St. Barnabas Hospital

All Charges

Charge

Type

Price

ARTH ENDO BL GASTRO R RE

Facility OP

$2,558.00

Hospital Charge Code	40009746
Hospital Revenue Code	272
Min. Negotiated Rate	$895.30
Max. Negotiated Rate	$2,046.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,406.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,279.00
Rate for Payer: Aetna Government	$1,279.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,046.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,739.44
Rate for Payer: Group Health Inc Commercial	$1,279.00
Rate for Payer: Group Health Inc Medicare	$895.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,279.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,279.00

ARTHEX 3.0X32MM CANN SCREW

Facility OP

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40205137
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
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	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: Fidelis Medicare Advantage	$315.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$195.00

ARTHEX 3.0X32MM CANN SCREW

Facility IP

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40205137
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

ARTH GUIDEWIRE TROCAR TIP 1.35MM

Facility IP

$29.00

Service Code	HCPCS C1769
Hospital Charge Code	40201577
Hospital Revenue Code	278
Min. Negotiated Rate	$14.50
Max. Negotiated Rate	$14.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.50
Rate for Payer: Hamaspik Choice Inc Medicare	$14.50

ARTH GUIDEWIRE TROCAR TIP 1.35MM

Facility OP

$29.00

Service Code	HCPCS C1769
Hospital Charge Code	40201577
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$30.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.68
Rate for Payer: Fidelis Medicare Advantage	$30.45
Rate for Payer: Group Health Inc Commercial	$14.50
Rate for Payer: Group Health Inc Medicare	$10.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.50
Rate for Payer: Hamaspik Choice Inc Medicare	$14.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.85

ARTH LOCK DISL FIB LFT 6H

Facility OP

$1,450.00

Service Code	HCPCS C1713
Hospital Charge Code	40004890
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,522.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$797.50
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	$725.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$833.75
Rate for Payer: Fidelis Medicare Advantage	$1,522.50
Rate for Payer: Group Health Inc Commercial	$725.00
Rate for Payer: Group Health Inc Medicare	$507.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$725.00
Rate for Payer: Hamaspik Choice Inc Medicare	$725.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$942.50

ARTH LOCK DISL FIB LFT 6H

Facility IP

$1,450.00

Service Code	HCPCS C1713
Hospital Charge Code	40004890
Hospital Revenue Code	278
Min. Negotiated Rate	$725.00
Max. Negotiated Rate	$725.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$725.00
Rate for Payer: Hamaspik Choice Inc Medicare	$725.00

ARTH LO PRO SCR 3.5 16MM

Facility IP

$70.00

Service Code	HCPCS C1713
Hospital Charge Code	40004889
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00
Rate for Payer: Hamaspik Choice Inc Medicare	$35.00

ARTH LO PRO SCR 3.5 16MM

Facility OP

$70.00

Service Code	HCPCS C1713
Hospital Charge Code	40004889
Hospital Revenue Code	278
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.50
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	$35.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.25
Rate for Payer: Fidelis Medicare Advantage	$73.50
Rate for Payer: Group Health Inc Commercial	$35.00
Rate for Payer: Group Health Inc Medicare	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00
Rate for Payer: Hamaspik Choice Inc Medicare	$35.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.50

ARTHOCARE WAND

Facility OP

$280.00

Hospital Charge Code	40203060
Hospital Revenue Code	272
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$224.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.00
Rate for Payer: Aetna Government	$140.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$190.40
Rate for Payer: Group Health Inc Commercial	$140.00
Rate for Payer: Group Health Inc Medicare	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.00
Rate for Payer: Hamaspik Choice Inc Medicare	$140.00

ARTH PLATE BLE DISTAL

Facility IP

$1,590.00

Service Code	HCPCS C1713
Hospital Charge Code	40009740
Hospital Revenue Code	278
Min. Negotiated Rate	$795.00
Max. Negotiated Rate	$795.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$795.00
Rate for Payer: Hamaspik Choice Inc Medicare	$795.00

ARTH PLATE BLE DISTAL

Facility OP

$1,590.00

Service Code	HCPCS C1713
Hospital Charge Code	40009740
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,669.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$874.50
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	$795.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$914.25
Rate for Payer: Fidelis Medicare Advantage	$1,669.50
Rate for Payer: Group Health Inc Commercial	$795.00
Rate for Payer: Group Health Inc Medicare	$556.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$795.00
Rate for Payer: Hamaspik Choice Inc Medicare	$795.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,033.50

