St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW YUKON 5.0 X 28MM

Facility IP

$4,590.00

Service Code	HCPCS C1713
Hospital Charge Code	64906725
Hospital Revenue Code	278
Min. Negotiated Rate	$2,295.00
Max. Negotiated Rate	$2,295.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,295.00

SCREW YUKON 5.0 X 28MM

Facility OP

$4,590.00

Service Code	HCPCS C1713
Hospital Charge Code	64906725
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,819.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,524.50
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	$2,295.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,639.25
Rate for Payer: Fidelis Medicare Advantage	$4,819.50
Rate for Payer: Group Health Inc Commercial	$2,295.00
Rate for Payer: Group Health Inc Medicare	$1,606.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,295.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,983.50

SCREW YUKON 5.0 X 30MM

Facility OP

$4,590.00

Service Code	HCPCS C1713
Hospital Charge Code	64906726
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,819.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,524.50
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	$2,295.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,639.25
Rate for Payer: Fidelis Medicare Advantage	$4,819.50
Rate for Payer: Group Health Inc Commercial	$2,295.00
Rate for Payer: Group Health Inc Medicare	$1,606.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,295.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,983.50

SCREW YUKON 5.0 X 30MM

Facility IP

$4,590.00

Service Code	HCPCS C1713
Hospital Charge Code	64906726
Hospital Revenue Code	278
Min. Negotiated Rate	$2,295.00
Max. Negotiated Rate	$2,295.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,295.00

SCRFEW STRYKER LOCKING 2.7MMX12MM

Facility IP

$453.00

Service Code	HCPCS C1713
Hospital Charge Code	40204484
Hospital Revenue Code	278
Min. Negotiated Rate	$226.50
Max. Negotiated Rate	$226.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.50
Rate for Payer: Hamaspik Choice Inc Medicare	$226.50

SCRFEW STRYKER LOCKING 2.7MMX12MM

Facility OP

$453.00

Service Code	HCPCS C1713
Hospital Charge Code	40204484
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$475.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$249.15
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	$226.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$260.48
Rate for Payer: Fidelis Medicare Advantage	$475.65
Rate for Payer: Group Health Inc Commercial	$226.50
Rate for Payer: Group Health Inc Medicare	$158.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.50
Rate for Payer: Hamaspik Choice Inc Medicare	$226.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$294.45

SCR MAMMO UNI INC CAD

Facility OP

$402.90

Service Code	HCPCS 77067 TC
Hospital Charge Code	41104719
Hospital Revenue Code	403
Min. Negotiated Rate	$102.73
Max. Negotiated Rate	$322.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$221.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$201.45
Rate for Payer: Aetna Government	$201.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$322.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$273.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$102.73
Rate for Payer: Group Health Inc Commercial	$201.45
Rate for Payer: Group Health Inc Medicare	$141.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$201.45
Rate for Payer: Hamaspik Choice Inc Medicare	$201.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$114.14

SCRN MAM PERF RSLTS DOC

Facility OP

$0.01

Service Code	HCPCS G9899
Hospital Charge Code	30307877
Hospital Revenue Code	510
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

SCROTAL SUPPORT

Facility OP

$75.48

Hospital Charge Code	40205715
Hospital Revenue Code	270
Min. Negotiated Rate	$26.42
Max. Negotiated Rate	$60.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.74
Rate for Payer: Aetna Government	$37.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.33
Rate for Payer: Group Health Inc Commercial	$37.74
Rate for Payer: Group Health Inc Medicare	$26.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.74
Rate for Payer: Hamaspik Choice Inc Medicare	$37.74

SCROTAL SUPPORT

Facility OP

$35.79

Hospital Charge Code	40195160
Hospital Revenue Code	710
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$28.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.90
Rate for Payer: Aetna Government	$17.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.34
Rate for Payer: Group Health Inc Commercial	$17.90
Rate for Payer: Group Health Inc Medicare	$12.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.90
Rate for Payer: Hamaspik Choice Inc Medicare	$17.90

SCROTAL ZERO DEGRE ANG SET

Facility OP

$21,975.00

Service Code	HCPCS C1813
Hospital Charge Code	64903841
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$23,073.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,086.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10,987.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,635.62
Rate for Payer: Fidelis Medicare Advantage	$23,073.75
Rate for Payer: Group Health Inc Commercial	$10,987.50
Rate for Payer: Group Health Inc Medicare	$7,691.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,987.50
Rate for Payer: Hamaspik Choice Inc Medicare	$10,987.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14,283.75

SCROTAL ZERO DEGRE ANG SET

Facility IP

$21,975.00

Service Code	HCPCS C1813
Hospital Charge Code	64903841
Hospital Revenue Code	278
Min. Negotiated Rate	$10,987.50
Max. Negotiated Rate	$10,987.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,987.50
Rate for Payer: Hamaspik Choice Inc Medicare	$10,987.50

