St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ORTHOFIX CLAMPS

Facility

$920.00

Hospital Charge Code	40200693
Hospital Revenue Code	270
Min. Negotiated Rate	$322.00
Max. Negotiated Rate	$736.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$506.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$460.00
Rate for Payer: Aetna Government	$460.00
Rate for Payer: Brighton Health Commercial	$690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$736.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$625.60
Rate for Payer: Group Health Inc Commercial	$460.00
Rate for Payer: Group Health Inc Medicare	$322.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$460.00

ORTHO INTRAMED BONE PLUG/SMALL

Facility

$272.00

Hospital Charge Code	40202206
Hospital Revenue Code	270
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$217.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$149.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$136.00
Rate for Payer: Aetna Government	$136.00
Rate for Payer: Brighton Health Commercial	$204.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.96
Rate for Payer: Group Health Inc Commercial	$136.00
Rate for Payer: Group Health Inc Medicare	$95.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.00
Rate for Payer: Hamaspik Choice Inc Medicare	$136.00

ORTHOPAEDICS 7HLE RECON PLATE

Facility

$511.00

Service Code	HCPCS C1713
Hospital Charge Code	40201385
Hospital Revenue Code	278
Min. Negotiated Rate	$255.50
Max. Negotiated Rate	$255.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.50
Rate for Payer: Hamaspik Choice Inc Medicare	$255.50

ORTHOPAEDICS 7HLE RECON PLATE

Facility

$511.00

Service Code	HCPCS C1713
Hospital Charge Code	40201385
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$536.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$281.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$306.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$255.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$293.82
Rate for Payer: EmblemHealth Commercial	$255.50
Rate for Payer: Fidelis Medicare Advantage	$536.55
Rate for Payer: Group Health Inc Commercial	$255.50
Rate for Payer: Group Health Inc Medicare	$178.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.50
Rate for Payer: Hamaspik Choice Inc Medicare	$255.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$332.15

ORTHOPED 1.60MM SMOOTH GUIDE

Facility

$39.00

Hospital Charge Code	40205509
Hospital Revenue Code	270
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$31.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.50
Rate for Payer: Aetna Government	$19.50
Rate for Payer: Brighton Health Commercial	$29.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.52
Rate for Payer: Group Health Inc Commercial	$19.50
Rate for Payer: Group Health Inc Medicare	$13.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.50
Rate for Payer: Hamaspik Choice Inc Medicare	$19.50

ORTHOPED 22MM I-PLATE

Facility

$930.00

Service Code	HCPCS C1713
Hospital Charge Code	40206275
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$976.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$511.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$558.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$465.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$534.75
Rate for Payer: EmblemHealth Commercial	$465.00
Rate for Payer: Fidelis Medicare Advantage	$976.50
Rate for Payer: Group Health Inc Commercial	$465.00
Rate for Payer: Group Health Inc Medicare	$325.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$465.00
Rate for Payer: Hamaspik Choice Inc Medicare	$465.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$604.50

ORTHOPED 22MM I-PLATE

Facility

$930.00

Service Code	HCPCS C1713
Hospital Charge Code	40206275
Hospital Revenue Code	278
Min. Negotiated Rate	$465.00
Max. Negotiated Rate	$465.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$465.00
Rate for Payer: Hamaspik Choice Inc Medicare	$465.00

ORTHOPED 24MM O PLATE

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	40205507
Hospital Revenue Code	278
Min. Negotiated Rate	$440.00
Max. Negotiated Rate	$440.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$440.00
Rate for Payer: Hamaspik Choice Inc Medicare	$440.00

ORTHOPED 24MM O PLATE

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	40205507
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$924.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$484.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$528.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$506.00
Rate for Payer: EmblemHealth Commercial	$440.00
Rate for Payer: Fidelis Medicare Advantage	$924.00
Rate for Payer: Group Health Inc Commercial	$440.00
Rate for Payer: Group Health Inc Medicare	$308.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$440.00
Rate for Payer: Hamaspik Choice Inc Medicare	$440.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$572.00

ORTHOPED 28MM CANN SCREW

Facility

$430.00

Service Code	HCPCS C1713
Hospital Charge Code	40205508
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$451.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$236.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$258.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$215.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$247.25
Rate for Payer: EmblemHealth Commercial	$215.00
Rate for Payer: Fidelis Medicare Advantage	$451.50
Rate for Payer: Group Health Inc Commercial	$215.00
Rate for Payer: Group Health Inc Medicare	$150.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$215.00
Rate for Payer: Hamaspik Choice Inc Medicare	$215.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$279.50

ORTHOPED 28MM CANN SCREW

Facility

$430.00

Service Code	HCPCS C1713
Hospital Charge Code	40205508
Hospital Revenue Code	278
Min. Negotiated Rate	$215.00
Max. Negotiated Rate	$215.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$215.00
Rate for Payer: Hamaspik Choice Inc Medicare	$215.00

ORTHOPED 3.2MM DRILL BIT

Facility

$640.00

Hospital Charge Code	40205511
Hospital Revenue Code	270
Min. Negotiated Rate	$224.00
Max. Negotiated Rate	$512.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$352.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$320.00
Rate for Payer: Aetna Government	$320.00
Rate for Payer: Brighton Health Commercial	$480.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$512.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$435.20
Rate for Payer: Group Health Inc Commercial	$320.00
Rate for Payer: Group Health Inc Medicare	$224.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$320.00
Rate for Payer: Hamaspik Choice Inc Medicare	$320.00

