St. Barnabas Hospital

All Charges

Charge

Type

Price

BIT DRILL

Facility IP

$455.00

Service Code	HCPCS C1713
Hospital Charge Code	64907232
Hospital Revenue Code	278
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$227.50
Rate for Payer: Hamaspik Choice Inc Medicare	$227.50

BIT DRILL 1.0X50M 6M STOP-6010506

Facility OP

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64906520
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
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	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

BIT DRILL 1.0X50M 6M STOP-6010506

Facility IP

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64906520
Hospital Revenue Code	278
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

BIT DRILL 1.2MM -6009504

Facility OP

$219.22

Service Code	HCPCS C1713
Hospital Charge Code	64906695
Hospital Revenue Code	278
Min. Negotiated Rate	$76.73
Max. Negotiated Rate	$230.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$120.57
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	$109.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.05
Rate for Payer: Fidelis Medicare Advantage	$230.18
Rate for Payer: Group Health Inc Commercial	$109.61
Rate for Payer: Group Health Inc Medicare	$76.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.61
Rate for Payer: Hamaspik Choice Inc Medicare	$109.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$142.49

BIT DRILL 1.2MM -6009504

Facility IP

$219.22

Service Code	HCPCS C1713
Hospital Charge Code	64906695
Hospital Revenue Code	278
Min. Negotiated Rate	$109.61
Max. Negotiated Rate	$109.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.61
Rate for Payer: Hamaspik Choice Inc Medicare	$109.61

BIT DRILL 1.3 X 54MM 12M STOP

Facility OP

$101.00

Service Code	HCPCS C1713
Hospital Charge Code	64906466
Hospital Revenue Code	278
Min. Negotiated Rate	$35.35
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.55
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	$50.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.08
Rate for Payer: Fidelis Medicare Advantage	$106.05
Rate for Payer: Group Health Inc Commercial	$50.50
Rate for Payer: Group Health Inc Medicare	$35.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.50
Rate for Payer: Hamaspik Choice Inc Medicare	$50.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.65

BIT DRILL 1.3 X 54MM 12M STOP

Facility IP

$101.00

Service Code	HCPCS C1713
Hospital Charge Code	64906466
Hospital Revenue Code	278
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$50.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.50
Rate for Payer: Hamaspik Choice Inc Medicare	$50.50

BIT DRILL 1.5MM J-LATCH 110MM

Facility IP

$272.00

Service Code	HCPCS C1776
Hospital Charge Code	40202437
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

BIT DRILL 1.5MM J-LATCH 110MM

Facility OP

$272.00

Service Code	HCPCS C1776
Hospital Charge Code	40202437
Hospital Revenue Code	278
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$149.60
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	$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

BIT DRILL 1.5MM J LATCH 12MM

Facility IP

$636.00

Service Code	HCPCS C1776
Hospital Charge Code	40202446
Hospital Revenue Code	278
Min. Negotiated Rate	$318.00
Max. Negotiated Rate	$318.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.00
Rate for Payer: Hamaspik Choice Inc Medicare	$318.00

BIT DRILL 1.5MM J LATCH 12MM

Facility OP

$636.00

Service Code	HCPCS C1776
Hospital Charge Code	40202446
Hospital Revenue Code	278
Min. Negotiated Rate	$222.60
Max. Negotiated Rate	$667.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$349.80
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	$318.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$365.70
Rate for Payer: Fidelis Medicare Advantage	$667.80
Rate for Payer: Group Health Inc Commercial	$318.00
Rate for Payer: Group Health Inc Medicare	$222.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.00
Rate for Payer: Hamaspik Choice Inc Medicare	$318.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$413.40

BIT DRILL 1.6 X 26MM (6016526)

Facility IP

$126.72

Service Code	HCPCS C1713
Hospital Charge Code	64906404
Hospital Revenue Code	278
Min. Negotiated Rate	$63.36
Max. Negotiated Rate	$63.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.36
Rate for Payer: Hamaspik Choice Inc Medicare	$63.36

BIT DRILL 1.6 X 26MM (6016526)

