St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SCOPOLAMINE PATCH

Facility

$22.42

Hospital Charge Code	41655255
Hospital Revenue Code	250
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$17.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.21
Rate for Payer: Aetna Government	$11.21
Rate for Payer: Brighton Health Commercial	$16.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.25
Rate for Payer: Group Health Inc Commercial	$11.21
Rate for Payer: Group Health Inc Medicare	$7.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.21
Rate for Payer: Hamaspik Choice Inc Medicare	$11.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.57

SCR/2.0X4MM LCKING CR PN

Facility

$225.23

Service Code	HCPCS C1713
Hospital Charge Code	64903283
Hospital Revenue Code	278
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$112.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.62
Rate for Payer: Hamaspik Choice Inc Medicare	$112.62

SCR/2.0X4MM LCKING CR PN

Facility

$225.23

Service Code	HCPCS C1713
Hospital Charge Code	64903283
Hospital Revenue Code	278
Min. Negotiated Rate	$78.83
Max. Negotiated Rate	$236.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$135.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$129.51
Rate for Payer: EmblemHealth Commercial	$112.62
Rate for Payer: Fidelis Medicare Advantage	$236.49
Rate for Payer: Group Health Inc Commercial	$112.62
Rate for Payer: Group Health Inc Medicare	$78.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.62
Rate for Payer: Hamaspik Choice Inc Medicare	$112.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$146.40

SCR/2.0X6.0MM BONE CROSS PIN

Facility

$85.68

Hospital Charge Code	40005869
Hospital Revenue Code	272
Min. Negotiated Rate	$29.99
Max. Negotiated Rate	$68.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.84
Rate for Payer: Aetna Government	$42.84
Rate for Payer: Brighton Health Commercial	$64.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.26
Rate for Payer: Group Health Inc Commercial	$42.84
Rate for Payer: Group Health Inc Medicare	$29.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.84
Rate for Payer: Hamaspik Choice Inc Medicare	$42.84

SCR/2.0X6MM LCKING CROSS PIN

Facility

$312.76

Hospital Charge Code	40005870
Hospital Revenue Code	272
Min. Negotiated Rate	$109.47
Max. Negotiated Rate	$250.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$156.38
Rate for Payer: Aetna Government	$156.38
Rate for Payer: Brighton Health Commercial	$234.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.68
Rate for Payer: Group Health Inc Commercial	$156.38
Rate for Payer: Group Health Inc Medicare	$109.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.38
Rate for Payer: Hamaspik Choice Inc Medicare	$156.38

SCR/2.0X8MM LCKING CROSS PIN

Facility

$312.76

Hospital Charge Code	40005860
Hospital Revenue Code	272
Min. Negotiated Rate	$109.47
Max. Negotiated Rate	$250.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$156.38
Rate for Payer: Aetna Government	$156.38
Rate for Payer: Brighton Health Commercial	$234.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.68
Rate for Payer: Group Health Inc Commercial	$156.38
Rate for Payer: Group Health Inc Medicare	$109.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.38
Rate for Payer: Hamaspik Choice Inc Medicare	$156.38

SCR DEP NEG, NO PLAN REQD

Facility

$0.01

Service Code	HCPCS G8510
Hospital Charge Code	30307868
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
Rate for Payer: United Healthcare Commercial	$222.00

SCR DEP POS, NO PLAN DOC RING

Facility

$0.01

Service Code	HCPCS G8511
Hospital Charge Code	30307869
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
Rate for Payer: United Healthcare Commercial	$222.00

SCRE 3.5MM CORTICAL LOCKING 22MM

Facility

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40007553
Hospital Revenue Code	278
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$300.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$143.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.45
Rate for Payer: EmblemHealth Commercial	$143.00
Rate for Payer: Fidelis Medicare Advantage	$300.30
Rate for Payer: Group Health Inc Commercial	$143.00
Rate for Payer: Group Health Inc Medicare	$100.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.90

SCRE 3.5MM CORTICAL LOCKING 22MM

Facility

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40007553
Hospital Revenue Code	278
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$143.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00

SCREEN DEPRESSION PERFORMED

Facility

$0.01

Service Code	HCPCS 3725F
Hospital Charge Code	30300372
Hospital Revenue Code	969
Max. Negotiated Rate	$2,915.00
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	$0.01
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: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

SCREEN HLTHY ETOH USE

Facility

$0.01

Service Code	HCPCS G2197
Hospital Charge Code	30300325
Hospital Revenue Code	929
Max. Negotiated Rate	$94.00
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	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$94.00

SCREENING MAMMO BILAT INC CAD

Facility

$402.90

Service Code	HCPCS 77067 TC
Hospital Charge Code	41104718
Hospital Revenue Code	403
Min. Negotiated Rate	$78.81
Max. Negotiated Rate	$322.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$221.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$78.81
Rate for Payer: Aetna Government	$78.81
Rate for Payer: Brighton Health Commercial	$302.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$322.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$273.97
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: United Healthcare Commercial	$83.18