SC&RP, 1 TO 3 TEETH/QUAD

Facility OP

$354.38

Service Code	HCPCS D4241
Hospital Charge Code	42303391
Hospital Revenue Code	361
Min. Negotiated Rate	$177.19
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,763.60
Rate for Payer: Aetna Government	$1,763.60
Rate for Payer: Cash Price	$1,763.60
Rate for Payer: Cash Price	$1,763.60
Rate for Payer: Cash Price	$1,763.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,763.60
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: Elderplan Medicare Advantage	$1,763.60
Rate for Payer: EmblemHealth Commercial	$1,763.60
Rate for Payer: Fidelis Essential Plan Aliesa	$1,499.06
Rate for Payer: Fidelis Essential Plan QHP	$1,569.60
Rate for Payer: Fidelis Medicare Advantage	$1,763.60
Rate for Payer: Fidelis Qualified Health Plan	$1,569.60
Rate for Payer: Group Health Inc Commercial	$1,763.60
Rate for Payer: Group Health Inc Medicare	$1,763.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1,763.60
Rate for Payer: Healthfirst Medicare Advantage	$1,499.06
Rate for Payer: Healthfirst QHP	$1,763.60
Rate for Payer: Senior Whole Health Medicare Advantage	$1,763.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,763.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,410.88
Rate for Payer: Wellcare Medicare	$1,675.42

SCR STRY NON-LK 2.7MM X 22MM

Facility IP

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40203439
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

SCR STRY NON-LK 2.7MM X 22MM

Facility OP

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40203439
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

SCRUB BRUSH

Facility OP

$35.66

Hospital Charge Code	41809547
Hospital Revenue Code	270
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$28.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.83
Rate for Payer: Aetna Government	$17.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.25
Rate for Payer: Group Health Inc Commercial	$17.83
Rate for Payer: Group Health Inc Medicare	$12.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.83
Rate for Payer: Hamaspik Choice Inc Medicare	$17.83

SCRUB BRUSH

Facility OP

$35.66

Hospital Charge Code	41709547
Hospital Revenue Code	270
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$28.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.83
Rate for Payer: Aetna Government	$17.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.25
Rate for Payer: Group Health Inc Commercial	$17.83
Rate for Payer: Group Health Inc Medicare	$12.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.83
Rate for Payer: Hamaspik Choice Inc Medicare	$17.83

SCR UNIII AXS SD 1.5X5MM

Facility IP

$205.00

Service Code	HCPCS C1713
Hospital Charge Code	64904753
Hospital Revenue Code	278
Min. Negotiated Rate	$102.50
Max. Negotiated Rate	$102.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.50
Rate for Payer: Hamaspik Choice Inc Medicare	$102.50

SCR UNIII AXS SD 1.5X5MM

Facility OP

$205.00

Service Code	HCPCS C1713
Hospital Charge Code	64904753
Hospital Revenue Code	278
Min. Negotiated Rate	$71.75
Max. Negotiated Rate	$215.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$112.75
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	$102.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$117.88
Rate for Payer: Fidelis Medicare Advantage	$215.25
Rate for Payer: Group Health Inc Commercial	$102.50
Rate for Payer: Group Health Inc Medicare	$71.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.50
Rate for Payer: Hamaspik Choice Inc Medicare	$102.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$133.25

SCRW 1.4X3MM C-P S-T E.R

Facility IP

$140.00

Service Code	HCPCS C1713
Hospital Charge Code	40201314
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.00
Rate for Payer: Hamaspik Choice Inc Medicare	$70.00

SCRW 1.4X3MM C-P S-T E.R

Facility OP

$140.00

Service Code	HCPCS C1713
Hospital Charge Code	40201314
Hospital Revenue Code	278
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$147.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.00
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	$70.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.50
Rate for Payer: Fidelis Medicare Advantage	$147.00
Rate for Payer: Group Health Inc Commercial	$70.00
Rate for Payer: Group Health Inc Medicare	$49.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.00
Rate for Payer: Hamaspik Choice Inc Medicare	$70.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$91.00

SCRW 1.4X5MM C-P S-T E.R

Facility IP

$108.00

Service Code	HCPCS C1713
Hospital Charge Code	40201315
Hospital Revenue Code	278
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.00
Rate for Payer: Hamaspik Choice Inc Medicare	$54.00

SCRW 1.4X5MM C-P S-T E.R

Facility OP

$108.00

Service Code	HCPCS C1713
Hospital Charge Code	40201315
Hospital Revenue Code	278
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.40
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	$54.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.10
Rate for Payer: Fidelis Medicare Advantage	$113.40
Rate for Payer: Group Health Inc Commercial	$54.00
Rate for Payer: Group Health Inc Medicare	$37.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.00
Rate for Payer: Hamaspik Choice Inc Medicare	$54.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.20

SCRW 1.5MM TIT CRANL W/STARDR SLF

Facility OP

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	40209365
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
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	$200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.00
Rate for Payer: Fidelis Medicare Advantage	$420.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.00

SCRW 1.5MM TIT CRANL W/STARDR SLF

Facility IP

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	40209365
Hospital Revenue Code	278
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00

Price Transparency.

All Charges