St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW 3.5MM CORTICAL LOCKING 20MM

Facility OP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40007552
Hospital Revenue Code	278
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$300.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.30
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	$143.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.45
Rate for Payer: Fidelis Medicare Advantage	$300.30
Rate for Payer: Group Health Inc Commercial	$143.00
Rate for Payer: Group Health Inc Medicare	$100.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.90

SCREW 3.5MM CORTICAL LOCKING 22MM

Facility OP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40204634
Hospital Revenue Code	278
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$300.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.30
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	$143.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.45
Rate for Payer: Fidelis Medicare Advantage	$300.30
Rate for Payer: Group Health Inc Commercial	$143.00
Rate for Payer: Group Health Inc Medicare	$100.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.90

SCREW 3.5MM CORTICAL LOCKING 22MM

Facility IP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40204634
Hospital Revenue Code	278
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$143.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00

SCREW 3.5MM CORTICAL LOCKING 32MM

Facility IP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40007554
Hospital Revenue Code	278
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$143.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00

SCREW 3.5MM CORTICAL LOCKING 32MM

Facility IP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40204635
Hospital Revenue Code	278
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$143.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00

SCREW 3.5MM CORTICAL LOCKING 32MM

Facility OP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40204635
Hospital Revenue Code	278
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$300.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.30
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	$143.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.45
Rate for Payer: Fidelis Medicare Advantage	$300.30
Rate for Payer: Group Health Inc Commercial	$143.00
Rate for Payer: Group Health Inc Medicare	$100.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.90

SCREW 3.5MM CORTICAL LOCKING 32MM

Facility OP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40007554
Hospital Revenue Code	278
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$300.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.30
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	$143.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.45
Rate for Payer: Fidelis Medicare Advantage	$300.30
Rate for Payer: Group Health Inc Commercial	$143.00
Rate for Payer: Group Health Inc Medicare	$100.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.90

SCREW 3.5MM CORTICAL LOCKING 38MM

Facility IP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40007555
Hospital Revenue Code	278
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$143.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00

SCREW 3.5MM CORTICAL LOCKING 38MM

Facility IP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40204636
Hospital Revenue Code	278
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$143.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00

SCREW 3.5MM CORTICAL LOCKING 38MM

Facility OP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40007555
Hospital Revenue Code	278
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$300.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.30
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	$143.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.45
Rate for Payer: Fidelis Medicare Advantage	$300.30
Rate for Payer: Group Health Inc Commercial	$143.00
Rate for Payer: Group Health Inc Medicare	$100.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.90

SCREW 3.5MM CORTICAL LOCKING 38MM

Facility OP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40204636
Hospital Revenue Code	278
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$300.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.30
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	$143.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.45
Rate for Payer: Fidelis Medicare Advantage	$300.30
Rate for Payer: Group Health Inc Commercial	$143.00
Rate for Payer: Group Health Inc Medicare	$100.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.90

SCREW 3.5MM CORTICAL LOCKING 40MM

Facility OP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40007556
Hospital Revenue Code	278
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$300.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.30
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	$143.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.45
Rate for Payer: Fidelis Medicare Advantage	$300.30
Rate for Payer: Group Health Inc Commercial	$143.00
Rate for Payer: Group Health Inc Medicare	$100.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.90

SCREW 3.5MM CORTICAL LOCKING 40MM

Facility IP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40007556
Hospital Revenue Code	278
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$143.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00

SCREW 3.5MM CORTICAL LOCKING 40MM

Facility OP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40204637
Hospital Revenue Code	278
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$300.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.30
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	$143.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.45
Rate for Payer: Fidelis Medicare Advantage	$300.30
Rate for Payer: Group Health Inc Commercial	$143.00
Rate for Payer: Group Health Inc Medicare	$100.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.90

SCREW 3.5MM CORTICAL LOCKING 40MM

Facility IP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40204637
Hospital Revenue Code	278
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$143.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00

SCREW 3.5MM CORTICAL LOCKING 44MM

Facility IP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40007557
Hospital Revenue Code	278
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$143.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00

SCREW 3.5MM CORTICAL LOCKING 44MM

Facility IP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40204638
Hospital Revenue Code	278
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$143.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00

SCREW 3.5MM CORTICAL LOCKING 44MM

Facility OP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40204638
Hospital Revenue Code	278
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$300.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.30
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	$143.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.45
Rate for Payer: Fidelis Medicare Advantage	$300.30
Rate for Payer: Group Health Inc Commercial	$143.00
Rate for Payer: Group Health Inc Medicare	$100.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.90

SCREW 3.5MM CORTICAL LOCKING 44MM

Facility OP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40007557
Hospital Revenue Code	278
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$300.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.30
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	$143.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.45
Rate for Payer: Fidelis Medicare Advantage	$300.30
Rate for Payer: Group Health Inc Commercial	$143.00
Rate for Payer: Group Health Inc Medicare	$100.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.90

SCREW 3.5MM LOW PROFILE CORT 24MM

Facility IP

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40204629
Hospital Revenue Code	278
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

SCREW 3.5MM LOW PROFILE CORT 24MM

Facility OP

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40007548
Hospital Revenue Code	278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$136.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
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	$65.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.75
Rate for Payer: Fidelis Medicare Advantage	$136.50
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

SCREW 3.5MM LOW PROFILE CORT 24MM

Facility IP

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40007548
Hospital Revenue Code	278
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

SCREW 3.5MM LOW PROFILE CORT 24MM

Facility OP

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40204629
Hospital Revenue Code	278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$136.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
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	$65.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.75
Rate for Payer: Fidelis Medicare Advantage	$136.50
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

SCREW 3.5MM LOW PROFILE CORT 40MM

Facility IP

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40204630
Hospital Revenue Code	278
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

SCREW 3.5MM LOW PROFILE CORT 40MM

Facility IP

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40007549
Hospital Revenue Code	278
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

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