St. Barnabas Hospital

All Charges

Charge

Type

Price

TI2.9MM LCKNGSCRW,SELFTAPPING8MM

Facility IP

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40209505
Hospital Revenue Code	278
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00

TI2.9MM LCKNGSCRW,SELFTAPPING8MM

Facility OP

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40209505
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$336.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
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	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.00
Rate for Payer: Fidelis Medicare Advantage	$336.00
Rate for Payer: Group Health Inc Commercial	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.00

TI2.9MM NONLCKNGSCRW SELFTAP 6MM

Facility IP

$200.00

Service Code	HCPCS C1713
Hospital Charge Code	40209513
Hospital Revenue Code	278
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00

TI2.9MM NONLCKNGSCRW SELFTAP 6MM

Facility OP

$200.00

Service Code	HCPCS C1713
Hospital Charge Code	40209513
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$210.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
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	$100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.00
Rate for Payer: Fidelis Medicare Advantage	$210.00
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$130.00

TIAGABINE 2 MG TAB

Facility OP

$11.00

Hospital Charge Code	41642746
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

TIAGABINE 2 MG TAB

Facility OP

$11.00

Hospital Charge Code	41652746
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

TIAGABINE 4 MG TAB

Facility OP

$11.00

Hospital Charge Code	41652650
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

TIAGABINE 4 MG TAB

Facility OP

$11.00

Hospital Charge Code	41642650
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

TI ASNIS III WASHER FOR 6.5/8

Facility OP

$86.13

Hospital Charge Code	64905575
Hospital Revenue Code	270
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$68.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.06
Rate for Payer: Aetna Government	$43.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.57
Rate for Payer: Group Health Inc Commercial	$43.06
Rate for Payer: Group Health Inc Medicare	$30.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.06
Rate for Payer: Hamaspik Choice Inc Medicare	$43.06

TIB BEAR DS FEM GRO

Facility IP

$9,148.12

Service Code	HCPCS C1776
Hospital Charge Code	64907277
Hospital Revenue Code	278
Min. Negotiated Rate	$4,574.06
Max. Negotiated Rate	$4,574.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,574.06
Rate for Payer: Hamaspik Choice Inc Medicare	$4,574.06

TIB BEAR DS FEM GRO

Facility OP

$9,148.12

Service Code	HCPCS C1776
Hospital Charge Code	64907277
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,605.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,031.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,574.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,260.17
Rate for Payer: Fidelis Medicare Advantage	$9,605.53
Rate for Payer: Group Health Inc Commercial	$4,574.06
Rate for Payer: Group Health Inc Medicare	$3,201.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,574.06
Rate for Payer: Hamaspik Choice Inc Medicare	$4,574.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,946.28

TIB BEARING COMP

Facility OP

$2,079.38

Service Code	HCPCS C1776
Hospital Charge Code	64907318
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,183.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,143.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,039.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,195.64
Rate for Payer: Fidelis Medicare Advantage	$2,183.35
Rate for Payer: Group Health Inc Commercial	$1,039.69
Rate for Payer: Group Health Inc Medicare	$727.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,039.69
Rate for Payer: Hamaspik Choice Inc Medicare	$1,039.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,351.60

TIB BEARING COMP

Facility IP

$2,079.38

Service Code	HCPCS C1776
Hospital Charge Code	64907318
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.69
Max. Negotiated Rate	$1,039.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,039.69
Rate for Payer: Hamaspik Choice Inc Medicare	$1,039.69

TIB GMRS

Facility IP

$3,864.38

Service Code	HCPCS C1776
Hospital Charge Code	64907274
Hospital Revenue Code	278
Min. Negotiated Rate	$1,932.19
Max. Negotiated Rate	$1,932.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,932.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1,932.19

TIB GMRS

Facility OP

$3,864.38

Service Code	HCPCS C1776
Hospital Charge Code	64907274
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,057.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,125.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,932.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,222.02
Rate for Payer: Fidelis Medicare Advantage	$4,057.60
Rate for Payer: Group Health Inc Commercial	$1,932.19
Rate for Payer: Group Health Inc Medicare	$1,352.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,932.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1,932.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,511.85

