St. Barnabas Hospital

All Charges

Charge

Type

Price

DRILL 2.0 ORTHO

Facility IP

$785.00

Service Code	HCPCS C1713
Hospital Charge Code	64907014
Hospital Revenue Code	278
Min. Negotiated Rate	$392.50
Max. Negotiated Rate	$392.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.50
Rate for Payer: Hamaspik Choice Inc Medicare	$392.50

DRILL 2.0X62MM WL 13MM REP PIN

Facility OP

$135.13

Service Code	HCPCS C1713
Hospital Charge Code	64906407
Hospital Revenue Code	278
Min. Negotiated Rate	$47.30
Max. Negotiated Rate	$141.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.32
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	$67.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.70
Rate for Payer: Fidelis Medicare Advantage	$141.89
Rate for Payer: Group Health Inc Commercial	$67.56
Rate for Payer: Group Health Inc Medicare	$47.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.56
Rate for Payer: Hamaspik Choice Inc Medicare	$67.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.83

DRILL 2.0X62MM WL 13MM REP PIN

Facility OP

$287.12

Hospital Charge Code	40202134
Hospital Revenue Code	270
Min. Negotiated Rate	$100.49
Max. Negotiated Rate	$229.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.56
Rate for Payer: Aetna Government	$143.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$229.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$195.24
Rate for Payer: Group Health Inc Commercial	$143.56
Rate for Payer: Group Health Inc Medicare	$100.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.56
Rate for Payer: Hamaspik Choice Inc Medicare	$143.56

DRILL 2.0X62MM WL 13MM REP PIN

Facility IP

$135.13

Service Code	HCPCS C1713
Hospital Charge Code	64906407
Hospital Revenue Code	278
Min. Negotiated Rate	$67.56
Max. Negotiated Rate	$67.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.56
Rate for Payer: Hamaspik Choice Inc Medicare	$67.56

DRILL 2.1MM CANNUL

Facility OP

$930.00

Service Code	HCPCS C1713
Hospital Charge Code	64907507
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$976.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$511.50
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	$465.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$534.75
Rate for Payer: Fidelis Medicare Advantage	$976.50
Rate for Payer: Group Health Inc Commercial	$465.00
Rate for Payer: Group Health Inc Medicare	$325.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$465.00
Rate for Payer: Hamaspik Choice Inc Medicare	$465.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$604.50

DRILL 2.1MM CANNUL

Facility IP

$930.00

Service Code	HCPCS C1713
Hospital Charge Code	64907507
Hospital Revenue Code	278
Min. Negotiated Rate	$465.00
Max. Negotiated Rate	$465.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$465.00
Rate for Payer: Hamaspik Choice Inc Medicare	$465.00

DRILL 2.3- 90009

Facility OP

$697.00

Service Code	HCPCS C1713
Hospital Charge Code	64906727
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$731.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$383.35
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	$348.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$400.78
Rate for Payer: Fidelis Medicare Advantage	$731.85
Rate for Payer: Group Health Inc Commercial	$348.50
Rate for Payer: Group Health Inc Medicare	$243.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$348.50
Rate for Payer: Hamaspik Choice Inc Medicare	$348.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$453.05

DRILL 2.3- 90009

Facility IP

$697.00

Service Code	HCPCS C1713
Hospital Charge Code	64906727
Hospital Revenue Code	278
Min. Negotiated Rate	$348.50
Max. Negotiated Rate	$348.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$348.50
Rate for Payer: Hamaspik Choice Inc Medicare	$348.50

DRILL 2.75MM, .066 CANN

Facility OP

$1,000.00

Hospital Charge Code	40004884
Hospital Revenue Code	272
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$800.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$500.00
Rate for Payer: Aetna Government	$500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$680.00
Rate for Payer: Group Health Inc Commercial	$500.00
Rate for Payer: Group Health Inc Medicare	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00

DRILL 3.1 SET (705301)

Facility IP

$219.00

Service Code	HCPCS C1713
Hospital Charge Code	64906489
Hospital Revenue Code	278
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$109.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.50
Rate for Payer: Hamaspik Choice Inc Medicare	$109.50

DRILL 3.1 SET (705301)

Facility OP

$219.00

Service Code	HCPCS C1713
Hospital Charge Code	64906489
Hospital Revenue Code	278
Min. Negotiated Rate	$76.65
Max. Negotiated Rate	$229.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$120.45
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	$109.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.92
Rate for Payer: Fidelis Medicare Advantage	$229.95
Rate for Payer: Group Health Inc Commercial	$109.50
Rate for Payer: Group Health Inc Medicare	$76.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.50
Rate for Payer: Hamaspik Choice Inc Medicare	$109.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$142.35

