St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DRILL GUIDE DOUBLE 3.2/49.MM

Facility

$844.48

Service Code	HCPCS C1713
Hospital Charge Code	64906536
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$886.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$464.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$506.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$422.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$485.58
Rate for Payer: EmblemHealth Commercial	$422.24
Rate for Payer: Fidelis Medicare Advantage	$886.70
Rate for Payer: Group Health Inc Commercial	$422.24
Rate for Payer: Group Health Inc Medicare	$295.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.24
Rate for Payer: Hamaspik Choice Inc Medicare	$422.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$548.91

DRILL GUIDE DOUBLE 3.2/49.MM

Facility

$844.48

Service Code	HCPCS C1713
Hospital Charge Code	64906536
Hospital Revenue Code	278
Min. Negotiated Rate	$422.24
Max. Negotiated Rate	$422.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.24
Rate for Payer: Hamaspik Choice Inc Medicare	$422.24

DRILL GUIDE HANDLE

Facility

$594.00

Hospital Charge Code	40200659
Hospital Revenue Code	270
Min. Negotiated Rate	$207.90
Max. Negotiated Rate	$475.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$326.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$297.00
Rate for Payer: Aetna Government	$297.00
Rate for Payer: Brighton Health Commercial	$445.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$475.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$403.92
Rate for Payer: Group Health Inc Commercial	$297.00
Rate for Payer: Group Health Inc Medicare	$207.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$297.00
Rate for Payer: Hamaspik Choice Inc Medicare	$297.00

DRILL NON CANN 4MM

Facility

$230.00

Hospital Charge Code	40004883
Hospital Revenue Code	272
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$184.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$115.00
Rate for Payer: Aetna Government	$115.00
Rate for Payer: Brighton Health Commercial	$172.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$184.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$156.40
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

DRILL ORTHO

Facility

$1,297.50

Service Code	HCPCS C1713
Hospital Charge Code	64906983
Hospital Revenue Code	278
Min. Negotiated Rate	$648.75
Max. Negotiated Rate	$648.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$648.75
Rate for Payer: Hamaspik Choice Inc Medicare	$648.75

DRILL ORTHO

Facility

$1,297.50

Service Code	HCPCS C1713
Hospital Charge Code	64906983
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,362.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$713.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$778.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$648.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$746.06
Rate for Payer: EmblemHealth Commercial	$648.75
Rate for Payer: Fidelis Medicare Advantage	$1,362.38
Rate for Payer: Group Health Inc Commercial	$648.75
Rate for Payer: Group Health Inc Medicare	$454.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$648.75
Rate for Payer: Hamaspik Choice Inc Medicare	$648.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$843.38

DRILL PILOT 1.6MM LONG MANDIBLE

Facility

$242.00

Service Code	HCPCS C1776
Hospital Charge Code	40206060
Hospital Revenue Code	278
Min. Negotiated Rate	$121.00
Max. Negotiated Rate	$121.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.00
Rate for Payer: Hamaspik Choice Inc Medicare	$121.00

DRILL PILOT 1.6MM LONG MANDIBLE

Facility

$242.00

Service Code	HCPCS C1776
Hospital Charge Code	40206060
Hospital Revenue Code	278
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$133.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$145.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$121.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$139.15
Rate for Payer: EmblemHealth Commercial	$121.00
Rate for Payer: Fidelis Medicare Advantage	$254.10
Rate for Payer: Group Health Inc Commercial	$121.00
Rate for Payer: Group Health Inc Medicare	$84.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.00
Rate for Payer: Hamaspik Choice Inc Medicare	$121.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$157.30

DRILL PROFILE

Facility

$500.00

Hospital Charge Code	64907237
Hospital Revenue Code	270
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$250.00
Rate for Payer: Aetna Government	$250.00
Rate for Payer: Brighton Health Commercial	$375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

DRILL SLD CUT 40'MM

Facility

$268.00

Service Code	HCPCS C1713
Hospital Charge Code	64906911
Hospital Revenue Code	278
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$281.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$160.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$134.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$154.10
Rate for Payer: EmblemHealth Commercial	$134.00
Rate for Payer: Fidelis Medicare Advantage	$281.40
Rate for Payer: Group Health Inc Commercial	$134.00
Rate for Payer: Group Health Inc Medicare	$93.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$174.20

DRILL SLD CUT 40'MM

Facility

$268.00

Service Code	HCPCS C1713
Hospital Charge Code	64906911
Hospital Revenue Code	278
Min. Negotiated Rate	$134.00
Max. Negotiated Rate	$134.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00

