St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

2.4 X 12 NONLOCK SCREW

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	64906790
Hospital Revenue Code	278
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$325.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$170.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$186.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$178.25
Rate for Payer: EmblemHealth Commercial	$155.00
Rate for Payer: Fidelis Medicare Advantage	$325.50
Rate for Payer: Group Health Inc Commercial	$155.00
Rate for Payer: Group Health Inc Medicare	$108.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.00
Rate for Payer: Hamaspik Choice Inc Medicare	$155.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$201.50

2.4 X 12 NONLOCK SCREW

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	64906790
Hospital Revenue Code	278
Min. Negotiated Rate	$155.00
Max. Negotiated Rate	$155.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.00
Rate for Payer: Hamaspik Choice Inc Medicare	$155.00

2.5% DIANEAL 2L

Facility

$40.00

Hospital Charge Code	40200984
Hospital Revenue Code	270
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$32.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.00
Rate for Payer: Aetna Government	$20.00
Rate for Payer: Brighton Health Commercial	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.20
Rate for Payer: Group Health Inc Commercial	$20.00
Rate for Payer: Group Health Inc Medicare	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20.00

2.5 DRILL BIT

Facility

$155.70

Hospital Charge Code	40202756
Hospital Revenue Code	272
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$124.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.85
Rate for Payer: Aetna Government	$77.85
Rate for Payer: Brighton Health Commercial	$116.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.88
Rate for Payer: Group Health Inc Commercial	$77.85
Rate for Payer: Group Health Inc Medicare	$54.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.85
Rate for Payer: Hamaspik Choice Inc Medicare	$77.85

2.5 LONG DRILL BIT

Facility

$174.60

Hospital Charge Code	40202757
Hospital Revenue Code	272
Min. Negotiated Rate	$61.11
Max. Negotiated Rate	$139.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$87.30
Rate for Payer: Aetna Government	$87.30
Rate for Payer: Brighton Health Commercial	$130.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$139.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$118.73
Rate for Payer: Group Health Inc Commercial	$87.30
Rate for Payer: Group Health Inc Medicare	$61.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.30
Rate for Payer: Hamaspik Choice Inc Medicare	$87.30

2.5MM INSERT FOR 4.3MM CA

Facility

$281.82

Hospital Charge Code	40006771
Hospital Revenue Code	272
Min. Negotiated Rate	$98.64
Max. Negotiated Rate	$225.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$155.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.91
Rate for Payer: Aetna Government	$140.91
Rate for Payer: Brighton Health Commercial	$211.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.64
Rate for Payer: Group Health Inc Commercial	$140.91
Rate for Payer: Group Health Inc Medicare	$98.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.91
Rate for Payer: Hamaspik Choice Inc Medicare	$140.91

26MM AND 7MM HEAD

Facility

$1,570.00

Service Code	HCPCS C1713
Hospital Charge Code	40209831
Hospital Revenue Code	278
Min. Negotiated Rate	$785.00
Max. Negotiated Rate	$785.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$785.00
Rate for Payer: Hamaspik Choice Inc Medicare	$785.00

26MM AND 7MM HEAD

Facility

$1,570.00

Service Code	HCPCS C1713
Hospital Charge Code	40209831
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,648.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$863.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$942.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$785.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$902.75
Rate for Payer: EmblemHealth Commercial	$785.00
Rate for Payer: Fidelis Medicare Advantage	$1,648.50
Rate for Payer: Group Health Inc Commercial	$785.00
Rate for Payer: Group Health Inc Medicare	$549.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$785.00
Rate for Payer: Hamaspik Choice Inc Medicare	$785.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,020.50

2.7X12M LOCKING SCREW 202.212

Facility

$255.60

Service Code	HCPCS C1713
Hospital Charge Code	40202754
Hospital Revenue Code	278
Min. Negotiated Rate	$89.46
Max. Negotiated Rate	$268.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$140.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$153.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$127.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.97
Rate for Payer: EmblemHealth Commercial	$127.80
Rate for Payer: Fidelis Medicare Advantage	$268.38
Rate for Payer: Group Health Inc Commercial	$127.80
Rate for Payer: Group Health Inc Medicare	$89.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.80
Rate for Payer: Hamaspik Choice Inc Medicare	$127.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$166.14

2.7X12M LOCKING SCREW 202.212

Facility

$255.60

Service Code	HCPCS C1713
Hospital Charge Code	40202754
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$127.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.80
Rate for Payer: Hamaspik Choice Inc Medicare	$127.80

2.8 DRILL BIT

Facility

$192.60

Hospital Charge Code	40202758
Hospital Revenue Code	272
Min. Negotiated Rate	$67.41
Max. Negotiated Rate	$154.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$105.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.30
Rate for Payer: Aetna Government	$96.30
Rate for Payer: Brighton Health Commercial	$144.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$154.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$130.97
Rate for Payer: Group Health Inc Commercial	$96.30
Rate for Payer: Group Health Inc Medicare	$67.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.30
Rate for Payer: Hamaspik Choice Inc Medicare	$96.30

