St. Barnabas Hospital

All Charges

Charge

Type

Price

BONE PLUG

Facility OP

$428.09

Hospital Charge Code	40207002
Hospital Revenue Code	270
Min. Negotiated Rate	$149.83
Max. Negotiated Rate	$342.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$214.04
Rate for Payer: Aetna Government	$214.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$342.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$291.10
Rate for Payer: Group Health Inc Commercial	$214.04
Rate for Payer: Group Health Inc Medicare	$149.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.04
Rate for Payer: Hamaspik Choice Inc Medicare	$214.04

BONE PLUGS EXETER

Facility IP

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907262
Hospital Revenue Code	278
Min. Negotiated Rate	$203.88
Max. Negotiated Rate	$203.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88

BONE PLUGS EXETER

Facility OP

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907262
Hospital Revenue Code	278
Min. Negotiated Rate	$142.71
Max. Negotiated Rate	$428.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.26
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	$203.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.46
Rate for Payer: Fidelis Medicare Advantage	$428.14
Rate for Payer: Group Health Inc Commercial	$203.88
Rate for Payer: Group Health Inc Medicare	$142.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$265.04

BONE REPLCMNT GRAFT-1ST SITE QUAD

Facility OP

$626.54

Service Code	HCPCS D4263
Hospital Charge Code	42303307
Hospital Revenue Code	361
Min. Negotiated Rate	$313.27
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$344.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.27
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

BONE REPLCMNT GRAFT- EA ADD. SITE

Facility OP

$248.06

Service Code	HCPCS D4264
Hospital Charge Code	42303308
Hospital Revenue Code	361
Min. Negotiated Rate	$86.82
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$136.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$106.69
Rate for Payer: Aetna Government	$106.69
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	$124.03
Rate for Payer: Group Health Inc Medicare	$86.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$124.03
Rate for Payer: Hamaspik Choice Inc Medicare	$124.03

BONE REPL.GRAFT-SINGLE SITE(INCL

Facility OP

$798.77

Service Code	HCPCS D4261
Hospital Charge Code	42300875
Hospital Revenue Code	361
Min. Negotiated Rate	$399.38
Max. Negotiated Rate	$3,723.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$439.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,723.23
Rate for Payer: Aetna Government	$3,723.23
Rate for Payer: Cash Price	$3,723.23
Rate for Payer: Cash Price	$3,723.23
Rate for Payer: Cash Price	$3,723.23
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,723.23
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	$3,723.23
Rate for Payer: EmblemHealth Commercial	$3,723.23
Rate for Payer: Fidelis Essential Plan Aliesa	$3,164.75
Rate for Payer: Fidelis Essential Plan QHP	$3,313.67
Rate for Payer: Fidelis Medicare Advantage	$3,723.23
Rate for Payer: Fidelis Qualified Health Plan	$3,313.67
Rate for Payer: Group Health Inc Commercial	$3,723.23
Rate for Payer: Group Health Inc Medicare	$3,723.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$399.38
Rate for Payer: Hamaspik Choice Inc Medicare	$3,723.23
Rate for Payer: Healthfirst Medicare Advantage	$3,164.75
Rate for Payer: Healthfirst QHP	$3,723.23
Rate for Payer: Senior Whole Health Medicare Advantage	$3,723.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,723.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,978.58
Rate for Payer: Wellcare Medicare	$3,537.07

BONE SCREW

Facility OP

$105.00

Service Code	HCPCS C1713
Hospital Charge Code	40203567
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
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	$52.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.38
Rate for Payer: Fidelis Medicare Advantage	$110.25
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.25

BONE SCREW

Facility IP

$105.00

Service Code	HCPCS C1713
Hospital Charge Code	40203567
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

BONE SCREW 1.4 X 4MM

Facility IP

$97.74

Service Code	HCPCS C1713
Hospital Charge Code	40005307
Hospital Revenue Code	278
Min. Negotiated Rate	$48.87
Max. Negotiated Rate	$48.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.87
Rate for Payer: Hamaspik Choice Inc Medicare	$48.87

BONE SCREW 1.4 X 4MM

Facility OP

$97.74

Service Code	HCPCS C1713
Hospital Charge Code	40005307
Hospital Revenue Code	278
Min. Negotiated Rate	$34.21
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.76
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	$48.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.20
Rate for Payer: Fidelis Medicare Advantage	$102.63
Rate for Payer: Group Health Inc Commercial	$48.87
Rate for Payer: Group Health Inc Medicare	$34.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.87
Rate for Payer: Hamaspik Choice Inc Medicare	$48.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.53

BONE SCREW 2.3X22MM

Facility IP

$232.50

Service Code	HCPCS C1713
Hospital Charge Code	64905155
Hospital Revenue Code	278
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.25
Rate for Payer: Hamaspik Choice Inc Medicare	$116.25

