St. Barnabas Hospital

All Charges

Charge

Type

Price

3.5MM NCV DR OVRSZ HOLE FOR 4.0NC

Facility OP

$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: 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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$460.00
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 IP

$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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$451.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$518.85
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 IP

$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 OP

$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: 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 IP

$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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$135.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$155.25
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 IP

$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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$183.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.45
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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$183.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.45
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 IP

$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,3 X 2 HOLE,RECTANGLE

Facility IP

$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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$260.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.00
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 IP

$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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$291.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$334.65
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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$292.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$335.80
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 IP

$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

3D PLT 6X2H, CURVED SQUARE

Facility IP

$656.00

Service Code	HCPCS C1713
Hospital Charge Code	40209834
Hospital Revenue Code	278
Min. Negotiated Rate	$328.00
Max. Negotiated Rate	$328.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$328.00

3D PLT 6X2H, CURVED SQUARE

Facility OP

$656.00

Service Code	HCPCS C1713
Hospital Charge Code	40209834
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$688.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$360.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$328.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$377.20
Rate for Payer: Fidelis Medicare Advantage	$688.80
Rate for Payer: Group Health Inc Commercial	$328.00
Rate for Payer: Group Health Inc Medicare	$229.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$328.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$426.40

3D PLT,6X2 HOLE,CURVED SQUARE

Facility OP

$656.00

Service Code	HCPCS C1713
Hospital Charge Code	40201070
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$688.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$360.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$328.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$377.20
Rate for Payer: Fidelis Medicare Advantage	$688.80
Rate for Payer: Group Health Inc Commercial	$328.00
Rate for Payer: Group Health Inc Medicare	$229.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$328.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$426.40

3D PLT,6X2 HOLE,CURVED SQUARE

Facility IP

$656.00

Service Code	HCPCS C1713
Hospital Charge Code	40201070
Hospital Revenue Code	278
Min. Negotiated Rate	$328.00
Max. Negotiated Rate	$328.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$328.00

3D PLTE 3X2 HOLE SQUR 6MM PROFILE

Facility IP

$408.00

Service Code	HCPCS C1713
Hospital Charge Code	40201067
Hospital Revenue Code	278
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$204.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.00
Rate for Payer: Hamaspik Choice Inc Medicare	$204.00

3D PLTE 3X2 HOLE SQUR 6MM PROFILE

Facility OP

$408.00

Service Code	HCPCS C1713
Hospital Charge Code	40201067
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$428.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.60
Rate for Payer: Fidelis Medicare Advantage	$428.40
Rate for Payer: Group Health Inc Commercial	$204.00
Rate for Payer: Group Health Inc Medicare	$142.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.00
Rate for Payer: Hamaspik Choice Inc Medicare	$204.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$265.20

3D PROFIL PLT .6MM 2X2L RECTNGL

Facility IP

$365.00

Service Code	HCPCS C1713
Hospital Charge Code	40201063
Hospital Revenue Code	278
Min. Negotiated Rate	$182.50
Max. Negotiated Rate	$182.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.50
Rate for Payer: Hamaspik Choice Inc Medicare	$182.50

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