Facility OP

$126.72

Service Code	HCPCS C1713
Hospital Charge Code	64906404
Hospital Revenue Code	278
Min. Negotiated Rate	$44.35
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.70
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	$63.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.86
Rate for Payer: Fidelis Medicare Advantage	$133.06
Rate for Payer: Group Health Inc Commercial	$63.36
Rate for Payer: Group Health Inc Medicare	$44.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.36
Rate for Payer: Hamaspik Choice Inc Medicare	$63.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$82.37

BIT DRILL 1.6 X 35MM

Facility IP

$438.58

Service Code	HCPCS C1713
Hospital Charge Code	64906772
Hospital Revenue Code	278
Min. Negotiated Rate	$219.29
Max. Negotiated Rate	$219.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.29
Rate for Payer: Hamaspik Choice Inc Medicare	$219.29

BIT DRILL 1.6 X 35MM

Facility OP

$438.58

Service Code	HCPCS C1713
Hospital Charge Code	64906772
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$460.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$241.22
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	$219.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$252.18
Rate for Payer: Fidelis Medicare Advantage	$460.51
Rate for Payer: Group Health Inc Commercial	$219.29
Rate for Payer: Group Health Inc Medicare	$153.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.29
Rate for Payer: Hamaspik Choice Inc Medicare	$219.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$285.08

BIT DRILL 1.8 X 125 CALIB

Facility IP

$358.00

Service Code	HCPCS C1776
Hospital Charge Code	40205074
Hospital Revenue Code	278
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00

BIT DRILL 1.8 X 125 CALIB

Facility OP

$358.00

Service Code	HCPCS C1776
Hospital Charge Code	40205074
Hospital Revenue Code	278
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$375.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
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	$179.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$205.85
Rate for Payer: Fidelis Medicare Advantage	$375.90
Rate for Payer: Group Health Inc Commercial	$179.00
Rate for Payer: Group Health Inc Medicare	$125.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$232.70

BIT DRILL 2.0 882701

Facility IP

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	64906646
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

BIT DRILL 2.0 882701

Facility OP

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	64906646
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

BIT DRILL 2.0M CALBRATED 894316

Facility OP

$190.00

Service Code	HCPCS C1713
Hospital Charge Code	64906652
Hospital Revenue Code	278
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$199.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.50
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	$95.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$109.25
Rate for Payer: Fidelis Medicare Advantage	$199.50
Rate for Payer: Group Health Inc Commercial	$95.00
Rate for Payer: Group Health Inc Medicare	$66.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.50

BIT DRILL 2.0M CALBRATED 894316

Facility IP

$190.00

Service Code	HCPCS C1713
Hospital Charge Code	64906652
Hospital Revenue Code	278
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$95.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00

BIT DRILL 2.0MM CALIBRTD

Facility OP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64906901
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$409.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$214.50
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	$195.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.25
Rate for Payer: Fidelis Medicare Advantage	$409.50
Rate for Payer: Group Health Inc Commercial	$195.00
Rate for Payer: Group Health Inc Medicare	$136.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.00
Rate for Payer: Hamaspik Choice Inc Medicare	$195.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$253.50

BIT DRILL 2.0MM CALIBRTD

Facility IP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64906901
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$195.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.00
Rate for Payer: Hamaspik Choice Inc Medicare	$195.00

BIT DRILL 2.2MM DIA 100MML F/

Facility IP

$152.00

Service Code	HCPCS C1713
Hospital Charge Code	64906560
Hospital Revenue Code	278
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$76.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.00
Rate for Payer: Hamaspik Choice Inc Medicare	$76.00

BIT DRILL 2.2MM DIA 100MML F/

Facility OP

$152.00

Service Code	HCPCS C1713
Hospital Charge Code	64906560
Hospital Revenue Code	278
Min. Negotiated Rate	$53.20
Max. Negotiated Rate	$159.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.60
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	$76.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.40
Rate for Payer: Fidelis Medicare Advantage	$159.60
Rate for Payer: Group Health Inc Commercial	$76.00
Rate for Payer: Group Health Inc Medicare	$53.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.00
Rate for Payer: Hamaspik Choice Inc Medicare	$76.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$98.80

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