ORTHOPED 4-H LEFT PLATE

Facility

$3,080.00

Service Code	HCPCS C1713
Hospital Charge Code	40206274
Hospital Revenue Code	278
Min. Negotiated Rate	$1,540.00
Max. Negotiated Rate	$1,540.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,540.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,540.00

ORTHOPED 4-H LEFT PLATE

Facility

$3,080.00

Service Code	HCPCS C1713
Hospital Charge Code	40206274
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,234.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,848.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,540.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,771.00
Rate for Payer: EmblemHealth Commercial	$1,540.00
Rate for Payer: Fidelis Medicare Advantage	$3,234.00
Rate for Payer: Group Health Inc Commercial	$1,540.00
Rate for Payer: Group Health Inc Medicare	$1,078.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,540.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,540.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,002.00

ORTHOPED CANN. SCREW

Facility

$456.00

Service Code	HCPCS C1713
Hospital Charge Code	40206273
Hospital Revenue Code	278
Min. Negotiated Rate	$228.00
Max. Negotiated Rate	$228.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.00
Rate for Payer: Hamaspik Choice Inc Medicare	$228.00

ORTHOPED CANN. SCREW

Facility

$456.00

Service Code	HCPCS C1713
Hospital Charge Code	40206273
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$478.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$250.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$273.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$228.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$262.20
Rate for Payer: EmblemHealth Commercial	$228.00
Rate for Payer: Fidelis Medicare Advantage	$478.80
Rate for Payer: Group Health Inc Commercial	$228.00
Rate for Payer: Group Health Inc Medicare	$159.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.00
Rate for Payer: Hamaspik Choice Inc Medicare	$228.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$296.40

ORTHOPEDIC HELMET

Facility

$1,930.50

Hospital Charge Code	40203158
Hospital Revenue Code	272
Min. Negotiated Rate	$675.68
Max. Negotiated Rate	$1,544.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,061.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$965.25
Rate for Payer: Aetna Government	$965.25
Rate for Payer: Brighton Health Commercial	$1,447.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,544.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,312.74
Rate for Payer: Group Health Inc Commercial	$965.25
Rate for Payer: Group Health Inc Medicare	$675.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$965.25
Rate for Payer: Hamaspik Choice Inc Medicare	$965.25

ORTHOPED LOCKING SCREW

Facility

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	40206272
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

ORTHOPED LOCKING SCREW

Facility

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	40206272
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

ORTHO RECORDS

Facility

$200.00

Service Code	HCPCS D8999
Hospital Charge Code	42302185
Hospital Revenue Code	361
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$100.00
Rate for Payer: Aetna Government	$100.00
Rate for Payer: Brighton Health Commercial	$150.00
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: Group Health Inc Commercial	$100.00
Rate for Payer: Group Health Inc Medicare	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00

ORTHO RETENT/REMOV APPL. RETAINER

Facility

$435.00

Service Code	HCPCS D8680
Hospital Charge Code	42303370
Hospital Revenue Code	361
Min. Negotiated Rate	$152.25
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$282.81
Rate for Payer: Aetna Government	$282.81
Rate for Payer: Brighton Health Commercial	$326.25
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: Group Health Inc Commercial	$217.50
Rate for Payer: Group Health Inc Medicare	$152.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.50
Rate for Payer: Hamaspik Choice Inc Medicare	$217.50

ORTHO REUN HA FRAC STM HUMCOMP8MM

Facility

$7,560.00

Service Code	HCPCS C1776
Hospital Charge Code	40202365
Hospital Revenue Code	278
Min. Negotiated Rate	$3,780.00
Max. Negotiated Rate	$3,780.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,780.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,780.00

ORTHO REUN HA FRAC STM HUMCOMP8MM

Facility

$7,560.00

Service Code	HCPCS C1776
Hospital Charge Code	40202365
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,938.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,158.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,536.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,780.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,347.00
Rate for Payer: EmblemHealth Commercial	$3,780.00
Rate for Payer: Fidelis Medicare Advantage	$7,938.00
Rate for Payer: Group Health Inc Commercial	$3,780.00
Rate for Payer: Group Health Inc Medicare	$2,646.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,780.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,780.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,914.00

ORTHO REUN HA FRAC STM HUMCOMP9MM

Facility

$7,560.00

Service Code	HCPCS C1776
Hospital Charge Code	40202366
Hospital Revenue Code	278
Min. Negotiated Rate	$3,780.00
Max. Negotiated Rate	$3,780.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,780.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,780.00

ORTHO REUN HA FRAC STM HUMCOMP9MM

Facility

$7,560.00

Service Code	HCPCS C1776
Hospital Charge Code	40202366
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,938.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,158.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,536.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,780.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,347.00
Rate for Payer: EmblemHealth Commercial	$3,780.00
Rate for Payer: Fidelis Medicare Advantage	$7,938.00
Rate for Payer: Group Health Inc Commercial	$3,780.00
Rate for Payer: Group Health Inc Medicare	$2,646.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,780.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,780.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,914.00

Know your out-of-pocket cost for care.

All Charges