St. Barnabas Hospital

All Charges

Charge

Type

Price

4.5 TAP

Facility OP

$218.00

Hospital Charge Code	40203576
Hospital Revenue Code	272
Min. Negotiated Rate	$76.30
Max. Negotiated Rate	$174.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$109.00
Rate for Payer: Aetna Government	$109.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$174.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$148.24
Rate for Payer: Group Health Inc Commercial	$109.00
Rate for Payer: Group Health Inc Medicare	$76.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.00
Rate for Payer: Hamaspik Choice Inc Medicare	$109.00

4.5X36MM SCREW

Facility OP

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	40203556
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$441.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.00
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	$210.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$241.50
Rate for Payer: Fidelis Medicare Advantage	$441.00
Rate for Payer: Group Health Inc Commercial	$210.00
Rate for Payer: Group Health Inc Medicare	$147.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$273.00

4.5X36MM SCREW

Facility IP

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	40203556
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00

4.5X44MM SCREW

Facility OP

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	40203557
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$441.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.00
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	$210.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$241.50
Rate for Payer: Fidelis Medicare Advantage	$441.00
Rate for Payer: Group Health Inc Commercial	$210.00
Rate for Payer: Group Health Inc Medicare	$147.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$273.00

4.5X44MM SCREW

Facility IP

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	40203557
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00

4.5X46MM SCREW

Facility IP

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	40203558
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00

4.5X46MM SCREW

Facility OP

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	40203558
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$441.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.00
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	$210.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$241.50
Rate for Payer: Fidelis Medicare Advantage	$441.00
Rate for Payer: Group Health Inc Commercial	$210.00
Rate for Payer: Group Health Inc Medicare	$147.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$273.00

4-6 TOTAL VISITS, ROUTINE OB

Facility OP

$1,215.00

Service Code	HCPCS 59425
Hospital Charge Code	30301246
Hospital Revenue Code	510
Min. Negotiated Rate	$233.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$428.75
Rate for Payer: Aetna Government	$428.75
Rate for Payer: Brighton Health Commercial	$233.00
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: Fidelis CHP/HARP/Medicaid	$512.81
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$607.50
Rate for Payer: Hamaspik Choice Inc Medicare	$607.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$569.79

4HL 29MM STRAIGHT RIGID PLATE

Facility IP

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	40209993
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$345.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$345.00
Rate for Payer: Hamaspik Choice Inc Medicare	$345.00

4HL 29MM STRAIGHT RIGID PLATE

Facility OP

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	40209993
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$724.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$379.50
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	$345.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$396.75
Rate for Payer: Fidelis Medicare Advantage	$724.50
Rate for Payer: Group Health Inc Commercial	$345.00
Rate for Payer: Group Health Inc Medicare	$241.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$345.00
Rate for Payer: Hamaspik Choice Inc Medicare	$345.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$448.50

4 HOLE BP NO BAR FRACTURE PLATE

Facility IP

$441.00

Service Code	HCPCS C1713
Hospital Charge Code	40201073
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$220.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.50
Rate for Payer: Hamaspik Choice Inc Medicare	$220.50

4 HOLE BP NO BAR FRACTURE PLATE

Facility OP

$441.00

Service Code	HCPCS C1713
Hospital Charge Code	40201073
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$463.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.55
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	$220.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$253.58
Rate for Payer: Fidelis Medicare Advantage	$463.05
Rate for Payer: Group Health Inc Commercial	$220.50
Rate for Payer: Group Health Inc Medicare	$154.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.50
Rate for Payer: Hamaspik Choice Inc Medicare	$220.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$286.65

4 HOLE BP STRAIGHT NO BAR

Facility IP

$234.00

Service Code	HCPCS C1713
Hospital Charge Code	40201074
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$117.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$117.00
Rate for Payer: Hamaspik Choice Inc Medicare	$117.00

4 HOLE BP STRAIGHT NO BAR

Facility OP

$234.00

Service Code	HCPCS C1713
Hospital Charge Code	40201074
Hospital Revenue Code	278
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$245.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$128.70
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	$117.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$134.55
Rate for Payer: Fidelis Medicare Advantage	$245.70
Rate for Payer: Group Health Inc Commercial	$117.00
Rate for Payer: Group Health Inc Medicare	$81.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$117.00
Rate for Payer: Hamaspik Choice Inc Medicare	$117.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$152.10

4 HOLE BP WITH BAR

Facility OP

$272.00

Service Code	HCPCS C1713
Hospital Charge Code	40201075
Hospital Revenue Code	278
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$285.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$149.60
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	$136.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$156.40
Rate for Payer: Fidelis Medicare Advantage	$285.60
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$176.80

4 HOLE BP WITH BAR

Facility IP

$272.00

Service Code	HCPCS C1713
Hospital Charge Code	40201075
Hospital Revenue Code	278
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$136.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.00
Rate for Payer: Hamaspik Choice Inc Medicare	$136.00

4 HOLE CURVED PLATE

Facility IP

$266.26

Service Code	HCPCS C1713
Hospital Charge Code	40005306
Hospital Revenue Code	278
Min. Negotiated Rate	$133.13
Max. Negotiated Rate	$133.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.13
Rate for Payer: Hamaspik Choice Inc Medicare	$133.13

4 HOLE CURVED PLATE

Facility OP

$266.26

Service Code	HCPCS C1713
Hospital Charge Code	40005306
Hospital Revenue Code	278
Min. Negotiated Rate	$93.19
Max. Negotiated Rate	$279.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.44
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	$133.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.10
Rate for Payer: Fidelis Medicare Advantage	$279.57
Rate for Payer: Group Health Inc Commercial	$133.13
Rate for Payer: Group Health Inc Medicare	$93.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.13
Rate for Payer: Hamaspik Choice Inc Medicare	$133.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$173.07

4 HOLE CURVED PLATE 1/ BAR MDFC

Facility IP

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40201077
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

4 HOLE CURVED PLATE 1/ BAR MDFC

Facility OP

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40201077
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
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	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

4 HOLE CURVED PLATE UPPERFACE

Facility IP

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	40201076
Hospital Revenue Code	278
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$92.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.00
Rate for Payer: Hamaspik Choice Inc Medicare	$92.00

4 HOLE CURVED PLATE UPPERFACE

Facility OP

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	40201076
Hospital Revenue Code	278
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$193.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.20
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	$92.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.80
Rate for Payer: Fidelis Medicare Advantage	$193.20
Rate for Payer: Group Health Inc Commercial	$92.00
Rate for Payer: Group Health Inc Medicare	$64.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.00
Rate for Payer: Hamaspik Choice Inc Medicare	$92.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$119.60

4 HOLE L-BP LEFT 4MM BAR

Facility IP

$484.00

Hospital Charge Code	40200859
Hospital Revenue Code	278
Min. Negotiated Rate	$242.00
Max. Negotiated Rate	$242.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$242.00

4 HOLE L-BP LEFT 4MM BAR

Facility OP

$484.00

Hospital Charge Code	40200859
Hospital Revenue Code	278
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$508.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$266.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$242.00
Rate for Payer: Aetna Government	$242.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$242.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$278.30
Rate for Payer: Fidelis Medicare Advantage	$508.20
Rate for Payer: Group Health Inc Commercial	$242.00
Rate for Payer: Group Health Inc Medicare	$169.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$242.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$314.60

4 HOLE L-BP LEFT NO BAR

Facility IP

$440.00

Service Code	HCPCS C1713
Hospital Charge Code	40200861
Hospital Revenue Code	278
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$220.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$220.00

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