St. Barnabas Hospital

All Charges

Charge

Type

Price

7HOLE NARROW T-PLATE

Facility OP

$1,796.00

Service Code	HCPCS C1713
Hospital Charge Code	40209947
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,885.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$987.80
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	$898.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,032.70
Rate for Payer: Fidelis Medicare Advantage	$1,885.80
Rate for Payer: Group Health Inc Commercial	$898.00
Rate for Payer: Group Health Inc Medicare	$628.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$898.00
Rate for Payer: Hamaspik Choice Inc Medicare	$898.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,167.40

7HOLE NARROW T-PLATE

Facility OP

$1,558.00

Service Code	HCPCS C1713
Hospital Charge Code	40201106
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,635.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$856.90
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	$779.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$895.85
Rate for Payer: Fidelis Medicare Advantage	$1,635.90
Rate for Payer: Group Health Inc Commercial	$779.00
Rate for Payer: Group Health Inc Medicare	$545.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$779.00
Rate for Payer: Hamaspik Choice Inc Medicare	$779.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,012.70

7HOLE NARROW T-PLATE

Facility IP

$1,796.00

Service Code	HCPCS C1713
Hospital Charge Code	40209947
Hospital Revenue Code	278
Min. Negotiated Rate	$898.00
Max. Negotiated Rate	$898.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$898.00
Rate for Payer: Hamaspik Choice Inc Medicare	$898.00

7 HOLE PLT UPPERFACE

Facility IP

$288.00

Service Code	HCPCS C1713
Hospital Charge Code	40201166
Hospital Revenue Code	278
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$144.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.00
Rate for Payer: Hamaspik Choice Inc Medicare	$144.00

7 HOLE PLT UPPERFACE

Facility OP

$288.00

Service Code	HCPCS C1713
Hospital Charge Code	40201166
Hospital Revenue Code	278
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$302.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$158.40
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	$144.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.60
Rate for Payer: Fidelis Medicare Advantage	$302.40
Rate for Payer: Group Health Inc Commercial	$144.00
Rate for Payer: Group Health Inc Medicare	$100.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.00
Rate for Payer: Hamaspik Choice Inc Medicare	$144.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$187.20

7MM T-WRENCH

Facility OP

$172.00

Hospital Charge Code	40200639
Hospital Revenue Code	270
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$137.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$86.00
Rate for Payer: Aetna Government	$86.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$137.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$116.96
Rate for Payer: Group Health Inc Commercial	$86.00
Rate for Payer: Group Health Inc Medicare	$60.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00

7+TOTAL VISISTS, ROUTINE OB

Facility OP

$2,174.40

Service Code	HCPCS 59426
Hospital Charge Code	30301247
Hospital Revenue Code	510
Min. Negotiated Rate	$233.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,195.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$754.76
Rate for Payer: Aetna Government	$754.76
Rate for Payer: Brighton Health Commercial	$233.00
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: Fidelis CHP/HARP/Medicaid	$942.44
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	$1,087.20
Rate for Payer: Hamaspik Choice Inc Medicare	$1,087.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,047.15

8H LATERAL FEMUR LOCKING PLATE

Facility OP

$1,816.00

Service Code	HCPCS C1713
Hospital Charge Code	40200561
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,906.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$998.80
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	$908.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,044.20
Rate for Payer: Fidelis Medicare Advantage	$1,906.80
Rate for Payer: Group Health Inc Commercial	$908.00
Rate for Payer: Group Health Inc Medicare	$635.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$908.00
Rate for Payer: Hamaspik Choice Inc Medicare	$908.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,180.40

8H LATERAL FEMUR LOCKING PLATE

Facility IP

$1,816.00

Service Code	HCPCS C1713
Hospital Charge Code	40200561
Hospital Revenue Code	278
Min. Negotiated Rate	$908.00
Max. Negotiated Rate	$908.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$908.00
Rate for Payer: Hamaspik Choice Inc Medicare	$908.00

8HOLE L PLT 90D LFT UPPERFACE

Facility OP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201178
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: Cigna HMO/Network Benefit Plan/Open Access	$141.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.15
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

