St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

5H Y-BONE PLT NO BAR

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40202257
Hospital Revenue Code	278
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$310.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$177.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: EmblemHealth Commercial	$148.00
Rate for Payer: Fidelis Medicare Advantage	$310.80
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

5H Y-BONE PLT NO BAR

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40202257
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

5H Y-BONE PLT W/ BAR

Facility

$396.00

Service Code	HCPCS C1713
Hospital Charge Code	40202258
Hospital Revenue Code	278
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$198.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$198.00
Rate for Payer: Hamaspik Choice Inc Medicare	$198.00

5H Y-BONE PLT W/ BAR

Facility

$396.00

Service Code	HCPCS C1713
Hospital Charge Code	40202258
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$415.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$237.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$198.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$227.70
Rate for Payer: EmblemHealth Commercial	$198.00
Rate for Payer: Fidelis Medicare Advantage	$415.80
Rate for Payer: Group Health Inc Commercial	$198.00
Rate for Payer: Group Health Inc Medicare	$138.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$198.00
Rate for Payer: Hamaspik Choice Inc Medicare	$198.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$257.40

5H Y PLATE W/4MM BAR MDFC LOC

Facility

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40202255
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$141.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00

5H Y PLATE W/4MM BAR MDFC LOC

Facility

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40202255
Hospital Revenue Code	278
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$296.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$155.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$169.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$141.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.15
Rate for Payer: EmblemHealth Commercial	$141.00
Rate for Payer: Fidelis Medicare Advantage	$296.10
Rate for Payer: Group Health Inc Commercial	$141.00
Rate for Payer: Group Health Inc Medicare	$98.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$183.30

5H Y PLATE W/8MM BAR MDFC LOC

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40202256
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

5H Y PLATE W/8MM BAR MDFC LOC

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40202256
Hospital Revenue Code	278
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$310.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$177.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: EmblemHealth Commercial	$148.00
Rate for Payer: Fidelis Medicare Advantage	$310.80
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

5% HYPROTIGEN 1000CC

Facility

$28.71

Hospital Charge Code	40509000
Hospital Revenue Code	260
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.36
Rate for Payer: Aetna Government	$14.36
Rate for Payer: Brighton Health Commercial	$21.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.52
Rate for Payer: Group Health Inc Commercial	$14.36
Rate for Payer: Group Health Inc Medicare	$10.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.36
Rate for Payer: Hamaspik Choice Inc Medicare	$14.36
Rate for Payer: United Healthcare Commercial	$76.00

5% HYPROTIGEN -5% DEXTROSE

Facility

$28.71

Hospital Charge Code	40509120
Hospital Revenue Code	260
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.36
Rate for Payer: Aetna Government	$14.36
Rate for Payer: Brighton Health Commercial	$21.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.52
Rate for Payer: Group Health Inc Commercial	$14.36
Rate for Payer: Group Health Inc Medicare	$10.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.36
Rate for Payer: Hamaspik Choice Inc Medicare	$14.36
Rate for Payer: United Healthcare Commercial	$76.00

5% LACTATED RINGERS - 1000CC

Facility

$10.64

Hospital Charge Code	40193510
Hospital Revenue Code	710
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$8.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.32
Rate for Payer: Aetna Government	$5.32
Rate for Payer: Brighton Health Commercial	$7.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.24
Rate for Payer: Group Health Inc Commercial	$5.32
Rate for Payer: Group Health Inc Medicare	$3.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.32
Rate for Payer: Hamaspik Choice Inc Medicare	$5.32

5% LACTATED RINGERS - 500CC

Facility

$9.92

Hospital Charge Code	40193511
Hospital Revenue Code	710
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$7.94
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

5% LACTATED RINGERS -500 CC

Facility

$11.70

Hospital Charge Code	40503511
Hospital Revenue Code	260
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.85
Rate for Payer: Aetna Government	$5.85
Rate for Payer: Brighton Health Commercial	$8.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.96
Rate for Payer: Group Health Inc Commercial	$5.85
Rate for Payer: Group Health Inc Medicare	$4.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.85
Rate for Payer: Hamaspik Choice Inc Medicare	$5.85
Rate for Payer: United Healthcare Commercial	$76.00

5% MANNITOL IN WATER-1000CC

Facility

$34.38

Hospital Charge Code	40501700
Hospital Revenue Code	260
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.19
Rate for Payer: Aetna Government	$17.19
Rate for Payer: Brighton Health Commercial	$25.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.38
Rate for Payer: Group Health Inc Commercial	$17.19
Rate for Payer: Group Health Inc Medicare	$12.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.19
Rate for Payer: Hamaspik Choice Inc Medicare	$17.19
Rate for Payer: United Healthcare Commercial	$76.00

