St. Barnabas Hospital

All Charges

Charge

Type

Price

1.2MM ORBITAL FL PLT,BSC,MED 4MM

Facility OP

$1,424.00

Service Code	HCPCS C1781
Hospital Charge Code	40209760
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,495.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$783.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$712.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$818.80
Rate for Payer: Fidelis Medicare Advantage	$1,495.20
Rate for Payer: Group Health Inc Commercial	$712.00
Rate for Payer: Group Health Inc Medicare	$498.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$712.00
Rate for Payer: Hamaspik Choice Inc Medicare	$712.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$925.60

1.2MM ORBITAL FL PLT,CMPLX,L 3MM

Facility IP

$1,144.00

Service Code	HCPCS C1781
Hospital Charge Code	40209761
Hospital Revenue Code	278
Min. Negotiated Rate	$572.00
Max. Negotiated Rate	$572.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00
Rate for Payer: Hamaspik Choice Inc Medicare	$572.00

1.2MM ORBITAL FL PLT,CMPLX,L 3MM

Facility OP

$1,144.00

Service Code	HCPCS C1781
Hospital Charge Code	40209761
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,201.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$629.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$572.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$657.80
Rate for Payer: Fidelis Medicare Advantage	$1,201.20
Rate for Payer: Group Health Inc Commercial	$572.00
Rate for Payer: Group Health Inc Medicare	$400.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00
Rate for Payer: Hamaspik Choice Inc Medicare	$572.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$743.60

1.2MM ORBITAL FL PLT,CMPLX,L 4MM

Facility IP

$1,144.00

Service Code	HCPCS C1781
Hospital Charge Code	40209762
Hospital Revenue Code	278
Min. Negotiated Rate	$572.00
Max. Negotiated Rate	$572.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00
Rate for Payer: Hamaspik Choice Inc Medicare	$572.00

1.2MM ORBITAL FL PLT,CMPLX,L 4MM

Facility OP

$1,144.00

Service Code	HCPCS C1781
Hospital Charge Code	40209762
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,201.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$629.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$572.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$657.80
Rate for Payer: Fidelis Medicare Advantage	$1,201.20
Rate for Payer: Group Health Inc Commercial	$572.00
Rate for Payer: Group Health Inc Medicare	$400.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00
Rate for Payer: Hamaspik Choice Inc Medicare	$572.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$743.60

1.2MM ORBITAL FL PLT,ISLTD,SM 3MM

Facility IP

$1,024.00

Service Code	HCPCS C1781
Hospital Charge Code	40209763
Hospital Revenue Code	278
Min. Negotiated Rate	$512.00
Max. Negotiated Rate	$512.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$512.00
Rate for Payer: Hamaspik Choice Inc Medicare	$512.00

1.2MM ORBITAL FL PLT,ISLTD,SM 3MM

Facility OP

$1,024.00

Service Code	HCPCS C1781
Hospital Charge Code	40209763
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,075.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$563.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$512.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$588.80
Rate for Payer: Fidelis Medicare Advantage	$1,075.20
Rate for Payer: Group Health Inc Commercial	$512.00
Rate for Payer: Group Health Inc Medicare	$358.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$512.00
Rate for Payer: Hamaspik Choice Inc Medicare	$512.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$665.60

12 MM SMALL ROUND ENDCAP

Facility OP

$383.00

Hospital Charge Code	40001657
Hospital Revenue Code	270
Min. Negotiated Rate	$134.05
Max. Negotiated Rate	$306.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$191.50
Rate for Payer: Aetna Government	$191.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$306.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$260.44
Rate for Payer: Group Health Inc Commercial	$191.50
Rate for Payer: Group Health Inc Medicare	$134.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.50
Rate for Payer: Hamaspik Choice Inc Medicare	$191.50

1.2 ORBITAL FLOOR PLATE

Facility OP

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	40201237
Hospital Revenue Code	278
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$340.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.20
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	$162.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.30
Rate for Payer: Fidelis Medicare Advantage	$340.20
Rate for Payer: Group Health Inc Commercial	$162.00
Rate for Payer: Group Health Inc Medicare	$113.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$210.60

1.2 ORBITAL FLOOR PLATE

Facility OP

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	40202313
Hospital Revenue Code	278
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$340.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.20
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	$162.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.30
Rate for Payer: Fidelis Medicare Advantage	$340.20
Rate for Payer: Group Health Inc Commercial	$162.00
Rate for Payer: Group Health Inc Medicare	$113.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$210.60

1.2 ORBITAL FLOOR PLATE

Facility IP

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	40202313
Hospital Revenue Code	278
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00

1.2 ORBITAL FLOOR PLATE

Facility IP

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	40201237
Hospital Revenue Code	278
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00