TIB/HUM CALI DRILL-4.3MM STR

Facility OP

$250.56

Service Code	HCPCS C1713
Hospital Charge Code	40006469
Hospital Revenue Code	278
Min. Negotiated Rate	$87.70
Max. Negotiated Rate	$263.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.81
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	$125.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.07
Rate for Payer: Fidelis Medicare Advantage	$263.09
Rate for Payer: Group Health Inc Commercial	$125.28
Rate for Payer: Group Health Inc Medicare	$87.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.28
Rate for Payer: Hamaspik Choice Inc Medicare	$125.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$162.86

TIB/HUM CALI DRILL-4.3MM STR

Facility IP

$250.56

Service Code	HCPCS C1713
Hospital Charge Code	40006469
Hospital Revenue Code	278
Min. Negotiated Rate	$125.28
Max. Negotiated Rate	$125.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.28
Rate for Payer: Hamaspik Choice Inc Medicare	$125.28

TIB/HUM CALI DRILL-4.4MMSTR

Facility IP

$223.20

Service Code	HCPCS C1713
Hospital Charge Code	40006468
Hospital Revenue Code	278
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.60
Rate for Payer: Hamaspik Choice Inc Medicare	$111.60

TIB/HUM CALI DRILL-4.4MMSTR

Facility OP

$223.20

Service Code	HCPCS C1713
Hospital Charge Code	40006468
Hospital Revenue Code	278
Min. Negotiated Rate	$78.12
Max. Negotiated Rate	$234.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.76
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	$111.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.34
Rate for Payer: Fidelis Medicare Advantage	$234.36
Rate for Payer: Group Health Inc Commercial	$111.60
Rate for Payer: Group Health Inc Medicare	$78.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.60
Rate for Payer: Hamaspik Choice Inc Medicare	$111.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$145.08

TIBIA INS ROT HNG

Facility IP

$2,161.88

Service Code	HCPCS C1776
Hospital Charge Code	64907302
Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.94
Max. Negotiated Rate	$1,080.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,080.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1,080.94

TIBIA INS ROT HNG

Facility OP

$2,161.88

Service Code	HCPCS C1776
Hospital Charge Code	64907302
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,269.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,189.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,080.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,243.08
Rate for Payer: Fidelis Medicare Advantage	$2,269.97
Rate for Payer: Group Health Inc Commercial	$1,080.94
Rate for Payer: Group Health Inc Medicare	$756.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,080.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1,080.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,405.22

TIBIA KRH POLY

Facility IP

$5,128.12

Service Code	HCPCS C1776
Hospital Charge Code	64907261
Hospital Revenue Code	278
Min. Negotiated Rate	$2,564.06
Max. Negotiated Rate	$2,564.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,564.06
Rate for Payer: Hamaspik Choice Inc Medicare	$2,564.06

TIBIA KRH POLY

Facility OP

$5,128.12

Service Code	HCPCS C1776
Hospital Charge Code	64907261
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,384.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,820.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,564.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,948.67
Rate for Payer: Fidelis Medicare Advantage	$5,384.53
Rate for Payer: Group Health Inc Commercial	$2,564.06
Rate for Payer: Group Health Inc Medicare	$1,794.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,564.06
Rate for Payer: Hamaspik Choice Inc Medicare	$2,564.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,333.28

TIBIAL 9 X 375

Facility IP

$3,466.13

Service Code	HCPCS C1713
Hospital Charge Code	64903220
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.06
Max. Negotiated Rate	$1,733.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,733.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1,733.06

TIBIAL 9 X 375

Facility OP

$3,466.13

Service Code	HCPCS C1713
Hospital Charge Code	64903220
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,639.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,906.37
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	$1,733.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,993.02
Rate for Payer: Fidelis Medicare Advantage	$3,639.44
Rate for Payer: Group Health Inc Commercial	$1,733.06
Rate for Payer: Group Health Inc Medicare	$1,213.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,733.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1,733.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,252.98

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