BONE SCREW 2.3X22MM

Facility OP

$232.50

Service Code	HCPCS C1713
Hospital Charge Code	64905155
Hospital Revenue Code	278
Min. Negotiated Rate	$81.38
Max. Negotiated Rate	$244.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.88
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	$116.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$133.69
Rate for Payer: Fidelis Medicare Advantage	$244.12
Rate for Payer: Group Health Inc Commercial	$116.25
Rate for Payer: Group Health Inc Medicare	$81.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.25
Rate for Payer: Hamaspik Choice Inc Medicare	$116.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$151.12

BONE SCREW 2.7X26MM

Facility IP

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905162
Hospital Revenue Code	278
Min. Negotiated Rate	$366.25
Max. Negotiated Rate	$366.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25

BONE SCREW 2.7X26MM

Facility OP

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905162
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$769.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$402.88
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	$366.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$421.19
Rate for Payer: Fidelis Medicare Advantage	$769.12
Rate for Payer: Group Health Inc Commercial	$366.25
Rate for Payer: Group Health Inc Medicare	$256.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$476.12

BONE SCREW 2.7X32MM

Facility IP

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905164
Hospital Revenue Code	278
Min. Negotiated Rate	$366.25
Max. Negotiated Rate	$366.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25

BONE SCREW 2.7X32MM

Facility OP

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905164
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$769.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$402.88
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	$366.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$421.19
Rate for Payer: Fidelis Medicare Advantage	$769.12
Rate for Payer: Group Health Inc Commercial	$366.25
Rate for Payer: Group Health Inc Medicare	$256.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$476.12

BONE SCREW 2.7X34MM

Facility IP

$737.50

Service Code	HCPCS C1713
Hospital Charge Code	64905166
Hospital Revenue Code	278
Min. Negotiated Rate	$368.75
Max. Negotiated Rate	$368.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.75
Rate for Payer: Hamaspik Choice Inc Medicare	$368.75

BONE SCREW 2.7X34MM

Facility OP

$737.50

Service Code	HCPCS C1713
Hospital Charge Code	64905166
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$774.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$405.62
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	$368.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$424.06
Rate for Payer: Fidelis Medicare Advantage	$774.38
Rate for Payer: Group Health Inc Commercial	$368.75
Rate for Payer: Group Health Inc Medicare	$258.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.75
Rate for Payer: Hamaspik Choice Inc Medicare	$368.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$479.38

BONE SCREW 2.7X36MM

Facility OP

$737.50

Service Code	HCPCS C1713
Hospital Charge Code	64905168
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$774.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$405.62
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	$368.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$424.06
Rate for Payer: Fidelis Medicare Advantage	$774.38
Rate for Payer: Group Health Inc Commercial	$368.75
Rate for Payer: Group Health Inc Medicare	$258.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.75
Rate for Payer: Hamaspik Choice Inc Medicare	$368.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$479.38

BONE SCREW 2.7X36MM

Facility IP

$737.50

Service Code	HCPCS C1713
Hospital Charge Code	64905168
Hospital Revenue Code	278
Min. Negotiated Rate	$368.75
Max. Negotiated Rate	$368.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.75
Rate for Payer: Hamaspik Choice Inc Medicare	$368.75

BONE SCREW 3.5 X 22 CM

Facility IP

$626.88

Service Code	HCPCS C1713
Hospital Charge Code	64905129
Hospital Revenue Code	278
Min. Negotiated Rate	$313.44
Max. Negotiated Rate	$313.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.44
Rate for Payer: Hamaspik Choice Inc Medicare	$313.44

BONE SCREW 3.5 X 22 CM

Facility OP

$626.88

Service Code	HCPCS C1713
Hospital Charge Code	64905129
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$658.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$344.78
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	$313.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.46
Rate for Payer: Fidelis Medicare Advantage	$658.22
Rate for Payer: Group Health Inc Commercial	$313.44
Rate for Payer: Group Health Inc Medicare	$219.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.44
Rate for Payer: Hamaspik Choice Inc Medicare	$313.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$407.47

BONE SCREW 3.5X30MM

Facility OP

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905158
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$769.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$402.88
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	$366.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$421.19
Rate for Payer: Fidelis Medicare Advantage	$769.12
Rate for Payer: Group Health Inc Commercial	$366.25
Rate for Payer: Group Health Inc Medicare	$256.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$476.12

BONE SCREW 3.5X30MM

Facility IP

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905158
Hospital Revenue Code	278
Min. Negotiated Rate	$366.25
Max. Negotiated Rate	$366.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25

BONE SCREW 4.0 X 55

Facility IP

$309.40

Service Code	HCPCS C1713
Hospital Charge Code	64905149
Hospital Revenue Code	278
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$154.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.70
Rate for Payer: Hamaspik Choice Inc Medicare	$154.70

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