ARTHR 3.5 DRILL BIT

Facility IP

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	40204202
Hospital Revenue Code	278
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$85.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

ARTHR 3.5 DRILL BIT

Facility OP

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	40204202
Hospital Revenue Code	278
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$178.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
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	$85.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$97.75
Rate for Payer: Fidelis Medicare Advantage	$178.50
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$110.50

ARTHREX 2.0 DRILL BIT 2.7MM

Facility IP

$85.00

Service Code	HCPCS C1713
Hospital Charge Code	40207458
Hospital Revenue Code	278
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$42.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.50
Rate for Payer: Hamaspik Choice Inc Medicare	$42.50

ARTHREX 2.0 DRILL BIT 2.7MM

Facility OP

$85.00

Service Code	HCPCS C1713
Hospital Charge Code	40207458
Hospital Revenue Code	278
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.75
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	$42.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.88
Rate for Payer: Fidelis Medicare Advantage	$89.25
Rate for Payer: Group Health Inc Commercial	$42.50
Rate for Payer: Group Health Inc Medicare	$29.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.50
Rate for Payer: Hamaspik Choice Inc Medicare	$42.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$55.25

ARTHREX 2.0MM DRILL BIT CALIBRAT

Facility IP

$95.00

Service Code	HCPCS C1713
Hospital Charge Code	40201576
Hospital Revenue Code	278
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$47.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.50
Rate for Payer: Hamaspik Choice Inc Medicare	$47.50

ARTHREX 2.0MM DRILL BIT CALIBRAT

Facility OP

$95.00

Service Code	HCPCS C1713
Hospital Charge Code	40201576
Hospital Revenue Code	278
Min. Negotiated Rate	$33.25
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.25
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	$47.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.62
Rate for Payer: Fidelis Medicare Advantage	$99.75
Rate for Payer: Group Health Inc Commercial	$47.50
Rate for Payer: Group Health Inc Medicare	$33.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.50
Rate for Payer: Hamaspik Choice Inc Medicare	$47.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.75

ARTHREX 2.5 DRILL BIT

Facility OP

$85.00

Service Code	HCPCS C1713
Hospital Charge Code	40201570
Hospital Revenue Code	278
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.75
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	$42.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.88
Rate for Payer: Fidelis Medicare Advantage	$89.25
Rate for Payer: Group Health Inc Commercial	$42.50
Rate for Payer: Group Health Inc Medicare	$29.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.50
Rate for Payer: Hamaspik Choice Inc Medicare	$42.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$55.25

ARTHREX 2.5 DRILL BIT

Facility IP

$85.00

Service Code	HCPCS C1713
Hospital Charge Code	40201570
Hospital Revenue Code	278
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$42.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.50
Rate for Payer: Hamaspik Choice Inc Medicare	$42.50

ARTHREX BIO TENODESIS DISP KIT

Facility OP

$3,420.00

Hospital Charge Code	40205151
Hospital Revenue Code	270
Min. Negotiated Rate	$1,197.00
Max. Negotiated Rate	$2,736.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,881.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,710.00
Rate for Payer: Aetna Government	$1,710.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,736.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,325.60
Rate for Payer: Group Health Inc Commercial	$1,710.00
Rate for Payer: Group Health Inc Medicare	$1,197.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,710.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,710.00

ARTHREX BTB TIGHTROPE

Facility IP

$393.00

Service Code	HCPCS C1713
Hospital Charge Code	40201550
Hospital Revenue Code	278
Min. Negotiated Rate	$196.50
Max. Negotiated Rate	$196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$196.50

ARTHREX BTB TIGHTROPE

Facility OP

$393.00

Service Code	HCPCS C1713
Hospital Charge Code	40201550
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$412.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$216.15
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	$196.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$225.98
Rate for Payer: Fidelis Medicare Advantage	$412.65
Rate for Payer: Group Health Inc Commercial	$196.50
Rate for Payer: Group Health Inc Medicare	$137.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$196.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$255.45

ARTHREX K WIRE .045

Facility IP

$20.00

Service Code	HCPCS C1713
Hospital Charge Code	40205139
Hospital Revenue Code	278
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$10.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00

ARTHREX K WIRE .045

Facility OP

$20.00

Service Code	HCPCS C1713
Hospital Charge Code	40205139
Hospital Revenue Code	278
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
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	$10.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.50
Rate for Payer: Fidelis Medicare Advantage	$21.00
Rate for Payer: Group Health Inc Commercial	$10.00
Rate for Payer: Group Health Inc Medicare	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.00

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