DRILL 3.5X230MM

Facility OP

$200.00

Service Code	HCPCS C1713
Hospital Charge Code	40200542
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$210.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
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	$100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.00
Rate for Payer: Fidelis Medicare Advantage	$210.00
Rate for Payer: Group Health Inc Commercial	$100.00
Rate for Payer: Group Health Inc Medicare	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$130.00

DRILL 3.5X230MM

Facility IP

$200.00

Service Code	HCPCS C1713
Hospital Charge Code	40200542
Hospital Revenue Code	278
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00

DRILL 4.2MM

Facility OP

$220.00

Hospital Charge Code	40202136
Hospital Revenue Code	270
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$176.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$110.00
Rate for Payer: Aetna Government	$110.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.60
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00

DRILL 4.2 X 130MM 4213S

Facility IP

$708.84

Service Code	HCPCS C1713
Hospital Charge Code	64906753
Hospital Revenue Code	278
Min. Negotiated Rate	$354.42
Max. Negotiated Rate	$354.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$354.42
Rate for Payer: Hamaspik Choice Inc Medicare	$354.42

DRILL 4.2 X 130MM 4213S

Facility OP

$708.84

Service Code	HCPCS C1713
Hospital Charge Code	64906753
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$744.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$389.86
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	$354.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$407.58
Rate for Payer: Fidelis Medicare Advantage	$744.28
Rate for Payer: Group Health Inc Commercial	$354.42
Rate for Payer: Group Health Inc Medicare	$248.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$354.42
Rate for Payer: Hamaspik Choice Inc Medicare	$354.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$460.75

DRILL 4.2 X 180MM

Facility OP

$238.00

Hospital Charge Code	40202412
Hospital Revenue Code	270
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$190.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$119.00
Rate for Payer: Aetna Government	$119.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.84
Rate for Payer: Group Health Inc Commercial	$119.00
Rate for Payer: Group Health Inc Medicare	$83.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$119.00

DRILL 430MM

Facility OP

$228.00

Service Code	HCPCS C1776
Hospital Charge Code	40202421
Hospital Revenue Code	278
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.40
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	$114.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.10
Rate for Payer: Fidelis Medicare Advantage	$239.40
Rate for Payer: Group Health Inc Commercial	$114.00
Rate for Payer: Group Health Inc Medicare	$79.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.00
Rate for Payer: Hamaspik Choice Inc Medicare	$114.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.20

DRILL 430MM

Facility IP

$228.00

Service Code	HCPCS C1776
Hospital Charge Code	40202421
Hospital Revenue Code	278
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$114.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.00
Rate for Payer: Hamaspik Choice Inc Medicare	$114.00

DRILL 4.3MM

Facility OP

$146.00

Hospital Charge Code	40202137
Hospital Revenue Code	270
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$116.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.00
Rate for Payer: Aetna Government	$73.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$116.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.28
Rate for Payer: Group Health Inc Commercial	$73.00
Rate for Payer: Group Health Inc Medicare	$51.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00

DRILL 4.3MML DISTAL GRADUATED

Facility OP

$624.00

Hospital Charge Code	40003335
Hospital Revenue Code	272
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$499.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$312.00
Rate for Payer: Aetna Government	$312.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$499.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$424.32
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

DRILL 4.3MML DISTAL GRADUTD

Facility OP

$624.00

Hospital Charge Code	40204592
Hospital Revenue Code	272
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$499.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$312.00
Rate for Payer: Aetna Government	$312.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$499.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$424.32
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

DRILL 4.3MML DISTAL GRADUTD

Facility OP

$624.00

Hospital Charge Code	40007511
Hospital Revenue Code	272
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$499.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$312.00
Rate for Payer: Aetna Government	$312.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$499.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$424.32
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

DRILL ANCHOR-C 10MM (48328910)

Facility IP

$326.41

Service Code	HCPCS C1713
Hospital Charge Code	64906379
Hospital Revenue Code	278
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$163.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.20
Rate for Payer: Hamaspik Choice Inc Medicare	$163.20

DRILL ANCHOR-C 10MM (48328910)

Facility OP

$326.41

Service Code	HCPCS C1713
Hospital Charge Code	64906379
Hospital Revenue Code	278
Min. Negotiated Rate	$114.24
Max. Negotiated Rate	$342.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.53
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	$163.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.69
Rate for Payer: Fidelis Medicare Advantage	$342.73
Rate for Payer: Group Health Inc Commercial	$163.20
Rate for Payer: Group Health Inc Medicare	$114.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.20
Rate for Payer: Hamaspik Choice Inc Medicare	$163.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$212.17

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