St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

3.3MM FREE HAND DRILL 152.5MM

Facility

$187.20

Service Code	HCPCS C1713
Hospital Charge Code	40006473
Hospital Revenue Code	278
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$93.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.60
Rate for Payer: Hamaspik Choice Inc Medicare	$93.60

3.3MM FREE HAND TARG DRILL

Facility

$410.40

Service Code	HCPCS C1713
Hospital Charge Code	40006471
Hospital Revenue Code	278
Min. Negotiated Rate	$205.20
Max. Negotiated Rate	$205.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$205.20
Rate for Payer: Hamaspik Choice Inc Medicare	$205.20

3.3MM FREE HAND TARG DRILL

Facility

$410.40

Service Code	HCPCS C1713
Hospital Charge Code	40006471
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$430.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$225.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$246.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$205.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$235.98
Rate for Payer: EmblemHealth Commercial	$205.20
Rate for Payer: Fidelis Medicare Advantage	$430.92
Rate for Payer: Group Health Inc Commercial	$205.20
Rate for Payer: Group Health Inc Medicare	$143.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$205.20
Rate for Payer: Hamaspik Choice Inc Medicare	$205.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$266.76

3/4SZ LID W/RETENTION PLT SLIVER

Facility

$228.44

Hospital Charge Code	40209548
Hospital Revenue Code	270
Min. Negotiated Rate	$79.95
Max. Negotiated Rate	$182.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$114.22
Rate for Payer: Aetna Government	$114.22
Rate for Payer: Brighton Health Commercial	$171.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$182.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$155.34
Rate for Payer: Group Health Inc Commercial	$114.22
Rate for Payer: Group Health Inc Medicare	$79.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.22
Rate for Payer: Hamaspik Choice Inc Medicare	$114.22

3.5 DRILL BIT

Facility

$165.60

Hospital Charge Code	40202760
Hospital Revenue Code	272
Min. Negotiated Rate	$57.96
Max. Negotiated Rate	$132.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$82.80
Rate for Payer: Aetna Government	$82.80
Rate for Payer: Brighton Health Commercial	$124.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$132.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.61
Rate for Payer: Group Health Inc Commercial	$82.80
Rate for Payer: Group Health Inc Medicare	$57.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.80
Rate for Payer: Hamaspik Choice Inc Medicare	$82.80

3.5MML HEX DRIVER AR/DIST SCRW

Facility

$672.00

Service Code	HCPCS C1713
Hospital Charge Code	40006151
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$705.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$369.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$403.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$336.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$386.40
Rate for Payer: EmblemHealth Commercial	$336.00
Rate for Payer: Fidelis Medicare Advantage	$705.60
Rate for Payer: Group Health Inc Commercial	$336.00
Rate for Payer: Group Health Inc Medicare	$235.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$336.00
Rate for Payer: Hamaspik Choice Inc Medicare	$336.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$436.80

3.5MML HEX DRIVER AR/DIST SCRW

Facility

$672.00

Service Code	HCPCS C1713
Hospital Charge Code	40006151
Hospital Revenue Code	278
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$336.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$336.00
Rate for Payer: Hamaspik Choice Inc Medicare	$336.00

3.5MM NCV DR OVRSZ HOLE FOR 4.0NC

Facility

$318.90

Hospital Charge Code	40006772
Hospital Revenue Code	272
Min. Negotiated Rate	$111.62
Max. Negotiated Rate	$255.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$175.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$159.45
Rate for Payer: Aetna Government	$159.45
Rate for Payer: Brighton Health Commercial	$239.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$255.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$216.85
Rate for Payer: Group Health Inc Commercial	$159.45
Rate for Payer: Group Health Inc Medicare	$111.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.45
Rate for Payer: Hamaspik Choice Inc Medicare	$159.45

3.5MMS HEX DRIVER DISTAL SCREW

Facility

$800.00

Service Code	HCPCS C1713
Hospital Charge Code	40006146
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$840.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$440.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$480.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$460.00
Rate for Payer: EmblemHealth Commercial	$400.00
Rate for Payer: Fidelis Medicare Advantage	$840.00
Rate for Payer: Group Health Inc Commercial	$400.00
Rate for Payer: Group Health Inc Medicare	$280.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$520.00

3.5MMS HEX DRIVER DISTAL SCREW

Facility

$800.00

Service Code	HCPCS C1713
Hospital Charge Code	40006146
Hospital Revenue Code	278
Min. Negotiated Rate	$400.00
Max. Negotiated Rate	$400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00

3.5MMX10CM ROC XS NONABS&CP2 NDLS

Facility

$902.34

Service Code	HCPCS C1713
Hospital Charge Code	40202051
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$947.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$496.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$541.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$451.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$518.85
Rate for Payer: EmblemHealth Commercial	$451.17
Rate for Payer: Fidelis Medicare Advantage	$947.46
Rate for Payer: Group Health Inc Commercial	$451.17
Rate for Payer: Group Health Inc Medicare	$315.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$451.17
Rate for Payer: Hamaspik Choice Inc Medicare	$451.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$586.52

3.5MMX10CM ROC XS NONABS&CP2 NDLS

Facility

$902.34

Service Code	HCPCS C1713
Hospital Charge Code	40202051
Hospital Revenue Code	278
Min. Negotiated Rate	$451.17
Max. Negotiated Rate	$451.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$451.17
Rate for Payer: Hamaspik Choice Inc Medicare	$451.17

