOCKING SCRW 5 X 525

Facility

$429.00

Service Code	HCPCS C1713
Hospital Charge Code	64902809
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$450.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$257.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$214.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.68
Rate for Payer: EmblemHealth Commercial	$214.50
Rate for Payer: Fidelis Medicare Advantage	$450.45
Rate for Payer: Group Health Inc Commercial	$214.50
Rate for Payer: Group Health Inc Medicare	$150.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.50
Rate for Payer: Hamaspik Choice Inc Medicare	$214.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$278.85

LOCK PEG 2.0 X 22

Facility

$563.13

Service Code	HCPCS C1713
Hospital Charge Code	64905131
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$591.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$337.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$281.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$323.80
Rate for Payer: EmblemHealth Commercial	$281.56
Rate for Payer: Fidelis Medicare Advantage	$591.29
Rate for Payer: Group Health Inc Commercial	$281.56
Rate for Payer: Group Health Inc Medicare	$197.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.56
Rate for Payer: Hamaspik Choice Inc Medicare	$281.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$366.03

LOCK PEG 2.0 X 22

Facility

$563.13

Service Code	HCPCS C1713
Hospital Charge Code	64905131
Hospital Revenue Code	278
Min. Negotiated Rate	$281.56
Max. Negotiated Rate	$281.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.56
Rate for Payer: Hamaspik Choice Inc Medicare	$281.56

LOCK SCREW 2.3 X 13

Facility

$245.00

Service Code	HCPCS C1713
Hospital Charge Code	64902801
Hospital Revenue Code	278
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.50
Rate for Payer: Hamaspik Choice Inc Medicare	$122.50

LOCK SCREW 2.3 X 13

Facility

$245.00

Service Code	HCPCS C1713
Hospital Charge Code	64902801
Hospital Revenue Code	278
Min. Negotiated Rate	$85.75
Max. Negotiated Rate	$257.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$134.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$147.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$122.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.88
Rate for Payer: EmblemHealth Commercial	$122.50
Rate for Payer: Fidelis Medicare Advantage	$257.25
Rate for Payer: Group Health Inc Commercial	$122.50
Rate for Payer: Group Health Inc Medicare	$85.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.50
Rate for Payer: Hamaspik Choice Inc Medicare	$122.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$159.25

LOCK SCREW 2.3 X 20

Facility

$245.00

Service Code	HCPCS C1713
Hospital Charge Code	64902802
Hospital Revenue Code	278
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.50
Rate for Payer: Hamaspik Choice Inc Medicare	$122.50

LOCK SCREW 2.3 X 20

Facility

$245.00

Service Code	HCPCS C1713
Hospital Charge Code	64902802
Hospital Revenue Code	278
Min. Negotiated Rate	$85.75
Max. Negotiated Rate	$257.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$134.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$147.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$122.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.88
Rate for Payer: EmblemHealth Commercial	$122.50
Rate for Payer: Fidelis Medicare Advantage	$257.25
Rate for Payer: Group Health Inc Commercial	$122.50
Rate for Payer: Group Health Inc Medicare	$85.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.50
Rate for Payer: Hamaspik Choice Inc Medicare	$122.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$159.25

LOCKS STEAM STERIL ORNG

Facility

$0.32

Hospital Charge Code	64903833
Hospital Revenue Code	270
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.22
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16

LOCK SWVL DX 3.5 X 8.5M EYELET

Facility

$1,062.50

Service Code	HCPCS C1713
Hospital Charge Code	64906979
Hospital Revenue Code	278
Min. Negotiated Rate	$531.25
Max. Negotiated Rate	$531.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$531.25
Rate for Payer: Hamaspik Choice Inc Medicare	$531.25

LOCK SWVL DX 3.5 X 8.5M EYELET

Facility

$1,062.50

Service Code	HCPCS C1713
Hospital Charge Code	64906979
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,115.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$584.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$637.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$531.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$610.94
Rate for Payer: EmblemHealth Commercial	$531.25
Rate for Payer: Fidelis Medicare Advantage	$1,115.62
Rate for Payer: Group Health Inc Commercial	$531.25
Rate for Payer: Group Health Inc Medicare	$371.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$531.25
Rate for Payer: Hamaspik Choice Inc Medicare	$531.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$690.62

LOCM 300-399MG/ML IODINE 1ML

Facility

$63.70

Service Code	HCPCS Q9967
Hospital Charge Code	41569593
Hospital Revenue Code	255
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$50.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$47.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.32
Rate for Payer: Group Health Inc Commercial	$31.85
Rate for Payer: Group Health Inc Medicare	$22.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.85
Rate for Payer: Hamaspik Choice Inc Medicare	$31.85
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.40

LOHEXOL 350MG/ML, 100ML VIAL

Facility

$1.96

Service Code	HCPCS Q9967
Hospital Charge Code	41647021
Hospital Revenue Code	255
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$1.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.33
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.27

LOHEXOL 350MG/ML,100ML VIAL

Facility

$1.96

Service Code	HCPCS Q9967
Hospital Charge Code	41657021
Hospital Revenue Code	255
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$1.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.33
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.27

LOHEXOL 350MG/ML, 50ML VIAL

Facility

$1.96

Service Code	HCPCS Q9967
Hospital Charge Code	41647020
Hospital Revenue Code	255
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$1.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.33
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.27

Know your out-of-pocket cost for care.

All Charges