SCREEN MAMMO DOC REV

Facility

$0.01

Service Code	HCPCS 3014F
Hospital Charge Code	30300375
Hospital Revenue Code	969
Max. Negotiated Rate	$2,915.00
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	$0.01
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: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

SCREEN UNHLTHY ETOH USE

Facility

$0.01

Service Code	HCPCS G2196
Hospital Charge Code	30300324
Hospital Revenue Code	929
Max. Negotiated Rate	$94.00
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	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$94.00

SCREW

Facility

$487.80

Service Code	HCPCS C1713
Hospital Charge Code	40203571
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$512.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$268.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$292.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$243.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$280.48
Rate for Payer: EmblemHealth Commercial	$243.90
Rate for Payer: Fidelis Medicare Advantage	$512.19
Rate for Payer: Group Health Inc Commercial	$243.90
Rate for Payer: Group Health Inc Medicare	$170.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.90
Rate for Payer: Hamaspik Choice Inc Medicare	$243.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$317.07

SCREW

Facility

$487.80

Service Code	HCPCS C1713
Hospital Charge Code	40203571
Hospital Revenue Code	278
Min. Negotiated Rate	$243.90
Max. Negotiated Rate	$243.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.90
Rate for Payer: Hamaspik Choice Inc Medicare	$243.90

SCREW 100-299

Facility

$342.92

Service Code	HCPCS C1713
Hospital Charge Code	40203069
Hospital Revenue Code	278
Min. Negotiated Rate	$171.46
Max. Negotiated Rate	$171.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.46
Rate for Payer: Hamaspik Choice Inc Medicare	$171.46

SCREW 100-299

Facility

$342.92

Service Code	HCPCS C1713
Hospital Charge Code	40203069
Hospital Revenue Code	278
Min. Negotiated Rate	$120.02
Max. Negotiated Rate	$360.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$188.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$205.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$171.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$197.18
Rate for Payer: EmblemHealth Commercial	$171.46
Rate for Payer: Fidelis Medicare Advantage	$360.07
Rate for Payer: Group Health Inc Commercial	$171.46
Rate for Payer: Group Health Inc Medicare	$120.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.46
Rate for Payer: Hamaspik Choice Inc Medicare	$171.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$222.90

SCREW 10MM VIRAGE

Facility

$2,798.00

Service Code	HCPCS C1713
Hospital Charge Code	40005333
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,937.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,538.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,678.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,399.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,608.85
Rate for Payer: EmblemHealth Commercial	$1,399.00
Rate for Payer: Fidelis Medicare Advantage	$2,937.90
Rate for Payer: Group Health Inc Commercial	$1,399.00
Rate for Payer: Group Health Inc Medicare	$979.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,818.70

SCREW 10MM VIRAGE

Facility

$2,798.00

Service Code	HCPCS C1713
Hospital Charge Code	40005333
Hospital Revenue Code	278
Min. Negotiated Rate	$1,399.00
Max. Negotiated Rate	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.00

SCREW- 10MM VIRAGE

Facility

$2,798.00

Service Code	HCPCS C1713
Hospital Charge Code	40204585
Hospital Revenue Code	278
Min. Negotiated Rate	$1,399.00
Max. Negotiated Rate	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.00

SCREW- 10MM VIRAGE

Facility

$2,798.00

Service Code	HCPCS C1713
Hospital Charge Code	40204585
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,937.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,538.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,678.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,399.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,608.85
Rate for Payer: EmblemHealth Commercial	$1,399.00
Rate for Payer: Fidelis Medicare Advantage	$2,937.90
Rate for Payer: Group Health Inc Commercial	$1,399.00
Rate for Payer: Group Health Inc Medicare	$979.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,818.70

SCREW- 10MM VIRAGE

Facility

$2,798.00

Service Code	HCPCS L8699
Hospital Charge Code	40007504
Hospital Revenue Code	278
Min. Negotiated Rate	$979.30
Max. Negotiated Rate	$2,937.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,538.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,399.00
Rate for Payer: Aetna Government	$1,399.00
Rate for Payer: Brighton Health Commercial	$1,678.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,399.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,608.85
Rate for Payer: EmblemHealth Commercial	$1,399.00
Rate for Payer: Fidelis Medicare Advantage	$2,937.90
Rate for Payer: Group Health Inc Commercial	$1,399.00
Rate for Payer: Group Health Inc Medicare	$979.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,818.70

SCREW- 10MM VIRAGE

Facility

$2,798.00

Service Code	HCPCS L8699
Hospital Charge Code	40007504
Hospital Revenue Code	278
Min. Negotiated Rate	$1,399.00
Max. Negotiated Rate	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.00

Know your out-of-pocket cost for care.

All Charges