3.5 NON LOCKING SCREW

Facility

$32.00

Hospital Charge Code	40202392
Hospital Revenue Code	270
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$25.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.00
Rate for Payer: Aetna Government	$16.00
Rate for Payer: Brighton Health Commercial	$24.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.76
Rate for Payer: Group Health Inc Commercial	$16.00
Rate for Payer: Group Health Inc Medicare	$11.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00

3.5X16 LOCKING SCREW 212.104

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40202750
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.00
Rate for Payer: Hamaspik Choice Inc Medicare	$135.00

3.5X16 LOCKING SCREW 212.104

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40202750
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$283.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$148.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$162.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$155.25
Rate for Payer: EmblemHealth Commercial	$135.00
Rate for Payer: Fidelis Medicare Advantage	$283.50
Rate for Payer: Group Health Inc Commercial	$135.00
Rate for Payer: Group Health Inc Medicare	$94.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.00
Rate for Payer: Hamaspik Choice Inc Medicare	$135.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$175.50

3D FL PROFIL PLT .6MM 2X2L QUAD

Facility

$366.00

Service Code	HCPCS C1713
Hospital Charge Code	40201064
Hospital Revenue Code	278
Min. Negotiated Rate	$183.00
Max. Negotiated Rate	$183.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$183.00
Rate for Payer: Hamaspik Choice Inc Medicare	$183.00

3D FL PROFIL PLT .6MM 2X2L QUAD

Facility

$366.00

Service Code	HCPCS C1713
Hospital Charge Code	40201064
Hospital Revenue Code	278
Min. Negotiated Rate	$128.10
Max. Negotiated Rate	$384.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$201.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$219.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$183.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.45
Rate for Payer: EmblemHealth Commercial	$183.00
Rate for Payer: Fidelis Medicare Advantage	$384.30
Rate for Payer: Group Health Inc Commercial	$183.00
Rate for Payer: Group Health Inc Medicare	$128.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$183.00
Rate for Payer: Hamaspik Choice Inc Medicare	$183.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$237.90

3D PLT 2X2 H SQ 6MM PROFILE

Facility

$366.00

Service Code	HCPCS C1713
Hospital Charge Code	40201061
Hospital Revenue Code	278
Min. Negotiated Rate	$183.00
Max. Negotiated Rate	$183.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$183.00
Rate for Payer: Hamaspik Choice Inc Medicare	$183.00

3D PLT 2X2 H SQ 6MM PROFILE

Facility

$366.00

Service Code	HCPCS C1713
Hospital Charge Code	40201061
Hospital Revenue Code	278
Min. Negotiated Rate	$128.10
Max. Negotiated Rate	$384.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$201.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$219.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$183.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.45
Rate for Payer: EmblemHealth Commercial	$183.00
Rate for Payer: Fidelis Medicare Advantage	$384.30
Rate for Payer: Group Health Inc Commercial	$183.00
Rate for Payer: Group Health Inc Medicare	$128.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$183.00
Rate for Payer: Hamaspik Choice Inc Medicare	$183.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$237.90

3D PLT,3 X 2 HOLE,RECTANGLE

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	40201068
Hospital Revenue Code	278
Min. Negotiated Rate	$260.00
Max. Negotiated Rate	$260.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.00
Rate for Payer: Hamaspik Choice Inc Medicare	$260.00

3D PLT,3 X 2 HOLE,RECTANGLE

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	40201068
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$546.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$286.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$312.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.00
Rate for Payer: EmblemHealth Commercial	$260.00
Rate for Payer: Fidelis Medicare Advantage	$546.00
Rate for Payer: Group Health Inc Commercial	$260.00
Rate for Payer: Group Health Inc Medicare	$182.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.00
Rate for Payer: Hamaspik Choice Inc Medicare	$260.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$338.00

3D PLT, 4 X 2 HOLE , SQUARE

Facility

$582.00

Service Code	HCPCS C1713
Hospital Charge Code	40201069
Hospital Revenue Code	278
Min. Negotiated Rate	$291.00
Max. Negotiated Rate	$291.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$291.00
Rate for Payer: Hamaspik Choice Inc Medicare	$291.00

3D PLT, 4 X 2 HOLE , SQUARE

Facility

$582.00

Service Code	HCPCS C1713
Hospital Charge Code	40201069
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$611.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$320.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$349.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$291.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$334.65
Rate for Payer: EmblemHealth Commercial	$291.00
Rate for Payer: Fidelis Medicare Advantage	$611.10
Rate for Payer: Group Health Inc Commercial	$291.00
Rate for Payer: Group Health Inc Medicare	$203.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$291.00
Rate for Payer: Hamaspik Choice Inc Medicare	$291.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$378.30

3D PLT 4X2H, SQUARE

Facility

$584.00

Service Code	HCPCS C1713
Hospital Charge Code	40209833
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$613.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$321.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$350.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$292.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$335.80
Rate for Payer: EmblemHealth Commercial	$292.00
Rate for Payer: Fidelis Medicare Advantage	$613.20
Rate for Payer: Group Health Inc Commercial	$292.00
Rate for Payer: Group Health Inc Medicare	$204.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$292.00
Rate for Payer: Hamaspik Choice Inc Medicare	$292.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$379.60

3D PLT 4X2H, SQUARE

Facility

$584.00

Service Code	HCPCS C1713
Hospital Charge Code	40209833
Hospital Revenue Code	278
Min. Negotiated Rate	$292.00
Max. Negotiated Rate	$292.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$292.00
Rate for Payer: Hamaspik Choice Inc Medicare	$292.00

Know your out-of-pocket cost for care.

All Charges