8HOLE L PLT 90D LFT UPPERFACE

Facility IP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201178
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

8HOLE L PLTE 90D LEFT UPPERFACE

Facility OP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201172
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: Cigna HMO/Network Benefit Plan/Open Access	$141.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.15
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

8HOLE L PLTE 90D LEFT UPPERFACE

Facility IP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201172
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

8HOLE L PLTE 90D RIGHT UPPERFACE

Facility OP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201173
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: Cigna HMO/Network Benefit Plan/Open Access	$141.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.15
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

8HOLE L PLTE 90D RIGHT UPPERFACE

Facility IP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201173
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

8HOLE PLATE,MIDFACE

Facility IP

$428.00

Service Code	HCPCS C1713
Hospital Charge Code	40201174
Hospital Revenue Code	278
Min. Negotiated Rate	$214.00
Max. Negotiated Rate	$214.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.00
Rate for Payer: Hamaspik Choice Inc Medicare	$214.00

8HOLE PLATE,MIDFACE

Facility OP

$428.00

Service Code	HCPCS C1713
Hospital Charge Code	40201174
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$449.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.40
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	$214.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.10
Rate for Payer: Fidelis Medicare Advantage	$449.40
Rate for Payer: Group Health Inc Commercial	$214.00
Rate for Payer: Group Health Inc Medicare	$149.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.00
Rate for Payer: Hamaspik Choice Inc Medicare	$214.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$278.20

8HOLE Y PLATE.MIDFACE LOCKING

Facility IP

$448.00

Service Code	HCPCS C1713
Hospital Charge Code	40201177
Hospital Revenue Code	278
Min. Negotiated Rate	$224.00
Max. Negotiated Rate	$224.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$224.00
Rate for Payer: Hamaspik Choice Inc Medicare	$224.00

8HOLE Y PLATE.MIDFACE LOCKING

Facility OP

$448.00

Service Code	HCPCS C1713
Hospital Charge Code	40201177
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$470.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$246.40
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	$224.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$257.60
Rate for Payer: Fidelis Medicare Advantage	$470.40
Rate for Payer: Group Health Inc Commercial	$224.00
Rate for Payer: Group Health Inc Medicare	$156.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$224.00
Rate for Payer: Hamaspik Choice Inc Medicare	$224.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$291.20

8H RGHT CLAVICLE PLATE

Facility OP

$1,764.00

Service Code	HCPCS C1713
Hospital Charge Code	40200115
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,852.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$970.20
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	$882.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,014.30
Rate for Payer: Fidelis Medicare Advantage	$1,852.20
Rate for Payer: Group Health Inc Commercial	$882.00
Rate for Payer: Group Health Inc Medicare	$617.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$882.00
Rate for Payer: Hamaspik Choice Inc Medicare	$882.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,146.60

8H RGHT CLAVICLE PLATE

Facility IP

$1,764.00

Service Code	HCPCS C1713
Hospital Charge Code	40200115
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$882.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$882.00
Rate for Payer: Hamaspik Choice Inc Medicare	$882.00

8MM THREADED POST W/13MM NUT

Facility OP

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	40200563
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

8MM THREADED POST W/13MM NUT

Facility IP

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	40200563
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

8x10 Bioclusive Dressing

Facility OP

$18.07

Hospital Charge Code	40200011
Hospital Revenue Code	270
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$14.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.04
Rate for Payer: Aetna Government	$9.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.29
Rate for Payer: Group Health Inc Commercial	$9.04
Rate for Payer: Group Health Inc Medicare	$6.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.04
Rate for Payer: Hamaspik Choice Inc Medicare	$9.04

8X28MM LEFT NAIL

Facility OP

$5,100.00

Service Code	HCPCS C1713
Hospital Charge Code	40203555
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,355.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,805.00
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	$2,550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,932.50
Rate for Payer: Fidelis Medicare Advantage	$5,355.00
Rate for Payer: Group Health Inc Commercial	$2,550.00
Rate for Payer: Group Health Inc Medicare	$1,785.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,315.00

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