St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

5.0MMX56MM MOTIONLOC SCREW TI

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40007236
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$240.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.28
Rate for Payer: EmblemHealth Commercial	$200.24
Rate for Payer: Fidelis Medicare Advantage	$420.50
Rate for Payer: Group Health Inc Commercial	$200.24
Rate for Payer: Group Health Inc Medicare	$140.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.31

5.0MMX56MM MOTIONLOC SCREW TI

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40007236
Hospital Revenue Code	278
Min. Negotiated Rate	$200.24
Max. Negotiated Rate	$200.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24

5.0MMX56MM MOTIONLOC SCR TI STRL

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40006972
Hospital Revenue Code	278
Min. Negotiated Rate	$200.24
Max. Negotiated Rate	$200.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24

5.0MMX56MM MOTIONLOC SCR TI STRL

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40006972
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$240.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.28
Rate for Payer: EmblemHealth Commercial	$200.24
Rate for Payer: Fidelis Medicare Advantage	$420.50
Rate for Payer: Group Health Inc Commercial	$200.24
Rate for Payer: Group Health Inc Medicare	$140.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.31

5.0MMX58MM MOTIONLOC SCREW TI

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40007237
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$240.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.28
Rate for Payer: EmblemHealth Commercial	$200.24
Rate for Payer: Fidelis Medicare Advantage	$420.50
Rate for Payer: Group Health Inc Commercial	$200.24
Rate for Payer: Group Health Inc Medicare	$140.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.31

5.0MMX58MM MOTIONLOC SCREW TI

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40007237
Hospital Revenue Code	278
Min. Negotiated Rate	$200.24
Max. Negotiated Rate	$200.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24

5.0MMX58MM MOTIONLOC SCR TI STRL

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40006973
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$240.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.28
Rate for Payer: EmblemHealth Commercial	$200.24
Rate for Payer: Fidelis Medicare Advantage	$420.50
Rate for Payer: Group Health Inc Commercial	$200.24
Rate for Payer: Group Health Inc Medicare	$140.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.31

5.0MMX58MM MOTIONLOC SCR TI STRL

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40006973
Hospital Revenue Code	278
Min. Negotiated Rate	$200.24
Max. Negotiated Rate	$200.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24

5.0MMX60MM MOTIONLOC SCREW TI

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40007238
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$240.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.28
Rate for Payer: EmblemHealth Commercial	$200.24
Rate for Payer: Fidelis Medicare Advantage	$420.50
Rate for Payer: Group Health Inc Commercial	$200.24
Rate for Payer: Group Health Inc Medicare	$140.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.31

5.0MMX60MM MOTIONLOC SCREW TI

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40007238
Hospital Revenue Code	278
Min. Negotiated Rate	$200.24
Max. Negotiated Rate	$200.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24

5.0MMX60MM MOTIONLOC SCR TI STRL

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40006974
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$240.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.28
Rate for Payer: EmblemHealth Commercial	$200.24
Rate for Payer: Fidelis Medicare Advantage	$420.50
Rate for Payer: Group Health Inc Commercial	$200.24
Rate for Payer: Group Health Inc Medicare	$140.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.31

5.0MMX60MM MOTIONLOC SCR TI STRL

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40006974
Hospital Revenue Code	278
Min. Negotiated Rate	$200.24
Max. Negotiated Rate	$200.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24

5.0X32MM MOTIONLOC SCR TI STRL

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40006960
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$240.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.28
Rate for Payer: EmblemHealth Commercial	$200.24
Rate for Payer: Fidelis Medicare Advantage	$420.50
Rate for Payer: Group Health Inc Commercial	$200.24
Rate for Payer: Group Health Inc Medicare	$140.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.31

5.0X32MM MOTIONLOC SCR TI STRL

Facility

$400.48

Service Code	HCPCS C1713
Hospital Charge Code	40006960
Hospital Revenue Code	278
Min. Negotiated Rate	$200.24
Max. Negotiated Rate	$200.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.24
Rate for Payer: Hamaspik Choice Inc Medicare	$200.24

5.5MM DRILLBITW/STOPJLATCH125MM

Facility

$500.00

Hospital Charge Code	40209529
Hospital Revenue Code	270
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$250.00
Rate for Payer: Aetna Government	$250.00
Rate for Payer: Brighton Health Commercial	$375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

5.5MM DRILLGUIDE FOR IM SPLINT

Facility

$900.00

Hospital Charge Code	40209524
Hospital Revenue Code	270
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$450.00
Rate for Payer: Aetna Government	$450.00
Rate for Payer: Brighton Health Commercial	$675.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00

5.5X195MM DRILL

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40200552
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.00
Rate for Payer: Hamaspik Choice Inc Medicare	$135.00

5.5X195MM DRILL

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40200552
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$283.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$148.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$162.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$155.25
Rate for Payer: EmblemHealth Commercial	$135.00
Rate for Payer: Fidelis Medicare Advantage	$283.50
Rate for Payer: Group Health Inc Commercial	$135.00
Rate for Payer: Group Health Inc Medicare	$94.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.00
Rate for Payer: Hamaspik Choice Inc Medicare	$135.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$175.50