5MM HEX CANN DRIVER END CAP

Facility

$352.00

Service Code	HCPCS C1713
Hospital Charge Code	40006154
Hospital Revenue Code	278
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$369.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$193.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$211.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$202.40
Rate for Payer: EmblemHealth Commercial	$176.00
Rate for Payer: Fidelis Medicare Advantage	$369.60
Rate for Payer: Group Health Inc Commercial	$176.00
Rate for Payer: Group Health Inc Medicare	$123.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$176.00
Rate for Payer: Hamaspik Choice Inc Medicare	$176.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$228.80

5MM HEX CANN DRIVER END CAP

Facility

$352.00

Service Code	HCPCS C1713
Hospital Charge Code	40006154
Hospital Revenue Code	278
Min. Negotiated Rate	$176.00
Max. Negotiated Rate	$176.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$176.00
Rate for Payer: Hamaspik Choice Inc Medicare	$176.00

5MM HEX DRIVER END CAP

Facility

$1,040.00

Service Code	HCPCS C1713
Hospital Charge Code	40006153
Hospital Revenue Code	278
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$520.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$520.00
Rate for Payer: Hamaspik Choice Inc Medicare	$520.00

5MM HEX DRIVER END CAP

Facility

$1,040.00

Service Code	HCPCS C1713
Hospital Charge Code	40006153
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,092.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$572.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$624.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$598.00
Rate for Payer: EmblemHealth Commercial	$520.00
Rate for Payer: Fidelis Medicare Advantage	$1,092.00
Rate for Payer: Group Health Inc Commercial	$520.00
Rate for Payer: Group Health Inc Medicare	$364.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$520.00
Rate for Payer: Hamaspik Choice Inc Medicare	$520.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$676.00

5MM HEX DRIVER SET SCREW

Facility

$1,376.00

Service Code	HCPCS C1713
Hospital Charge Code	40006137
Hospital Revenue Code	278
Min. Negotiated Rate	$688.00
Max. Negotiated Rate	$688.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$688.00
Rate for Payer: Hamaspik Choice Inc Medicare	$688.00

5MM HEX DRIVER SET SCREW

Facility

$1,376.00

Service Code	HCPCS C1713
Hospital Charge Code	40006137
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,444.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$825.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$688.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$791.20
Rate for Payer: EmblemHealth Commercial	$688.00
Rate for Payer: Fidelis Medicare Advantage	$1,444.80
Rate for Payer: Group Health Inc Commercial	$688.00
Rate for Payer: Group Health Inc Medicare	$481.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$688.00
Rate for Payer: Hamaspik Choice Inc Medicare	$688.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$894.40

5MM PIN DRIVER

Facility

$227.00

Hospital Charge Code	40200638
Hospital Revenue Code	270
Min. Negotiated Rate	$79.45
Max. Negotiated Rate	$181.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.50
Rate for Payer: Aetna Government	$113.50
Rate for Payer: Brighton Health Commercial	$170.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$181.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$154.36
Rate for Payer: Group Health Inc Commercial	$113.50
Rate for Payer: Group Health Inc Medicare	$79.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.50
Rate for Payer: Hamaspik Choice Inc Medicare	$113.50

5MM PRE-DRILLING ASSEMBLY-LONG

Facility

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40200553
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

5MM PRE-DRILLING ASSEMBLY-LONG

Facility

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40200553
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

5MM PRE-DRILLING ASSEMBLY-SHORT

Facility

$182.00

Service Code	HCPCS C1713
Hospital Charge Code	40200554
Hospital Revenue Code	278
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$91.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.00
Rate for Payer: Hamaspik Choice Inc Medicare	$91.00

5MM PRE-DRILLING ASSEMBLY-SHORT

Facility

$182.00

Service Code	HCPCS C1713
Hospital Charge Code	40200554
Hospital Revenue Code	278
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$191.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$109.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$91.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.65
Rate for Payer: EmblemHealth Commercial	$91.00
Rate for Payer: Fidelis Medicare Advantage	$191.10
Rate for Payer: Group Health Inc Commercial	$91.00
Rate for Payer: Group Health Inc Medicare	$63.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.00
Rate for Payer: Hamaspik Choice Inc Medicare	$91.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$118.30

Know your out-of-pocket cost for care.

All Charges