DRILL SLD STATE 2.5 X 40MM

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64906999
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$299.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$142.50
Rate for Payer: Fidelis Medicare Advantage	$299.25
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.25

DRILL SLD STATE 2.5 X 40MM

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64906999
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

DRILL SMALL 17660

Facility

$90.00

Hospital Charge Code	64906770
Hospital Revenue Code	270
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$72.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.00
Rate for Payer: Aetna Government	$45.00
Rate for Payer: Brighton Health Commercial	$67.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$72.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.20
Rate for Payer: Group Health Inc Commercial	$45.00
Rate for Payer: Group Health Inc Medicare	$31.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.00
Rate for Payer: Hamaspik Choice Inc Medicare	$45.00

DRILL, SOLID AO 2.0X110MM

Facility

$393.93

Hospital Charge Code	40004428
Hospital Revenue Code	272
Min. Negotiated Rate	$137.88
Max. Negotiated Rate	$315.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$216.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$196.96
Rate for Payer: Aetna Government	$196.96
Rate for Payer: Brighton Health Commercial	$295.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$315.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$267.87
Rate for Payer: Group Health Inc Commercial	$196.96
Rate for Payer: Group Health Inc Medicare	$137.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.96
Rate for Payer: Hamaspik Choice Inc Medicare	$196.96

DRILL STEP

Facility

$2,097.00

Service Code	HCPCS C1713
Hospital Charge Code	40204059
Hospital Revenue Code	278
Min. Negotiated Rate	$1,048.50
Max. Negotiated Rate	$1,048.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,048.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,048.50

DRILL STEP

Facility

$2,097.00

Service Code	HCPCS C1713
Hospital Charge Code	40204059
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,201.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,153.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,258.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,048.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,205.78
Rate for Payer: EmblemHealth Commercial	$1,048.50
Rate for Payer: Fidelis Medicare Advantage	$2,201.85
Rate for Payer: Group Health Inc Commercial	$1,048.50
Rate for Payer: Group Health Inc Medicare	$733.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,048.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,048.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,363.05

DRILL STRAIGHT 3.0

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	64907512
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

DRILL STRAIGHT 3.0

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	64907512
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

DRILL SURG 3.2MM DIA 200MML

Facility

$160.00

Service Code	HCPCS C1713
Hospital Charge Code	64906561
Hospital Revenue Code	278
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$168.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$96.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.00
Rate for Payer: EmblemHealth Commercial	$80.00
Rate for Payer: Fidelis Medicare Advantage	$168.00
Rate for Payer: Group Health Inc Commercial	$80.00
Rate for Payer: Group Health Inc Medicare	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$104.00

DRILL SURG 3.2MM DIA 200MML

Facility

$160.00

Service Code	HCPCS C1713
Hospital Charge Code	64906561
Hospital Revenue Code	278
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$80.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00

DRILL SURG 4.2MM DIA 180MML

Facility

$252.06

Service Code	HCPCS C1713
Hospital Charge Code	64906569
Hospital Revenue Code	278
Min. Negotiated Rate	$88.22
Max. Negotiated Rate	$264.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$151.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.93
Rate for Payer: EmblemHealth Commercial	$126.03
Rate for Payer: Fidelis Medicare Advantage	$264.66
Rate for Payer: Group Health Inc Commercial	$126.03
Rate for Payer: Group Health Inc Medicare	$88.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.03
Rate for Payer: Hamaspik Choice Inc Medicare	$126.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.84

DRILL SURG 4.2MM DIA 180MML

Facility

$252.06

Service Code	HCPCS C1713
Hospital Charge Code	64906569
Hospital Revenue Code	278
Min. Negotiated Rate	$126.03
Max. Negotiated Rate	$126.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.03
Rate for Payer: Hamaspik Choice Inc Medicare	$126.03

DRILL SURG 4.2MM DIA 340MML

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	64906327
Hospital Revenue Code	278
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$141.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$81.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.62
Rate for Payer: EmblemHealth Commercial	$67.50
Rate for Payer: Fidelis Medicare Advantage	$141.75
Rate for Payer: Group Health Inc Commercial	$67.50
Rate for Payer: Group Health Inc Medicare	$47.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.50
Rate for Payer: Hamaspik Choice Inc Medicare	$67.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.75

DRILL SURG 4.2MM DIA 340MML

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	64906327
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.50
Rate for Payer: Hamaspik Choice Inc Medicare	$67.50

Know your out-of-pocket cost for care.

All Charges