St. Barnabas Hospital

All Charges

Charge

Type

Price

13X380MMX125 GAMMA 3 LONG

Facility IP

$3,453.80

Service Code	HCPCS C1713
Hospital Charge Code	40203003
Hospital Revenue Code	278
Min. Negotiated Rate	$1,726.90
Max. Negotiated Rate	$1,726.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,726.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1,726.90

13X380MMX125 GAMMA 3 LONG

Facility OP

$3,453.80

Service Code	HCPCS C1713
Hospital Charge Code	40203003
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,626.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,899.59
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	$1,726.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,985.94
Rate for Payer: Fidelis Medicare Advantage	$3,626.49
Rate for Payer: Group Health Inc Commercial	$1,726.90
Rate for Payer: Group Health Inc Medicare	$1,208.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,726.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1,726.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,244.97

14 SHAFT ANTLAT TIBIA PLATE

Facility IP

$5,278.00

Service Code	HCPCS C1713
Hospital Charge Code	40005311
Hospital Revenue Code	278
Min. Negotiated Rate	$2,639.00
Max. Negotiated Rate	$2,639.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,639.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,639.00

14 SHAFT ANTLAT TIBIA PLATE

Facility OP

$5,278.00

Service Code	HCPCS C1713
Hospital Charge Code	40005311
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,541.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,902.90
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	$2,639.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,034.85
Rate for Payer: Fidelis Medicare Advantage	$5,541.90
Rate for Payer: Group Health Inc Commercial	$2,639.00
Rate for Payer: Group Health Inc Medicare	$1,847.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,639.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,639.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,430.70

1.4 X 3 MM EMERGENCY SCREW

Facility IP

$132.38

Service Code	HCPCS C1713
Hospital Charge Code	40005309
Hospital Revenue Code	278
Min. Negotiated Rate	$66.19
Max. Negotiated Rate	$66.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.19
Rate for Payer: Hamaspik Choice Inc Medicare	$66.19

1.4 X 3 MM EMERGENCY SCREW

Facility OP

$132.38

Service Code	HCPCS C1713
Hospital Charge Code	40005309
Hospital Revenue Code	278
Min. Negotiated Rate	$46.33
Max. Negotiated Rate	$139.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.81
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	$66.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.12
Rate for Payer: Fidelis Medicare Advantage	$139.00
Rate for Payer: Group Health Inc Commercial	$66.19
Rate for Payer: Group Health Inc Medicare	$46.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.19
Rate for Payer: Hamaspik Choice Inc Medicare	$66.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$86.05

150MM FOOT RING

Facility OP

$1,140.00

Hospital Charge Code	40200585
Hospital Revenue Code	270
Min. Negotiated Rate	$399.00
Max. Negotiated Rate	$912.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$627.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$570.00
Rate for Payer: Aetna Government	$570.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$912.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$775.20
Rate for Payer: Group Health Inc Commercial	$570.00
Rate for Payer: Group Health Inc Medicare	$399.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$570.00
Rate for Payer: Hamaspik Choice Inc Medicare	$570.00

150MM OPEN RING

Facility OP

$804.00

Hospital Charge Code	40200586
Hospital Revenue Code	270
Min. Negotiated Rate	$281.40
Max. Negotiated Rate	$643.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$442.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.00
Rate for Payer: Aetna Government	$402.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$643.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$546.72
Rate for Payer: Group Health Inc Commercial	$402.00
Rate for Payer: Group Health Inc Medicare	$281.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$402.00
Rate for Payer: Hamaspik Choice Inc Medicare	$402.00

15CC HYDROSET BONE SUBSTITUTE

Facility OP

$5,040.00

Service Code	HCPCS C1713
Hospital Charge Code	40009116
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,292.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,772.00
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	$2,520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,898.00
Rate for Payer: Fidelis Medicare Advantage	$5,292.00
Rate for Payer: Group Health Inc Commercial	$2,520.00
Rate for Payer: Group Health Inc Medicare	$1,764.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,520.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,520.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,276.00

15CC HYDROSET BONE SUBSTITUTE

Facility IP

$5,040.00

Service Code	HCPCS C1713
Hospital Charge Code	40009116
Hospital Revenue Code	278
Min. Negotiated Rate	$2,520.00
Max. Negotiated Rate	$2,520.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,520.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,520.00

1.5X4MM SELF DRILLING SCREW

Facility OP

$116.00

Service Code	HCPCS C1713
Hospital Charge Code	40202316
Hospital Revenue Code	278
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.80
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	$58.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.70
Rate for Payer: Fidelis Medicare Advantage	$121.80
Rate for Payer: Group Health Inc Commercial	$58.00
Rate for Payer: Group Health Inc Medicare	$40.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.00
Rate for Payer: Hamaspik Choice Inc Medicare	$58.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75.40