>55 YRS TEMP HD ACHE

Facility

$0.01

Service Code	HCPCS G2192
Hospital Charge Code	30300320
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

5-6 REGIONS

Facility

$140.40

Service Code	HCPCS 98927
Hospital Charge Code	30305015
Hospital Revenue Code	530
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$112.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Affinity Essential Plan 1&2	$21.00
Rate for Payer: Affinity Essential Plan 3&4	$21.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$21.00
Rate for Payer: Brighton Health Commercial	$105.30
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.47
Rate for Payer: Elderplan Medicare Advantage	$30.00
Rate for Payer: EmblemHealth Commercial	$30.00
Rate for Payer: Fidelis Essential Plan Aliesa	$25.50
Rate for Payer: Fidelis Essential Plan QHP	$26.70
Rate for Payer: Fidelis Medicare Advantage	$30.00
Rate for Payer: Fidelis Qualified Health Plan	$26.70
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.20
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00
Rate for Payer: Healthfirst Medicare Advantage	$25.50
Rate for Payer: Healthfirst QHP	$30.00
Rate for Payer: Humana Medicare	$30.60
Rate for Payer: Senior Whole Health Medicare Advantage	$30.00
Rate for Payer: United Healthcare Medicare Advantage	$30.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.00
Rate for Payer: Wellcare Medicare	$28.50

5-6 REGIONS

Facility

$140.40

Service Code	HCPCS 98927
Hospital Charge Code	30305015
Hospital Revenue Code	530
Rate for Payer: Cash Price	$30.00

5% ALBUMIN 250ML

Facility

$131.13

Service Code	HCPCS P9045
Hospital Charge Code	40701086
Hospital Revenue Code	636
Min. Negotiated Rate	$65.56
Max. Negotiated Rate	$65.56
Rate for Payer: Cash Price	$53.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.56
Rate for Payer: Hamaspik Choice Inc Medicare	$65.56

5% ALBUMIN 250ML

Facility

$131.13

Service Code	HCPCS P9045
Hospital Charge Code	40701086
Hospital Revenue Code	636
Min. Negotiated Rate	$37.15
Max. Negotiated Rate	$85.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$53.08
Rate for Payer: Aetna Government	$53.08
Rate for Payer: Affinity Essential Plan 1&2	$37.15
Rate for Payer: Affinity Essential Plan 3&4	$37.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$37.15
Rate for Payer: Brighton Health Commercial	$78.68
Rate for Payer: Cash Price	$53.08
Rate for Payer: Cash Price	$53.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$53.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$75.40
Rate for Payer: Elderplan Medicare Advantage	$53.08
Rate for Payer: EmblemHealth Commercial	$53.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53.08
Rate for Payer: Fidelis Essential Plan Aliesa	$53.08
Rate for Payer: Fidelis Essential Plan QHP	$55.73
Rate for Payer: Fidelis Medicare Advantage	$53.08
Rate for Payer: Fidelis Qualified Health Plan	$55.73
Rate for Payer: Group Health Inc Commercial	$53.08
Rate for Payer: Group Health Inc Medicare	$53.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.56
Rate for Payer: Hamaspik Choice Inc Medicare	$65.56
Rate for Payer: Healthfirst Medicare Advantage	$45.12
Rate for Payer: Healthfirst QHP	$53.08
Rate for Payer: Humana Medicare	$54.14
Rate for Payer: Senior Whole Health Medicare Advantage	$53.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$56.26
Rate for Payer: SOMOS Essential	$56.26
Rate for Payer: United Healthcare Commercial	$52.77
Rate for Payer: United Healthcare Medicare Advantage	$53.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$85.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42.46
Rate for Payer: Wellcare Medicare	$50.42

5% DEX. IN 0.2 SC-1000CC

Facility

$10.28

Hospital Charge Code	40502160
Hospital Revenue Code	260
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.14
Rate for Payer: Aetna Government	$5.14
Rate for Payer: Brighton Health Commercial	$7.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.99
Rate for Payer: Group Health Inc Commercial	$5.14
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14
Rate for Payer: Hamaspik Choice Inc Medicare	$5.14
Rate for Payer: United Healthcare Commercial	$76.00

5% DEX IN .3% SC 1000CC

Facility

$9.92

Hospital Charge Code	40509787
Hospital Revenue Code	260
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.96
Rate for Payer: Aetna Government	$4.96
Rate for Payer: Brighton Health Commercial	$7.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.75
Rate for Payer: Group Health Inc Commercial	$4.96
Rate for Payer: Group Health Inc Medicare	$3.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.96
Rate for Payer: Hamaspik Choice Inc Medicare	$4.96
Rate for Payer: United Healthcare Commercial	$76.00

Know your out-of-pocket cost for care.

All Charges