2X2H 3D PLATE MDFC MALLEABLE

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200588
Hospital Revenue Code	278
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$310.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$177.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: EmblemHealth Commercial	$148.00
Rate for Payer: Fidelis Medicare Advantage	$310.80
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

2X2H 3D PLATE MDFC MALLEABLE

Facility

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200588
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

2X2 H 3D PLATE UPFACE MALLEABLE

Facility

$376.00

Service Code	HCPCS C1713
Hospital Charge Code	40200589
Hospital Revenue Code	278
Min. Negotiated Rate	$188.00
Max. Negotiated Rate	$188.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.00
Rate for Payer: Hamaspik Choice Inc Medicare	$188.00

2X2 H 3D PLATE UPFACE MALLEABLE

Facility

$376.00

Service Code	HCPCS C1713
Hospital Charge Code	40200589
Hospital Revenue Code	278
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$394.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$206.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$225.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$188.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$216.20
Rate for Payer: EmblemHealth Commercial	$188.00
Rate for Payer: Fidelis Medicare Advantage	$394.80
Rate for Payer: Group Health Inc Commercial	$188.00
Rate for Payer: Group Health Inc Medicare	$131.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.00
Rate for Payer: Hamaspik Choice Inc Medicare	$188.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$244.40

2X2H 3D PLT, MDFACE, LOCK

Facility

$822.00

Service Code	HCPCS C1781
Hospital Charge Code	40209814
Hospital Revenue Code	278
Min. Negotiated Rate	$411.00
Max. Negotiated Rate	$411.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.00
Rate for Payer: Hamaspik Choice Inc Medicare	$411.00

2X2H 3D PLT, MDFACE, LOCK

Facility

$822.00

Service Code	HCPCS C1781
Hospital Charge Code	40209814
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$863.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$452.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$493.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$411.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$472.65
Rate for Payer: EmblemHealth Commercial	$411.00
Rate for Payer: Fidelis Medicare Advantage	$863.10
Rate for Payer: Group Health Inc Commercial	$411.00
Rate for Payer: Group Health Inc Medicare	$287.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.00
Rate for Payer: Hamaspik Choice Inc Medicare	$411.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$534.30

2X2H 3D PLT MIDFACE

Facility

$822.00

Service Code	HCPCS C1781
Hospital Charge Code	40209815
Hospital Revenue Code	278
Min. Negotiated Rate	$411.00
Max. Negotiated Rate	$411.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.00
Rate for Payer: Hamaspik Choice Inc Medicare	$411.00

2X2H 3D PLT MIDFACE

Facility

$822.00

Service Code	HCPCS C1781
Hospital Charge Code	40209815
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$863.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$452.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$493.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$411.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$472.65
Rate for Payer: EmblemHealth Commercial	$411.00
Rate for Payer: Fidelis Medicare Advantage	$863.10
Rate for Payer: Group Health Inc Commercial	$411.00
Rate for Payer: Group Health Inc Medicare	$287.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.00
Rate for Payer: Hamaspik Choice Inc Medicare	$411.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$534.30

2X2H 3D PLT UPFACE MALLBL

Facility

$376.00

Service Code	HCPCS C1713
Hospital Charge Code	40209832
Hospital Revenue Code	278
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$394.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$206.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$225.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$188.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$216.20
Rate for Payer: EmblemHealth Commercial	$188.00
Rate for Payer: Fidelis Medicare Advantage	$394.80
Rate for Payer: Group Health Inc Commercial	$188.00
Rate for Payer: Group Health Inc Medicare	$131.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.00
Rate for Payer: Hamaspik Choice Inc Medicare	$188.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$244.40

2X2H 3D PLT UPFACE MALLBL

Facility

$376.00

Service Code	HCPCS C1713
Hospital Charge Code	40209832
Hospital Revenue Code	278
Min. Negotiated Rate	$188.00
Max. Negotiated Rate	$188.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.00
Rate for Payer: Hamaspik Choice Inc Medicare	$188.00

2X2 H 3D PLT UPPERFACE

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	40202321
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

2X2 H 3D PLT UPPERFACE

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	40202321
Hospital Revenue Code	278
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

2X2H 3D PLT UPPERFACE

Facility

$822.00

Service Code	HCPCS C1781
Hospital Charge Code	40209816
Hospital Revenue Code	278
Min. Negotiated Rate	$411.00
Max. Negotiated Rate	$411.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.00
Rate for Payer: Hamaspik Choice Inc Medicare	$411.00

2X2H 3D PLT UPPERFACE

Facility

$822.00

Service Code	HCPCS C1781
Hospital Charge Code	40209816
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$863.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$452.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$493.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$411.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$472.65
Rate for Payer: EmblemHealth Commercial	$411.00
Rate for Payer: Fidelis Medicare Advantage	$863.10
Rate for Payer: Group Health Inc Commercial	$411.00
Rate for Payer: Group Health Inc Medicare	$287.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.00
Rate for Payer: Hamaspik Choice Inc Medicare	$411.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$534.30

Know your out-of-pocket cost for care.

All Charges