1.5X4MM SELF DRILLING SCREW

Facility IP

$116.00

Service Code	HCPCS C1713
Hospital Charge Code	40202316
Hospital Revenue Code	278
Min. Negotiated Rate	$58.00
Max. Negotiated Rate	$58.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.00
Rate for Payer: Hamaspik Choice Inc Medicare	$58.00

1.5X5MM NEURO SCREW C-P SELF DRL

Facility OP

$718.00

Service Code	HCPCS C1713
Hospital Charge Code	40202317
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$753.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$394.90
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	$359.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$412.85
Rate for Payer: Fidelis Medicare Advantage	$753.90
Rate for Payer: Group Health Inc Commercial	$359.00
Rate for Payer: Group Health Inc Medicare	$251.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$359.00
Rate for Payer: Hamaspik Choice Inc Medicare	$359.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$466.70

1.5X5MM NEURO SCREW C-P SELF DRL

Facility IP

$718.00

Service Code	HCPCS C1713
Hospital Charge Code	40202317
Hospital Revenue Code	278
Min. Negotiated Rate	$359.00
Max. Negotiated Rate	$359.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$359.00
Rate for Payer: Hamaspik Choice Inc Medicare	$359.00

16H BP NO BAR

Facility IP

$794.00

Service Code	HCPCS C1781
Hospital Charge Code	40209810
Hospital Revenue Code	278
Min. Negotiated Rate	$397.00
Max. Negotiated Rate	$397.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$397.00
Rate for Payer: Hamaspik Choice Inc Medicare	$397.00

16H BP NO BAR

Facility OP

$794.00

Service Code	HCPCS C1781
Hospital Charge Code	40209810
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$833.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$436.70
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	$397.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$456.55
Rate for Payer: Fidelis Medicare Advantage	$833.70
Rate for Payer: Group Health Inc Commercial	$397.00
Rate for Payer: Group Health Inc Medicare	$277.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$397.00
Rate for Payer: Hamaspik Choice Inc Medicare	$397.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$516.10

16H START PLT MAN LOCK CONDSD

Facility OP

$656.00

Service Code	HCPCS C1781
Hospital Charge Code	40209811
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$688.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$360.80
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	$328.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$377.20
Rate for Payer: Fidelis Medicare Advantage	$688.80
Rate for Payer: Group Health Inc Commercial	$328.00
Rate for Payer: Group Health Inc Medicare	$229.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$328.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$426.40

16H START PLT MAN LOCK CONDSD

Facility IP

$656.00

Service Code	HCPCS C1781
Hospital Charge Code	40209811
Hospital Revenue Code	278
Min. Negotiated Rate	$328.00
Max. Negotiated Rate	$328.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$328.00

16H STRIP PLATE

Facility IP

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	40200063
Hospital Revenue Code	278
Min. Negotiated Rate	$275.00
Max. Negotiated Rate	$275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00

16H STRIP PLATE

Facility OP

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	40200063
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$577.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
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	$275.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$316.25
Rate for Payer: Fidelis Medicare Advantage	$577.50
Rate for Payer: Group Health Inc Commercial	$275.00
Rate for Payer: Group Health Inc Medicare	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$357.50

16H STRT PLT, MDFACE LOCK

Facility IP

$624.00

Service Code	HCPCS C1781
Hospital Charge Code	40209812
Hospital Revenue Code	278
Min. Negotiated Rate	$312.00
Max. Negotiated Rate	$312.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.00
Rate for Payer: Hamaspik Choice Inc Medicare	$312.00

16H STRT PLT, MDFACE LOCK

Facility OP

$624.00

Service Code	HCPCS C1781
Hospital Charge Code	40209812
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$655.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.20
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	$312.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$358.80
Rate for Payer: Fidelis Medicare Advantage	$655.20
Rate for Payer: Group Health Inc Commercial	$312.00
Rate for Payer: Group Health Inc Medicare	$218.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.00
Rate for Payer: Hamaspik Choice Inc Medicare	$312.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$405.60

1/6 MLAR SODUM LACTATE 1000CC

Facility OP

$16.31

Hospital Charge Code	40504100
Hospital Revenue Code	260
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$13.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.16
Rate for Payer: Aetna Government	$8.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.09
Rate for Payer: Group Health Inc Commercial	$8.16
Rate for Payer: Group Health Inc Medicare	$5.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.16
Rate for Payer: Hamaspik Choice Inc Medicare	$8.16

1.7 EMERGENCY SCREW

Facility IP

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	40202318
Hospital Revenue Code	278
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

1.7 EMERGENCY SCREW

Facility OP

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	40202318
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$735.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
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	$350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$402.50
Rate for Payer: Fidelis Medicare Advantage	$735.00
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$455.00

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