12X285 T2 TIBIAL NAIL, STANDARD

Facility IP

$2,350.00

Service Code	HCPCS C1713
Hospital Charge Code	40200582
Hospital Revenue Code	278
Min. Negotiated Rate	$1,175.00
Max. Negotiated Rate	$1,175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,175.00

12X285 T2 TIBIAL NAIL, STANDARD

Facility OP

$2,350.00

Service Code	HCPCS C1713
Hospital Charge Code	40200582
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,467.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,292.50
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	$1,175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,351.25
Rate for Payer: Fidelis Medicare Advantage	$2,467.50
Rate for Payer: Group Health Inc Commercial	$1,175.00
Rate for Payer: Group Health Inc Medicare	$822.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,527.50

12X360MM T2 TIBIAL NAIL, STANDARD

Facility OP

$2,360.00

Service Code	HCPCS C1713
Hospital Charge Code	40200583
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,478.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,298.00
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	$1,180.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,357.00
Rate for Payer: Fidelis Medicare Advantage	$2,478.00
Rate for Payer: Group Health Inc Commercial	$1,180.00
Rate for Payer: Group Health Inc Medicare	$826.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,534.00

12X360MM T2 TIBIAL NAIL, STANDARD

Facility IP

$2,360.00

Service Code	HCPCS C1713
Hospital Charge Code	40200583
Hospital Revenue Code	278
Min. Negotiated Rate	$1,180.00
Max. Negotiated Rate	$1,180.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,180.00

12X390MM T2 TIBIAL NAIL, STANDARD

Facility OP

$2,364.00

Service Code	HCPCS C1713
Hospital Charge Code	40200584
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,482.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,300.20
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	$1,182.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,359.30
Rate for Payer: Fidelis Medicare Advantage	$2,482.20
Rate for Payer: Group Health Inc Commercial	$1,182.00
Rate for Payer: Group Health Inc Medicare	$827.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,182.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,182.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,536.60

12X390MM T2 TIBIAL NAIL, STANDARD

Facility IP

$2,364.00

Service Code	HCPCS C1713
Hospital Charge Code	40200584
Hospital Revenue Code	278
Min. Negotiated Rate	$1,182.00
Max. Negotiated Rate	$1,182.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,182.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,182.00

1.2 X3MM BONE SCREW

Facility IP

$126.70

Service Code	HCPCS C1713
Hospital Charge Code	40005304
Hospital Revenue Code	278
Min. Negotiated Rate	$63.35
Max. Negotiated Rate	$63.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.35
Rate for Payer: Hamaspik Choice Inc Medicare	$63.35

1.2 X3MM BONE SCREW

Facility OP

$126.70

Service Code	HCPCS C1713
Hospital Charge Code	40005304
Hospital Revenue Code	278
Min. Negotiated Rate	$44.34
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.68
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	$63.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.85
Rate for Payer: Fidelis Medicare Advantage	$133.04
Rate for Payer: Group Health Inc Commercial	$63.35
Rate for Payer: Group Health Inc Medicare	$44.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.35
Rate for Payer: Hamaspik Choice Inc Medicare	$63.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$82.36

1.35 5MM TWIST DRILL

Facility OP

$221.62

Hospital Charge Code	40005305
Hospital Revenue Code	272
Min. Negotiated Rate	$77.57
Max. Negotiated Rate	$177.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$110.81
Rate for Payer: Aetna Government	$110.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$177.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.70
Rate for Payer: Group Health Inc Commercial	$110.81
Rate for Payer: Group Health Inc Medicare	$77.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.81
Rate for Payer: Hamaspik Choice Inc Medicare	$110.81

13 HOLE NARROW Z-PLT

Facility IP

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	40203443
Hospital Revenue Code	278
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$422.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.50
Rate for Payer: Hamaspik Choice Inc Medicare	$422.50

13 HOLE NARROW Z-PLT

Facility OP

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	40203443
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$887.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$464.75
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	$422.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$485.88
Rate for Payer: Fidelis Medicare Advantage	$887.25
Rate for Payer: Group Health Inc Commercial	$422.50
Rate for Payer: Group Health Inc Medicare	$295.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.50
Rate for Payer: Hamaspik Choice Inc Medicare	$422.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$549.25

13_HOLE NARROW Z-PLT

Facility IP

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	40204725
Hospital Revenue Code	278
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$422.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.50
Rate for Payer: Hamaspik Choice Inc Medicare	$422.50

13_HOLE NARROW Z-PLT

Facility OP

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	40204725
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$887.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$464.75
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	$422.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$485.88
Rate for Payer: Fidelis Medicare Advantage	$887.25
Rate for Payer: Group Health Inc Commercial	$422.50
Rate for Payer: Group Health Inc Medicare	$295.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.50
Rate for Payer: Hamaspik Choice Inc Medicare	$422.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$549.25

Price Transparency.

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